Sleep Apnea Treatment

CPAP

CPAP is an acronym for Continuous Positive Airway Pressure. CPAP therapy is the most effective non-invasive treatment for patients with OSA. A mask is worn over your nose and attached to a small blower unit during sleep. It uses a low level of pressurized room air to open your airway. It prevents your airway from collapsing, and helps to normalize your breathing during sleep. Some patients need very little pressure to open the airway during sleep, whereas others need considerably more. Most patients start with auto-CPAP, a machine which identifies the optimal pressure; however this does not always work for everyone. CPAP is typically covered by medical insurance. 

Oral Appliance

Oral appliance, also called Mandibular Advancement Device, repositions the front of your lower jaw (mandible) to a more forward (prognathic) position. The device moves your tongue forward and opens the back of the airway during sleep, therefore reducing apnea events. This therapy is best suited for patients with mild to lower moderate obstructive sleep apnea or prominent snoring during sleep. It is not recommended, and generally not adequately effective, for patients with a more severe form of OSA. Oral appliance therapy is generally well tolerated, although some patients may experience temporomandibular joint (TMJ) pain or movement of their teeth.  The device is typically covered by medical insurance. 

Inspire

Inspire (also called hypoglossal nerve stimulation) is based on upper airway stimulation and is specifically designed for patients 18 years of age or older with moderate to severe OSA who are unable to use CPAP therapy. A small device is implanted under the skin near the right collar bone and activated at bedtime via a handheld remote. A small battery is attached to a breathing sensor lead and a stimulation lead. The system stimulates the hypoglossal nerve, which in turn, activates key airway muscles during breathing to keep the airway open during sleep. Inspire allows you to move freely in bed without any mask on your face or appliance in your mouth.

The treatment requires an upper airway screening endoscopy, followed by an outpatient procedure performed by a specially trained ENT physician. Our provider will monitor you after the surgery to refine the optimal stimulation signal in relation to your breathing efforts during sleep.  The device is typically covered by medical insurance. 

Weight loss

Weight loss can be one of the most important ways of improving your breathing during sleep. Patients with mild OSA may, in some circumstances, normalize breathing in sleep with weight loss. Even if weight reduction does not normalize breathing in sleep, patients on CPAP often will require less CPAP pressure following weight loss. Lower CPAP pressures help minimize complications from CPAP such as nasal congestion or mask leaks. On the other hand, weight gain may increase your pressure requirements with CPAP possibly leading you to require a repeat sleep study.

GLP-1 medications, like Zepbound, Ozempic or Mounjaro, can help with sleep apnea by primarily promoting significant weight loss, which in turn reduces the excess fat around the airway that contributes to obstructive sleep apnea (OSA) by allowing for better airflow during sleep; essentially, the key mechanism is decreasing airway obstruction due to weight loss induced by the GLP-1 medication. 

Surgical Options

Numerous surgical treatments may be appropriate when a specific physical abnormality is present or when other treatment plans have failed. The type of surgery selected should be directed to the specific site of the obstruction. Choosing the wrong surgery for the wrong patient will typically not be successful for improving breathing during sleep.

Mandibulomaxillary Advancement

MMA involves moving the lower jaw (mandible) forward and upper jaw (maxilla) permanently. This procedure will advance the tongue forward and open the airway. This is generally a relatively well-tolerated procedure, ideally for patients who are younger, with moderate to severe OSA and have a naturally small or retrognathic mandible (small lower jaw) and a narrow posterior airway space.

Tonsillectomy / Adenoidectomy

Tonsillectomy and/or adenoidectomy can be helpful in patients (and often in children) who have obstructive breathing during sleep and who also have enlarged tonsillar or adenoidal tissue.

Modified Uvulopalatopharyngoplasy

Modified uvulopalatopharyngoplasy (UPPP) involves shaving off the uvula and part of the soft palate. A UPPP procedure may be helpful in patients with mild obstructive breathing in sleep and a selectively lengthened soft palate with an otherwise open airway. Patients with a large tongue base should generally not be considered for this procedure.

Behavioral Changes

Avoid alcohol which acts as a muscle relaxant. It will worsen obstructive sleep apnea, particularly if ingested within 3-5 hours of bedtime. Even for patients on CPAP therapy, having 2 or more alcoholic drinks can cause breakthrough snoring with the CPAP device and lead to more fragmentation of sleep.

Quit smoking since cigarette smoke may cause the upper airway tissues to swell and the nasal passages to be congested, all leading to more airway obstruction during sleep.

Remedē

The Remedē system works by implanting a small device under the skin in the chest that sends electrical signals to the phrenic nerve, which then stimulates the diaphragm muscle to contract and initiate breathing, effectively treating central sleep apnea by regulating breathing during sleep through nerve stimulation; essentially acting like a pacemaker for the diaphragm muscle. The treatment is typically covered by medical insurance.

Medication

Protriptyline (Vivactil) has shown to improve breathing in patients with mild obstructive sleep apnea in several randomized, double blind, placebo-controlled, clinical trials. It improves symptoms of daytime sleepiness or fatigue. A low dose is generally well-tolerated although side effects may include dry mouth, constipation, urinary retention in men, and blurred vision.

Please refer to the weight loss section regarding GLP-1 for the treatment of sleep apnea.

Positional Therapy

Belts, pillows, noodles can be used to promote sleeping on your side and avoid sleeping on your back. It is recommended for patients with mild obstructive breathing in sleep.

Excite OSA

eXcite OSA is a removable tongue muscle stimulation device which delivers neurostimulation to the tongue to improve mild sleep apnea and snoring in adult patients. The enhancement of muscle function prevents the airway from collapsing and keeps the airway open while sleeping. Patients use the device for 20 minutes each day for 6 weeks and only two times per week thereafter. This device is developed by Signifier Medical Technologies and has been clinically tested with 90% of patients reporting less snoring time and 79% of sleep apnea patients demonstrating decreased apneas. 

This treatment is not recommended for sleep apnea patients with an AHI ≥ 15, or with a pacemaker, implanted electrodes, metal implants, dental braces/prothesis or for patients suffering from mouth ulcers or pregnant. 

iNAP

iNAP Sleep Therapy System is a non-surgical device for adult patients with mild, moderate or severe Obstructive Sleep Apnea. Developed by Somnics, iNAP uses a soft mouthpiece to open the airway and deliver a gentle suction, moving the tong forward and away from the posterior airway. It uses intermittent negative airway pressure to eliminate apnea events. The mouthpiece attaches to a thin tube connected to a small console. 

The therapy works for patients who normally breathe through their nose while asleep. The device is quiet, battery-powered, and travel friendly. It can only be prescribed by a sleep medicine practitioner and is currently not covered by insurance. In a company led study, 88% of patients reported a significant improvement and the therapy demonstrated a 75% clinical success rate.