Sleep Apnea Treatment: With and Without CPAP

Sleep apnea is a common sleep disorder that causes frequent breathing pauses while you sleep. Treating sleep apnea aims to reduce breathing interruptions (called apneas) and improve your sleep.

Sleep apnea typically cannot be cured, but the condition is treatable and manageable. Treatment might include lifestyle changes, oral appliances, positive airway pressure, adaptive ventilation devices, and more. Continuous positive airway pressure (CPAP) can successfully treat most sleep apnea cases, including mild ones.

Treatment can begin once you receive a sleep apnea diagnosis. Diagnosing sleep apnea starts with your healthcare provider asking about your symptoms and medical history.

If they suspect sleep apnea based on this information, they will request a sleep study to determine the source of your sleep troubles. This may be an overnight test where you are monitored in a sleep lab, or a device may monitor your sleep pattern at home.

This article covers sleep apnea treatment options, including CPAP therapy, treatment without CPAP, and surgical treatment. 

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Sleep Apnea Treatment: Before CPAP

The two types of sleep apnea are obstructive and central. The most common is obstructive sleep apnea (OSA). It causes the throat muscles to relax and block air from entering the lungs.

The American Heart Association notes that in middle-aged people, about 17% of women and 24% of men meet the diagnostic criteria for OSA.

Central sleep apnea (CSA) inhibits your breathing while you sleep and occurs because the brain does not send proper signals to the muscles that control breathing.

The breathing pauses from sleep apnea cause your brain to respond and briefly wake up to breathe normally again. This is why you feel fatigued, even when you have slept most of the night. 

Untreated sleep apnea can affect your mental and physical health. It can lead to problems with concentration and focus, making decisions, remembering, and regulating behavior and emotions. It is also linked to high blood pressure, headaches, sore throats, blood vessel problems, and weight gain.

What Is the Connection Between High Blood Pressure and Sleep Apnea?

High blood pressure and sleep apnea often coexist. Research shows that in people without high blood pressure, blood pressure naturally lowers by up to 20% during sleep. People with sleep apnea experience blood pressure dips at less than 10%, which increases their risk for cardiovascular disease.

Sleep apnea treatment can help lower blood pressure because it improves sleep, so blood pressure dips can occur at normal levels.

Sleep Apnea Treatment With CPAP 

CPAP therapy aims to reduce breathing disruption and improve your sleep. It keeps the airway open using pressured air pumped from a machine into a hose and a mask worn on the face.

To reduce abnormal breathing, the CPAP machine works to push air into the airway so it stays open while you sleep. As a result, you will experience fewer apneas during sleep. 

A CPAP device can offer both short and long-term benefits and can treat all types of sleep apnea and nighttime breathing troubles. It can also reduce the additional symptoms of the condition, including snoring, daytime fatigue, nighttime awakenings, and associated health conditions like high blood pressure.

Auto-CPAP and bilevel positive airway pressure (BiPAP) are additional airway pressure devices. Auto-CPAP automatically adjusts the pressure while you sleep, and BiPAP provides more pressure with inhaling and less with exhaling. 

Sleep Apnea Treatment Without CPAP

CPAP therapy is considered the most effective therapy for sleep apnea. But CPAP compliance and use can be hard for some people due to health problems or the inability to get comfortable and fall asleep using a CPAP mask.

Additional problems with CPAP compliance include dry mouth and nasal congestion, claustrophobia, and infections. If this is true for you, you might consider other treatment options.

Lifestyle Changes

Lifestyle changes might help with milder cases of sleep apnea.

Weight loss: Numerous studies show a connection between weight and sleep, but researchers do not know exactly what that connection is. What they do know, however, is that weight loss can alleviate sleep apnea.

A 2021 report examined how weight loss might help reduce sleep apnea symptoms. Researchers found weight loss led to reduced fat on the tongue and abdomen and reduced size of soft tissues in the airway. At the same time, all three factors led to symptom improvements; reduced tongue fat was found to have the most significant effect. 

Exercise: Physical exercise can help ease sleep apnea symptoms even without weight loss. Try to get at least 30 minutes of moderate activity several times a week. Moderate activity includes brisk walking, jogging, using an elliptical machine, biking, and swimming.

Avoiding alcohol and other sedatives: Both alcohol and sedatives relax the throat muscles and affect your breathing. Alcohol disrupts sleep, and research shows alcohol consumption is linked to more prolonged and frequent apnea events and lower blood oxygen levels.

Cutting out alcohol or reducing the amount you drink can lead to reduced sleep apnea symptoms. Sedative drugs, including sleep aids, might also worsen sleep apnea symptoms, so it makes sense to avoid these to improve sleep quality. 

Don’t smoke: A study reported in 2014 shows cigarette smoking increases the severity of OSA because it disrupts the body’s natural sleep rhythm, inflames the upper airway, constricts muscles in the respiratory system, and reduces the body’s ability to wake up naturally.

While quitting smoking won’t cure sleep apnea, it will reduce the number of apnea events and improve sleep quality.

Changing your sleep position: Sleeping on your side might help you breathe better, reduce snoring, and help you to wake up feeling more refreshed. Studies on people with sleep apnea show that side sleeping can improve breathing and sleep quality and reduce snoring.

Other Sleep Apnea Devices

Another option is an oral appliance designed to keep your throat open by pushing your jaw forward, which helps relieve snoring and sleep apnea. This is called a mandibular advancement device. It looks similar to a mouthguard.

You may have additional options if you have been diagnosed with CSA. For example, supplemental oxygen can help deliver oxygen to your lungs while you sleep, and adaptive servo-ventilation (ASV) therapy uses pressure to regulate breathing patterns and prevent pauses while you sleep.

Oropharyngeal Exercises

Myofunctional therapy, or oropharyngeal exercise, is designed to strengthen the mouth, tongue, and throat muscles to help maintain the airway while you sleep. These exercises can improve sleep apnea and serve as an adjunct (additional) therapy to other sleep apnea treatments.

Many of these exercises are easy and are meant to strengthen your tongue, facial, and throat muscles. You can group them and do them twice or thrice daily. 

Oropharyngeal exercise examples from the Sleep Foundation include:

  • Tongue exercises, including the tongue slide and tongue stretch: With the tongue slide, you would place the tongue against the back of the front teeth and slowly slide the tongue backward, with the tip moving along the roof of the mouth. Repeat up to 10 times. With the tongue stretch, you would stick your tongue out as far as it will go and try to touch your chin with the tongue while looking up. Hold each stretch for 10 to 15 seconds. Repeat five times.
  • Facial muscle exercises, such as the cheek hook, engage the facial muscles to prevent snoring: Use a hooked finger to lightly pull your cheek outward and then use your facial muscles to pull the cheek back inward. Repeat 10 times on each side.
  • Breathing through your nose to improve nasal breathing and stabilize the airway while you sleep: With your mouth closed and your jaw relaxed, inhale through your nose. Then use your finger to close off the nostril. Breathe slowly through the open nostril. You can do this up to 10 times, alternating between the nostrils.
  • Sounding out vowel sounds to tone throat muscles: Repeat the five vowel sounds—a-e-i-o-u. Start saying them normally and then stretch out each sound. Repeat each vowel 10 to 20 minutes in a row and then move on to the following vowel.  
  • Singing: Singing activates multiple muscles in the mouth and throat. As you sing, try to focus on repeating and forcing pronouncing musical sounds rather than just singing lyrics.

Surgical Sleep Apnea Treatment 

Surgery might be an option for people with sleep apnea when other therapies have failed. Your healthcare provider will want you to try other treatments for a few months before considering surgery. 

Surgical options for sleep apnea include:

  • Surgery to repair jaw structure problems
  • Removal of enlarged tonsils or adenoids
  • Weight-loss surgery 
  • Tissue removal or tissue shrinkage: Tissue removal removes tissues from the rear of the mouth and top of the throat, while shrinkage shrinks the tissues at the back of the mouth and throat using radiofrequency ablation. 
  • Tracheostomy: People with life-threatening sleep apnea may need surgery that makes an opening into the neck and inserts a metal or plastic tube to help them breathe. The tube is covered during the day and uncovered at night to allow air to pass and out of the lungs.

Newest/Emerging Sleep Apnea Treatments

Phrenic nerve stimulation is an option for people with CSA who do not respond to other treatments. This involves surgically implanting a device to encourage breathing. The device will send an electric current to stimulate the diaphragm helping it to contract as it should.

Both procedures are relatively new and have not been thoroughly researched.

Sleep Apnea Treatment Not Working

If you are not noticing improvements, you should inform the healthcare provider treating your sleep apnea. You might consider seeing a board-certified sleep specialist who can help you best find therapies that might best help you and improve your sleep apnea symptoms. 

Summary 

Sleep apnea is a severe sleep disorder where breathing repeatedly stops and starts while you sleep. People with sleep apnea often snore loudly and feel tired even after sleeping all night. A sleep specialist can diagnose the condition with an overnight or home sleep study. 

There is no cure for sleep apnea, but the condition is treatable. Treatments can improve the condition and include lifestyle changes like weight loss and not smoking, oral appliances, CPAP therapy, and as a last resort, surgery to treat an underlying cause. CPAP is the most common treatment for the condition and treat both mild and severe sleep apnea. 

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