Which is the best option for you?

Change of Lifestyle

For many patients relatively simple lifestyle changes can make a significant impact on the severity of their sleep disordered breathing. These changes include:

Weight loss
Avoidance of sedatives and/or alcohol before bed.
Avoiding sleeping on your back.

However, if you are not significantly overweight, don't drink, or don't sleep on your back--these changes will have little effect.

While sleep apnea just a few years ago was considered to be a disease of "fat, older men," we are now finding significant sleep apnea in thin women and even children.

C-PAP

CPAP stands for Continuous Positive Air Pressure. CPAP is the gold standard for the treatment of obstructive sleep apnea. There have been many advances in the use of CPAP from better, quieter CPAP machines to more comfortable masks. There are always improvements being made with CPAP and the masks. Our office encourages everyone to try CPAP before considering use of an oral appliance.

If you've tried CPAP and have not been able to make it work for you in spite of trying many different masks, then an oral appliance is usually your next option.

Oral Appliances

Oral appliances are simple in how they function. An oral appliance keeps the airway open by keeping the lower jaw and tongue from falling back and blocking the airway. This is similar to the "head tilt, chin lift" procedure taught in CPR classes. While there are many appliances on the market, they all basically do the same thing--keep the airway open by keeping the jaw from falling back.

Oral appliances are made out of a variety of materials and most are adjustable. The appliance being adjustable is important so that an effective jaw position can be found. In our offices patients are routinely scheduled for follow up sleep studies during which the appliance can be adjusted by the sleep technician to assure that the appliance is working as well as possible.

Surgery

Surgery is rarely used for the treatment of obstructive sleep apnea. When there is a problem with the nasal airway, such as deviated septum or nasal polyps, nasal surgery may be used to help the patient use CPAP better. Surgery to the palate has been used with some success in the treatment of snoring but has had less success in the treatment of sleep apnea.

In some very severe cases when a patient has failed CPAP therapy and oral appliance therapy a surgery called "bimaxillary advancement" is performed. This surgery involves the surgical moving of the upper and lower jaw forward to create more room in the airway. Although this may sound extreme, it is usually very effective. This procedure is actually done routinely for cosmetic reasons and in those cases is referred to as "orthognathic surgery."

The "last hope" surgical procedure is tracheostomy. Tracheostomy bypasses the colapsible part of the airway by surgically placing a tube through the throat into the trachea. With this surgery the sleep apnea is eliminated. Obviously this surgery is reserved for the most extreme cases.