Obstructive Sleep Apnea Treatment

How do we treat Obstructive Sleep Apnea (OSA)?

If you have been told that you snore loudly, stop breathing in your sleep, or wake up feeling unrefreshed no matter how long you spend in bed, you may have obstructive sleep apnoea (OSA). It is more common than many people realise, and the good news is that it is very treatable.

With the right treatment, many people notice that they sleep better, feel more alert during the day, and protect their long-term health.

Understanding Obstructive Sleep Apnoea

Obstructive sleep apnoea is a chronic condition in which breathing is repeatedly disrupted during sleep. As you sleep, the muscles of the throat relax, and in people with OSA the airway narrows or closes, which makes breathing shallow or stops it for short periods. This can happen many times a night. Each time, the brain briefly wakes the body to restart breathing, usually without you realising it, so your sleep is broken up and your body and brain can be deprived of oxygen.

On the surface, OSA is usually associated with loud snoring and tiredness from unrefreshing sleep. However, left untreated over the long term, it can have more serious consequences, including heart disease, high blood pressure, and depression. This is why treating sleep apnoea is about more than a quieter night; it is about protecting your health.

How Is Treatment Chosen?

The right treatment depends on how severe your sleep apnoea is, what is causing the airway to collapse, your symptoms, your overall health, and your personal preferences. Your doctor will usually base this on your sleep study results and an examination of your nose, throat, and jaw. Treatment is often a combination of approaches, and it is not unusual for the plan to be adjusted over time as you progress.

• Lifestyle modifications: Changes to weight, sleeping position, alcohol use, and exercise that reduce airway collapse. These support every other form of treatment.
• Positive airway pressure therapy: A machine that delivers air through a mask to keep the airway open during sleep. It is the most commonly used and effective treatment for OSA.
• Surgery: Procedures to remove tissue, reposition the jaw, or stimulate the airway muscles. It is usually considered when other treatments have not worked, or where a structural problem is the cause.

Lifestyle Modifications

Lifestyle changes may not cure sleep apnoea on their own, but they can make a real difference to its severity, and they make other treatments work better.

• Weight loss: Reduces fat deposits around the airway and improves breathing. Even a modest amount of weight loss can help.
• Sleeping position: Avoiding sleeping on your back (positional therapy) may reduce airway collapse. Sleeping on your side is often more helpful.
• Avoiding alcohol and sedatives: These relax the airway muscles and worsen OSA. Avoid alcohol and sleeping pills in the hours before bed.
• Regular exercise: Improves overall sleep quality and reduces the severity of sleep apnoea, even before any weight is lost.

Positive Airway Pressure Therapy

Sleep apnoea can be managed with a positive airway pressure device, which is a mask-like device that keeps the airways open while you sleep. A small machine gently blows air through a hose into a mask that you wear over your nose, or over your nose and mouth. The air pressure acts as a splint that keeps the throat open, so that your breathing stays steady through the night. The devices include:

• Continuous Positive Airway Pressure (CPAP): The most common and effective treatment. A machine delivers a steady stream of air through a mask to keep the airway open during sleep.
• Bi-level Positive Airway Pressure (BiPAP): Provides different pressures for breathing in and breathing out, which can be useful for those who cannot tolerate CPAP.
• Auto-adjusting Positive Airway Pressure (APAP): Adjusts the air pressure automatically, based on the patient’s breathing patterns through the night.

Getting Used to Your Device

It can take a few weeks to get used to sleeping with a mask, and this is completely normal. Many people find that the benefits, such as deeper sleep and more energy, soon make it worthwhile. These tips can help:

• Get the right fit: A mask that fits well and is comfortable makes a big difference. There are different styles and sizes, and your team can help you find one that suits you.
• Start gradually: Wear the mask for short periods while awake, such as when reading or watching television, to get used to the feel of it.
• Use it every night: The treatment works only when you use it, so aim to wear it for the whole night, including naps, for the best results.
• Keep it clean: Clean your mask, tubing, and water chamber regularly as advised. In Singapore’s warm and humid climate, masks can become sweaty and bacteria can build up more easily, so regular cleaning is important.
• Keep it clean: Clean your mask, tubing, and water chamber regularly as advised. In Singapore’s warm and humid climate, masks can become sweaty and bacteria can build up more easily, so regular cleaning is important.
• Take it with you: Many devices are compact enough to travel with, which is helpful if you travel often.

Surgery

Surgery is usually considered only after other treatments have failed, and is usually suggested after a trial of at least three months of other treatment options. It is, however, a first treatment option for people with certain jaw structure problems. The options include:

• Uvulopalatopharyngoplasty (UPPP): Removes excess tissue from the throat, such as the uvula, soft palate, and sometimes the tonsils, to widen the airway.
• Maxillomandibular advancement: Moves the upper and lower jaw forward to enlarge the airway behind the tongue and soft palate.
• Hypoglossal nerve stimulation: An implanted device stimulates the tongue muscles to keep the airway open during sleep.

The right procedure depends on where and why your airway is collapsing, and not everyone is a suitable candidate. Your doctor will discuss the potential benefits, risks, and recovery time of each, and will take the time to answer your questions. Other treatments, such as custom-made oral appliances that move the lower jaw forward, may also be discussed for selected patients.

Follow-up and Long-Term Care

Sleep apnoea is a long-term condition, so ongoing care matters. Your doctor will review how you are doing after you start treatment, and may check data from your device to see how well it is working and adjust the settings if needed. If your weight changes, your symptoms return, or your mask no longer fits comfortably, your treatment can be reviewed. With regular follow-up, most people continue to benefit from treatment for many years.