If you have been diagnosed with obstructive sleep apnea -- a condition in which relaxation of the muscles around the tongue and throat causes the tissues to block airflow to the lungs while you sleep -- there are a number of treatment options to discuss with your doctor. Two of the most widely used and most effective are continuous positive airway pressure (CPAP) and dental appliances, or mouth guards.
CPAP (Continuous Positive Airway Pressure)
The most effective treatment for obstructive sleep apnea, CPAP blows air with continuous pressure down your throat at night to keep your airways open while you sleep. The treatment is done using a CPAP machine, which consists of three main parts:
- Mask that fits over your nose -- or your nose and mouth -- and is held in place with straps while you sleep
- Motor that blows air
- Large tube called a cannula that connects the motor to the mask
CPAP machines are small, lightweight, and fairly quiet. If you travel, you should take your CPAP with you.
Although you will likely feel better rested and alert once you start CPAP, getting used to the device can take some time. Some people have difficulty sleeping the first few nights of treatment.
Side effects of CPAP use are usually minor and may include:
- Feelings of confinement from the face mask
- Sore or dry mouth
- Nasal congestion, runny nose, sinusitis, or nosebleeds
- Irritation and sores over the bridge of the nose
- Stomach bloating and discomfort
- Discomfort in chest muscles.
If you are having any of these or other problems, call your doctor. An adjustment to your CPAP machine may make it more comfortable. Some CPAP machines have special features such as heated humidifiers to reduce problems such as drying of the airways. Other possible fixes include using a cushioned face mask, chin straps, and nasal saltwater sprays. Your doctor may have additional suggestions.
If you have mild to moderate obstructive sleep apnea and can't tolerate or haven't been helped by CPAP, oral appliances may be an effective treatment option.
These devices, which must be fitted by a dentist or orthodontist, and worn in the mouth at night include:
Mandibular advancement device (MAD). The most widely used mouth device for sleep apnea, MADs look much like a mouth guard used in sports. The devices snap over the upper and lower dental arches and have metal hinges that make it possible for the lower jaw to be eased forward. Some, such as the Thornton Adjustable Positioner (TAP), allow you to control the degree of advancement.
Tongue retaining device. Used less commonly than MAD, this device is a splint that holds the tongue in place to keep the airway open.
For people with mild to moderate sleep apnea, particularly those who sleep on their backs or stomachs, dental devices may improve sleep and reduce the frequency and loudness of snoring. Also, people are more likely to use their dental appliances regularly than CPAP.
Dental devices have also been shown to control sleep apnea long term compared to uvulopalatopharyngoplasty (UPPP), the standard surgical procedure for apnea, in which the surgeon removes soft tissue from the back of the throat. However, dental devices do have some potential drawbacks, including altered bite, movement of teeth, pain, arthritis of the temporal mandibular joint (TMJ), dry lips, and excessive salivation.
If you are fitted with a dental device you should have a checkup early on to see if it is working and periodic checkups for possible adjustment or replacement. If you experience pain or changes in your bite, your dentist or orthodontist who fitted your device may be able to make modifications to correct the problem.
The best treatment for obstructive sleep apnea depends on a number of factors, including the severity of your problem, the physical structure of your upper airway, other medical problems you may have, as well as your personal preference. You should work with your doctor or sleep specialist to select the best treatment option for you.