Sleep Apnea Treatments Compared

How do you know which sleep apnea treatment is right for you? There are a number of ways to treat your symptoms and help you get a restful night’s sleep.

Talk with your doctor before you try one. If you like your treatment, you’re more likely to stick with it and find relief.

Positive Airway Pressure (PAP) Devices

There are several kinds of positive airway pressure devices, or PAPs, that help open up your airways while you sleep. They deliver air through a mask.

CPAP

Continuous positive airway pressure devices treat moderate to severe obstructive sleep apnea. They give you constant air pressure to keep your breathing passages open as you sleep.

Things to know about CPAP:

BiPAP

With bilevel positive airway pressure, the air pressure is higher when you breathe in than it is when you exhale. This may help you exhale more easily.

Things to know about BiPAP:

  • It's the best choice for people with more severe obstructive sleep apnea.
  • It may not be effective for people with impaired breathing, reduced alertness when awake, or who have trouble swallowing.
  • The masks may be uncomfortable or leak air.
  • You may also have dry mouth, sinus pain, congestion, or eye irritation.
  • Some people get mild belly bloating.

APAP

Automatic positive airway pressure devices have two air pressure settings, low and high, that adjust automatically as you sleep. The machine detects the amount of air pressure you need as your needs change through the night.

Things to know about APAP:

  • They sense your need for increased air pressure during REM sleep, so they’re good for people who have apnea mainly in this stage.
  • Some people find APAPs more comfortable than other PAPs.
  • Pressure changes may be too slow, so you notice the lag, wake up, and have poorer quality sleep.
  • They're not for anyone with chronic heart failure or obesity hypoventilation syndrome.

ASV

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Adaptive servo-ventilation devices also adjust air pressure according to your body’s needs. They have a pressure gauge to sense changes in your breathing during sleep to raise or lower air pressure as needed. The pressure adjustments happen continuously during the night as your breathing patterns change, so ASVs are more effective for people with central apneas than CPAPs or BiPAPs.

Things to know about ASV:

  • It's good for people with central or complex sleep apnea.
  • It may be dangerous for anyone with severe symptomatic heart failure.
  • It's not recommended for people with profound or chronic hypoventilation, moderate to severe chronic obstructive pulmonary disease (COPD), chronically elevated partial pressure of carbon dioxide on arterial blood gas (ABG), or restrictive or thoracic neuromuscular disease.

Upper Airway Stimulation Therapy

Upper airway stimulation therapy is a new sleep apnea treatment. It’s also called hypoglossus nerve stimulation.

Your doctor will put three small devices in your chest during surgery to track how you breathe as you sleep. They can stimulate your throat muscles to move your tongue or palate forward to open your upper airways if you need it.

This therapy is good for people with moderate to severe obstructive sleep apnea. If PAP therapy hasn’t worked for you, it’s another option that works well and has few side effects.

Appliances and Mouthpieces

A few gadgets may help your airways stay open as you sleep:

Oral appliances. Your dentist can fit you with an oral appliance that looks like a mouth guard worn by athletes to move your tongue and jaw forward as you sleep. They’re best for treating milder sleep apnea or snoring. Some people get jaw pain when they use oral appliances.

Oral pressure therapy (OPT). Instead of a mask like a PAP device, you wear a mouthpiece. It connects by a tube to a vacuum that puts your tongue in the right position to help your airways stay open as you sleep.

Nasal dilators. Small devices called dilators can help your nostrils stay open during sleep. Internal dilators are small inserts that go inside your nostrils. External dilators are strips that you stick to the outside of your nose to pull your nostrils open. While dilators may help mild snoring, they don’t work well for sleep apnea.

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Surgery

Surgery to remove extra tissue that blocks your airways may treat sleep apnea. But it’s not right for everyone. It can be painful, and your sleep apnea may come back later.

  • Soft palate surgery. This trims extra tissue in the back of your throat or tongue, or removes tonsils to widen your airways. It's also called uvulopalatopharyngoplasty (UPPP).
  • Septoplasty or turbinate reduction. This is nose surgery to straighten a deviated septum or trim extra tissues in your nasal passages. It may help air flow easier through your nose.
  • Radiofrequency volumetric tissue reduction. This shrinks and tightens your soft palate, tonsils, or tongue with heat.
  • Palatal implants. This surgery treats mild sleep apnea or snoring. Small rods are inserted into your soft palate to stiffen the tissue and prevent airway blockage.
  • Genioglossus advancement. This moves your tongue forward by making a cut into your jawbone, then moving that piece of bone up to push your tongue up.
  • Maxillomandibular osteotomy and advancement. This surgery for more severe sleep apnea cuts and repositions your jaw to widen your throat so you breathe better. You’ll need to have your jaw wired shut for a few days.

Alternative Treatments

There are some alternative or natural therapies for sleep apnea, too.

Acupuncture. Could tiny needles treat sleep apnea symptoms? Some research says that acupuncture may relieve some of the breathing symptoms of moderate obstructive sleep apnea.

Valerian. This herbal supplement may help you fall asleep faster and stay asleep. You’ll have to take it regularly for 2 weeks or longer to see any benefit. Side effects like headache, stomach upset, or dizziness are possible. It may also backfire and keep you awake.

WebMD Medical Reference Reviewed by Jennifer Robinson, MD on March 17, 2020

Sources

SOURCES:

Mayo Clinic: “Sleep Apnea.”

American Sleep Association: “CPAP Machines and CPAP Masks,” “Information on the Sleep Apnea Mouthpiece Device.”

American Association of Sleep Technologists: “Pros and Cons of APAP Therapy,” “Pros and Cons of Adaptive Servo-Ventilation (ASV) for Sleep Apnea,” “5 Alternative Sleep Apnea Treatment Options.”

National Heart, Lung, and Blood Institute: “CPAP.”

Journal of Thoracic Disease: “New developments in the use of positive airway pressure for obstructive sleep apnea.”

Johns Hopkins Medicine: “BiPAP.”

Duke Health: “New Sleep Apnea Treatment Offers CPAP Alternative.”

National Sleep Foundation: “The Latest Treatments for Obstructive Sleep Apnea.”

Evidence Based Complementary and Alternative Medicine: “The Clinical Effect of Acupuncture in the Treatment of Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.”

Sleep Medicine: “Treatment of moderate obstructive sleep apnea syndrome with acupuncture: a randomised, placebo-controlled pilot trial.”

Mayo Clinic: “Valerian: a safe and effective herbal sleep aid?”

Neurotherapeutics: “New and Unconventional Treatments for Obstructive Sleep Apnea.”

American Academy of Sleep Medicine: “Surgery--Surgical Procedures.”

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