Sleep Disorders - Treatment Guide

With the proper guidance and compliance, treatment for sleep disorders are effective. With up to 80% of people who have Obstructive Sleep Apnea (OSA), Insomnia, Narcolepsy or Periodic Limb Movement of Sleep (PLMS) find a relief and regain restful nights’ sleep with a treatment.

For OSA, treatment options include weight loss, use of CPAP machine, surgeries or use of a dental appliance. For Narcolepsy and PLMS, medication treatment can be effective. For Insomnia, following certain sleep hygiene measures and a proper use of sleeping medications as prescribed are effective.

Your physician or one of our sleep specialists can help direct you to the appropriate treatment. The following is a list of treatment options that may help:

Weight Loss
An increased in body weight can worsen and interrupt the proper breathing patterns during sleep. In general, a 10% -15% loss of body weight can lead to a 50% improvement in snoring or OSA. For example, if a patient who weighs 220 pound loses about 22-33 pounds, his/her breathing pattern can improve by 50%. Weight loss must be gradual and should be done under the proper guidance of a physician. Weight loss is recommended for all patients with severe snoring problems or OSA, often in combination with one or more of other treatments listed below. After a substantial weight loss, other treatments can often be discontinued. These decisions should be made in follow-up visits with the physician.

Avoidance of Alcoholic Beverages & Certain Sleeping Medications
Alcoholic beverages and certain types of sleeping medications may relax the throat muscles more than other body muscles and may dramatically worsen snoring or OSA. They should be avoided initially but may be used under some circumstances after other treatments have been started.

Snoreball
If the snoring or OSA occurs only when one is sleeping on the back, the Sleep Technologist notes it during the study. A t-shirt, with one or more tennis balls in a pocket on the back, can be used to keep the patient on his/her side or the front to allow a good night's sleep.

Medication Therapy
People with mild snoring or OSA may experience an improvement certain medications such as Vivactyl or medroxyprogesterone. Vivactyl was originally developed as an antidepressant, and medroxyprogesterone is a synthetic hormone. Even among patients whose sleep test shows only a mild problem, some do not respond well to these medicines, while others may have unwanted side effects. A nasal decongestant or an antihistamine may also be prescribed.

Dental Appliance
A dental appliance is a small plastic device, similar to an orthodontic retainer or an athletic mouth guard. It is worn each night during sleep. It works by either thrusting the mandible (the lower jaw) forward or pulling the tongue forward, increasing the breathing space behind the tongue. Dentists with a special training can design, construct, and fit these special devices to meet the patient’s individual needs. In general, dental appliances can improve the condition by 50% or more in some patients; however, but we cannot predict which patients will respond the best. After one has become comfortable with a dental appliance and experiences an improvement in the sleep quality, a repeat sleep test is usually recommended to determine the level of effectiveness of it in treating snoring or OSA.

CPAP Machine
A CPAP machine’s base unit operates as an air blower, similar to a vacuum cleaner in reverse. A plastic tube is attached to the base unit to deliver pressurized room air (not flammable oxygen) to a mask or a nasal pillow that fits around or under the nose. The pressurized air is directed into the nasal passageways and the throat. The pressurized air keeps the airway open, allowing the patient to breathe and sleep normally. The machine does not breathe for the patient; however, it keeps the airway open so that air can pass through it into the lungs. It is effective for alleviating severe snoring and symptoms of Sleep Apnea in over 90% of cases. The entire unit is portable, and most patients take it with them when they go on a travel. The humming noise it makes is usually less bothersome to the bed partner than the sound of a patient’s snoring or air gasping. Disadvantages, however, include the cost, the inconvenience of having to go through a second over-night sleep test to determine the accurate air pressure, and the need to use the machine every night. Over time, only about 50-70% of patients continue to use their CPAP machines on a regular basis; however, CPAP machine continues to be the best choice of treatment for most patient with moderate or severe OSA, and it may also be effective in some patients with milder form of OSA or snoring.

Uvulopalatopharyngoplasty (UPPP or UP3)
This surgical procedure, usually performed by an Ear, Nose, and Throat (ENT) physician or an Otorhinolaryngologist, involves a removal of excess tissue from the interior of a patient’s throat, creating a larger air passageway. Surgery may completely treat the problem, leaving the patient with no further need to use a CPAP machine, dental appliance or medications; however, but it is not always successful. In general, it improves snoring or OSA by just over 50% in 40%-70% of cases; therefore, many patients continue to rely on other alternative treatments even after undergoing the surgery.

Laser-Assisted Surgery
New techniques include using a laser as an "electronic scalpel" instead of using a conventional steel scalpel to remove excess throat tissue. Laser-assisted surgeries have advantages since they may be performed in a physician’s office or an outpatient setting rather than in a hospital surgical suite. In addition, they allow a surgeon to remove the excess tissue more gradually. On the other hand, these procedures are still considered new, we do not have enough statistical data about their long-term success rate. We suggest that laser-assisted surgeries will be more helpful for patients with mild snoring problems than for those with OSA.

Other Surgical Procedures
Tonsillectomy may be very helpful, particularly in children with OSA. Nasal surgery may correct snoring in many patients; however, it is often not helpful for OSA. If UPPP has not been a complete success, then other surgeries to reduce the tongue size or to push the upper (maxilla) and lower (mandible) jaw bones forward may be helpful. Tracheotomy is direct and curative but is rarely is used.