Treating obstructive sleep apnoea

Treatment for obstructive sleep apnoea (OSA) may include making lifestyle changes and using breathing apparatus while you sleep.

OSA is a long-term condition and many cases require lifelong treatment.

Lifestyle changes

Inmost cases ofOSA you'll be advised to make healthy lifestyle changes,suchas:

• losing weight if you're overweight or obese
• stopping smoking if you smoke
• limiting your alcohol consumption, particularly before going to bed the NHS recommends not regularly drinking more than 14 units of alcohol a week; if you drink as much as 14 units a week, it's best to spread this evenly over three or more days
• avoidingsedative medications and sleeping tablets

Losing weight, reducing the amount of alcohol you drink and avoiding sedativeshave allbeen shown tohelp improve the symptoms of OSA.

Although it'sless clear whether stopping smoking can improve the condition,you'll probablybe advised to stop for general health reasons.

Sleeping on your side, rather than on your back, may also help relieve the symptoms of OSA.

Continuous positive airway pressure (CPAP)

As well asthe lifestyle changes mentioned above, people with moderate to severe OSAusuallyneed touse a continuous positive airway pressure (CPAP) device.

This is a small pumpthatdelivers a continuous supply of compressed air through a mask thateither covers your nose or your nose and mouth. The compressed air prevents your throat closing.

CPAP can feel peculiar to start with andyou may be tempted to stop using it.But people who persevereusually soonget used toit and their symptoms improve significantly.

CPAP is available on the NHS and is the most effective therapy for treating severe cases of OSA.

As well as reducing symptoms such as snoring and tiredness, it can also reduce the risk ofcomplications of OSA, such as high blood pressure .

Possible side effects of using a CPAP device can include:

• mask discomfort
• nasal congestion, runny nose or irritation
• difficulty breathing through your nose
• headaches and ear pain
• stomach pain and flatulence (wind)

Earlier versions of CPAP also often caused problems such as nasal dryness and a sore throat. However, modern versions tend to include humidifiers, a device that increases moisture, which helps reduce these side effects.

If CPAP causes you discomfort, inform your treatment staffas the device can be modified to make it more comfortable. For example, you can try using a CPAP machine that starts with a low air pressure and gradually builds up to a higher air pressure as you fall asleep.

Mandibular advancement device (MAD)

A mandibular advancement device (MAD) is a dental appliance, similar to a gum shield, sometimes used to treat mild OSA.

They're not generally recommended for more severe OSA, although they may be an option if you're unable to tolerate using a CPAP device.

An MAD is worn over your teeth when you're asleep. It's designed to hold your jaw and tongue forward to increase the space at the back of your throat and reduce the narrowing of your airway that causes snoring.

Off-the-shelf MADs are available from specialist websites, but most experts don't recommend them, as poor-fitting MADs can make symptoms worse.

It's recommended you have an MAD made for you by a dentist with training and experience in treating sleep apnoea. MADs aren't always available on the NHS, so you may need to pay for the device privately through a dentist or orthodontist.

An MAD may not be suitable treatment for you if you don't have many or anyteeth. If you have dental caps, crowns or bridgework, consult your dentist to ensure they won't be stressed or damaged by an MAD.

Surgery for OSA

Surgery to treat OSA isn't routinely recommended because evidence shows it's not as effective as CPAP at controlling the symptoms of the condition. It also carriesthe risk of more serious complications.

Surgery is usually only considered as a last resort when all other treatment options have failed, and also if the conditionis severely affecting your quality of life.

Arange of surgical treatmentshave been used to treat OSA. These include:

• tonsillectomy where the tonsils are removed if they're enlarged and blocking your airway when you sleep
• adenoidectomy where the adenoids, small lumps of tissueat the back of the throat above the tonsils, are removed if they're enlarged and are blocking the airway during sleep
• tracheostomy where a tube is inserted directly into your neck to allow you to breathe freely, even if the airways in your upper throat are blocked
• weight loss (bariatric) surgery where the size of the stomach is reduced if you're severely obese andthis is making your sleep apnoeaworse

Surgery toremove excess tissue in the throat to widen your airway (uvulopalatopharyngoplasty) used to be a common surgical treatment for OSA, but it's performed less often nowadays.

This isbecause more effective treatments are available, such as CPAP. This type of surgery can mean you're unable to use a CPAP device properly in the future if you need to.

Soft palate implants

Soft palate implants make the soft palate, part of the roof of the mouth, stiffer and less likely to vibrate and cause an obstruction. The implants are inserted into the soft palate under local anaesthetic .

The National Institutefor Health and Care Excellence (NICE) has said soft palate implants are safe, but they're not currently recommended for treating OSAas there's a lack of evidence about their effectiveness.

However, this form of treatment is recommended for treating snoring associated with OSA in exceptional cases.

Support groups

OSA can have a significant impact on the quality of life for someone with the condition, as well as their friends and families.

As well as causing physical problems such as tiredness and headaches, the condition can have a significant emotional impact and affect your relationships with others.

For support and advice about living with OSA, you may find it helpful to contact a support group, such as:

British Lung Foundation

Sleep Apnoea Trust