Treatment

The treatment for both snoring and sleep apnea falls under generally three categories: (1) surgical; (2) medical; (3) dental. Measures such as weight loss, smoking cessation, and decreasing or eliminating drugs or alcohol should be undertaken. Usually, substantial lifestyle changes are unrealistic in many patients, so other forms of therapy must be considered. Many treatment options open to most people have been, at best, unattractive and undesirable and unobtainable.

Surgical procedures have had recent developments, such as laser surgical techniques for reduction and/or elimination of the uvula and other pharyngeal tissues. A surgical solution offers the patient a chance of relief, but with considerable discomfort, whatever the technique. There also remains no guarantee of success when the anatomical changes are irreversible. The surgical approach usually involves removal of a lot of soft tissue, such as the soft palate, tonsils, uvula and some adjacent throat muscles so as to enlarge the opening of the airway. The disadvantage of the surgical approach, of course, are the inherent risks of the surgical procedure itself. Sometimes the removed tissue grows back over time, and there is the possibility that one could get a nasal speech or a regurgitation of food into the nose. The surgical approach has proven to be only about 40 to 50% effective, and there are other disadvantages in that it is an irreversible procedure.

The current gold standard of treatment is a respirator-like device known as a NCPAP (or nasal continuous positive air pressure). The patient wears a mask which fits over the nose, forming an airtight seal. A hose connects the mask to an air pump near the bedside. A continuous flow of air holds the airway open and relieves the snoring and sleep apnea. Pump noise, voice changes, skin irritation from the mask, along with general throat dryness, reduce the patient compliance with this form of treatment. Also, nighttime use of the CPAP appliance is difficult because a restless sleeper can get caught in the hose and perhaps loosen it, and also, the hose must be unhooked and reconnected during the nighttime if the patient needs to go to the bathroom or get up for any other reason. Although the CPAP appliance is very effective in treating snoring and sleep apnea, the compliance rate is fairly low sometimes.

Another effective way of treating sleep apnea or snoring is sleeping position. The preferable sleep position is on one side, which makes it easier for the airway to remain open. Some people even go to the length of sewing tennis balls in the back of their nighttime sleepwear so as to be reminded or prodded into not turning over and sleeping on their back. The adjacent airway diagrams are representative of sleeping position and the effect of the tongue on closing the airway. As you can see in the diagram, a forward tongue and jaw position, which can be obtained with a dental sleep appliance, is an effective way to open up the airway and keep it open during the night.