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 Sleep Apnea 
 
The following is one in an ongoing series of columns entitled From Fatigued to Fantastic by . View all columns in series

There are several treatments for sleep apnea and they fall into three main treatment categories: behavioral, pharmacologic, and mechanical. Let us consider each in turn.

Behavioral Treatments

As noted above, being overweight is the main cause of OSA. Because of this, weight loss is one of the most effective ways to treat it. Markedly cutting back on your carbohydrate intake and increasing your protein intake can help as well. as many people with this also have severe daytime somnolence, I sometimes prescribe medications that help to treat the daytime sleepiness that also assist with weight loss, among them dextroamphetamine (Adderall, Dexedrine), thyroid hormone, and certain antidepressants.

Avoid sleeping in positions that cause you to snore and have sleep apnea, especially lying on your back. As noted above, Sleep apnea can often be decreased by taking a tennis ball, putting it into a cloth pocket and then sewing it into the mid-back of your pajama shirt. Then, when you lie on your back, the tennis ball makes it uncomfortable, forcing you to roll onto your side or stomach without waking you. Finally, avoid bedtime alcohol and other substances that can aggravate sleep apnea.

Pharmacologic Treatments

A number of drugs have been used for OSA, but with limited success. A few patients have also been helped by supplemental oxygen. This is especially helpful if you live at high altitude.

Drugs that contribute to weight loss (including the ones noted above), as well as antidepressants that help weight loss, such as Prozac, can also be useful. It is important, though, to not take these drugs later in the day if they interrupt sleep.

Mechanical Treatments

There are several mechanical devices that change the shape of the upper airway and help to prevent the throat from collapsing. Orthodontic devices can help to keep the lower jaw and tongue forward. These are most likely to be helpful for mild cases of sleep apnea and for people who who cannot tolerate the C-pap machine. A nasal C-pap is a mask that is kept over your face while you sleep. It keeps constant pressure in your airway and, as noted above, helps to keep the airway inflated and open while sleeping. Unfortunately, to three quarters of people with sleep apnea are not able or willing to continue with the C-pap treatment because of the noise of the machine, the discomfort of wearing the mask, and the cost. Most patients find that if they can tolerate the C-pap for three to six months, the treatment becomes second nature and comfortable.

Another possibility is surgery to reshape the throat so it stays open during sleep. Removing the tonsils, nasal surgery, and surgically trimming back the soft palate and the uvula (the tiny thing that hangs down in the back of your throat) are the most common treatments performed. Although these surgeries can be very helpful for snoring, they are less likely to help the sleep apnea. A new technique, in which stick like implants or high-frequency radio waves are used to scar areas in the soft palate and tongue and thus shrink them, shows promise.

It is controversial whether using more aggressive treatments for sleep apnea are worthwhile for people who have fewer than fifteen episodes of apnea per hour. The more conservative approaches (for example, weight loss and avoiding sleeping on your back) are a more reasonable way for those with mild apnea to begin treatment.

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 About The Author
Jacob Teitelbaum MD is author of the popular free iPhone application "Cures A-Z" and author of the best-selling book From Fatigued to Fantastic! (3rd revised edition, Avery/Penguin Group) and Pain Free 1-2-3-A......moreJacob Teitelbaum MD
 
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