Treatments for Sleep Apnea

 

 

Today we're gonna talk about treatment options for sleep apnea. We posted previously about, if somebody has obstructive sleep apnea, they have a throat issue and then more specifically, they have an issue either with their tonsils being too big, their tongue being too big for the size of the back of the throat, or their palate being elongated and most folks have all those issues in play.

 

When we treat somebody who has sleep apnea, we look in the back of the throat. We make sure we understand what's going on. We also make sure that their nose is working. That's our starting point before we start anybody down the road towards adequate and proper treatment. If somebody's got a throat that's too tight and has signs and symptoms of sleep apnea then we'll do an at home sleep study and figure out do they have sleep apnea or not?

Based of that sleep study and their anatomy, we can lock into a treatment plan. If somebody has sleep apnea, they've got three different pathways they can take.

First pathway is the CPAP machine. CPAP stands for Continuous Positive Airway Pressure. CPAP is the most common treatment for obstructive sleep apnea.

 

A CPAP is a machine that sits on your bedside. It has a hose that comes off of it attached to a mask. That mask can either sit on your nose or on both your nose and your mouth and what it's doing is, it's pushing air into the back of the throat and tenting that area open. It's not a breathing machine. It's not a respirator, it's not doing that. It's just pushing air.

If you think about puffing your cheeks out and you close your mouth and you push out, CPAP machine puffs your throat out. It pushes air in to your nose or your mouth into the back of your throat and it's tenting that open so try as your body might to try to collapse that down. The machine is putting enough pressure in to hold that open. Ideally, that's it. That's it. It's not putting more pressure than that, not less pressure than that, just the right pressure.

 

Newer machines can adjust their pressure on the fly. They can give you various amount of pressure depending on the need, depending on your sleep position, depending on a lot of different factors. So CPAP, that's the first pathway.

 

A second pathway is an oral appliance. An oral appliance is basically a retainer that you wear when you're sleeping. It's in your mouth between your upper and your lower teeth and what it's doing is, it's using your upper teeth to pull your lower jaw forward.  Your tongue is attached to your lower jaw, so if your lower jaw comes forward even a little bit, all of a sudden that opens up your airway.

 

Most folks who are good candidates for a CPAP machine are also a good candidate for an oral appliance. Most folks never hear about the option of an oral appliance because most sleep centers don't offer that option.  CPAP is one option, an oral appliance is another option.

 

The final option for folks who have sleep apnea involves procedures. Procedures can run a bit of a gamut. There's a lot of different procedures that are out there to try to treat sleep apnea.

 

All the procedures are either trying to stiffen the tissue in the back of the throat, or trying to remove some of that blocking tissue to make things more open.  We won't get into every procedure that we do for folks who have sleep apnea, but if you think about the anatomy in the back of the throat, any of the structures back there are fair game.

 

The most common treatment that's out there when you consider kids and adults is removing tonsils. If somebody's got enlarged tonsils that are taking up space in the back of the throat, removing them is gonna give you more space back there.

 

There's another procedure called a uvulopalatopharyngoplasty. Big name, we called it a UP3 or UPPP. What that means is removing the tonsils and then removing a portion of the soft palate and the uvula usually and then putting that back together to open things up. When we do a UP3, what we're doing is opening the sides of the throat up by removing the tonsils. Opening the top of the throat up by trimming down the palate. Not doing anything to the tongue and so there are procedures that can be done to the back of the tongue. Those procedures aren't yet as reliable as we would like them to be and so we're sort of waiting, hoping that there's gonna be some advances there that allow us to do more.

 

Currently if somebody's got a tongue issue, and that's the cause for their sleep apnea, we will typically get that patient into an oral appliance or a CPAP machine because the procedures just really aren't there yet.

 

There three different options CPAP, oral appliance, procedures. Those could be separate. Sometimes we'll combine and sometimes, kind of sounds weird, but there are folks who will use a CPAP machine along with an oral appliance. Okay, fine. There are folks who will use an oral appliance along with a procedure, so they're not mutually exclusive and some times it's just finding that right fit for somebody.

 

If you think about those last two options, an oral appliance versus procedures, procedures we can mainly work on the sides of the throat and the top of the throat. That's where procedures are focused.

 

An oral appliance works mainly on the tongue. Procedures don't work very well on the tongue. You put those two things together and sometimes we'll start somebody in an oral appliance knowing we could do procedures on the throat if they're not quite where they need to be. Flip that around. Sometimes we'll start with procedures on the sides and the top of the throat, to see where that takes us, and we can always get them into an oral appliance or a CPAP machine if those procedures don't get them where they need to be.

 

Part of what we do on the front end is putting all that information in front of somebody, not to confuse them but to make sure they are empowered with choices. Because there are a lot of choices that can be made and there's not one size fits all.

 

The one size fits all approach that we do take is I don't care if it's an appliance, if it's a surgery, if it's a CPAP machine, it ain't gonna work properly unless somebody's nose is working properly. It's not gonna happen. We can force somebody into a machine or an appliance with a jammed up nose, but you're not doing them any favors. That's the sin that happens outside of our walls on a minute by minute basis unfortunately and so there are a lot of people who are trying to do the right thing and trying to get treated and are frustrated by a system that's broken and so we're trying to do our part to fix that system.

 

It's really about figuring out what's the right option for each person, depending on what their anatomy looks like, and depending what their sleep study numbers look like, and depending on what that person wants.

 

 

 

Previous Segments:

Obstructive Sleep Apnea

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