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Reaching out

Sleep therapy is the general term for any treatment for sleep related disorders. For sleep apnoea, treatments aim to reduce the number of episodes of apnoea/hypopnoea experienced during sleep.

The most common treatment for sleep apnoea is Continuous Positive Airway Pressure (CPAP). This involves a mask, worn over the nose at night, to supply a constant airway pressure. A machine connected to this mask blows air into the airways to prevent them from collapsing so that the individual is able to breathe normally.

The alternatives to CPAP are position therapy, lifestyle management, dental devices and surgery.

Position therapy, for example staying off the back and raising the head of the bed, may reduce symptoms for patients with mild sleep apnoea.

Lifestyle management may involve helping people to lose weight, stop smoking and/or decrease alcohol consumption.

Dental devices are designed to keep the upper airway open during sleep. The efficacy of dental devices has been established in clinical trials (1), but these devices are traditionally viewed as a treatment option only for mild and moderate sleep apnoea.

Surgery may be another option, whereby the size of the upper airway is increased to prevent collapse of the airway and make breathing easier. This involves, specifically, resection of the uvula and redundant retrolingual soft tissue. However, there is a lack of evidence of clinical effectiveness, and surgery is not routinely used in clinical practice.

The diagnosis and treatment of sleep apnoea, and the monitoring of the response, should be carried out by a physician or specialist.

(1) Thicket EM, Hirani S, Williams A, Hodgkins J.Royal Bournemouth Hospital, Castle Lane East, Bournemouth, BH7 7DW. Eleanor.thickett@rbch.nhs.uk . A prospective evaluation assessing the effectiveness of the 'Dynamax' mandibular appliance in the management of obstructive sleep apnoea. Surgeon. 2009 Feb;7(1):14-7.