Part 1 - Lifestyle Modification
Obstructive sleep apnea (OSA) is a disorder characterized by obstruction of the upper airway during sleep. An introduction to this disorder and its diagnosis is described in an earlier page. This page is the first of three that will describe how OSA is treated.
Management: Basic Concepts
It should be emphasized that the causes for OSA are highly variable and there seldom is one specific treatment option that will cure the problem. Also, OSA is one of many medical disorders where treatment must be highly indvidualized to each patient. These two pages will cover most of the common types of treatment for OSA. The first page emphasizes non-surgical treatment, a second page covers devices to help with breathing and ventilation (e.g. CPAP), and a third page covers various types of surgery used for sleep apnea.
Lifestyle Approaches
Many of the lifestyle changes that improve OSA will also improve one's overall health. Lifestyle changes are also sometimes some of the hardest things to accomplish, but they can really make a dramatic improvement in OSA. Regardless of the final treatment or treatments chosen, the items described below are worthwhile goals.
Weight Loss
Obstructive sleep apnea is often associated with obesity. Overweight individuals often have respiratory problems due to thick chest walls and increased compression on the diaphragm from abdominal contents. The thick neck often seen in obesity also increases airway resistance. Weight loss, even in small amounts, can therefore have a profound effect on improving sleep apnea.
One quick and easy way to assess your weight that you might read abutr is called the Body Mass Index (BMI). The BMI is equal to the weight (in kilograms) divided by the square of the height (in meters), i.e. BMI= weight/ (height*height) . To get a rough approximate of your weight in kilograms, just divide it my 2. And to get a rough estimate of your height in meters, divide your heightin inches by 39.
The exact definition for a normal BMI varies somewhat, but anything over 30 is fairly well recognized as being overweight. Very heavy people will commonly have BMIs up around 40 or so.
Alcohol Reduction
Alcohol is known to worsen sleep apnea. The muscles of the upper airway have been shown to lose some of their motor activity after consumption of alcohol. Individuals with sleep apnea should therefore have no more than a small drink before bedtime.
Other Measures
Sleep apnea is usually worse when lying on one's back. Gravity causes the base of the tongue to fall back and obstruct the airway. Various simple techniques have been proposed prevent the person from rolling on his or her back: tennis balls sewn to the back of the pajamas, special pillows, etc. These usually are not effective in actual practice.
Medications
There are no specific medications that directly prevent OSA. As with alcohol, certain medications like narcotic pain relievers and barbituates are generally felt to worsen OSA, so these should be avoided. Sleep apnea is usually worsened with nasal obstruction, so any medicine that improves nasal airflow may be helpful. Strong nasal decongestants like Afrin (oxymetazoline) will do this, but this medicine can only be taken for about a week at one time. (If taken for a longer period of time, the nose develops a "rebound" effect in which it becomes even more swollen when the medication is stopped). There are various nasal steroid sprays that can be taken for many months and these may be helpful if reducing nasal obstruction (examples of these include Flonase, Rhinocort, Nasocort). Antihistamines such as Claritin or Allegra may be useful if allergies are present. Salt water (saline) irrigations also may be helpful for clearing the nose of crusts and improving nasal airflow.
Sleep apnea is worse with certain medical conditions such as hypothyroidism, and medical treatment of this disorder will therefore improve the apnea.
Dental Applicances
There are many dental appliances that can be worn at nighttime to help resposition the tongue and jaw, thereby reducing the risk or severity of OSA. Some of these lift the soft palate, some pull the tongue forward, and some pull forward the lower jaw (the mandible). These appliances are usually simple to use, have very little risks associated with their use, and are not that expensive. However, many of them have not had formal testing for effectiveness. They success rate will also depend very strongly on each individuals thoat and dental anatomy. They often cannot be used in people who do not have teeth. |
