Treatment for sleep apnea include CPAP, oxygen at night, surgery, a pocket T-shirt?

Weight loss

Logical in theory, but difficult in practice, due to a vicious cycle.

Neck weight gain is generally in the form of fatty tissue which tends to block the airway when the muscles in that airway collapse during REM sleep.

Weight gain in the belly makes it more difficult for the diaphragm to move up and down, preventing the ability to take deep breaths.

Both the airway obstruction during REM and the shallow breaths at all other times lead to low oxygen levels.

The low oxygen levels result in the multiple micro-arousals which cause excessive daytime sleepiness (EDS).

EDS leaves you with no energy to exercise.

In addition, the metabolism has responded to the OSA by slowing down to the point that in order to burn the same number of calories as before (when the metabolic rate was normal) more vigorous exercise is needed.

Hence the vicious cycle.

Positional therapy

While snoring could be considered a good thing, because there must be at least some airflow in order to produce a snore, most bed partners do not find it to be good.

Most snoring and many mild to moderate apneas only occur when a person is lying on their back.

If this is the case, the solution is quite simple and inexpensive.

Take a pocket t-shirt, put a tennis ball in the pocket and have them wear it backwards.

It will keep them off their back and therefore breathing quietly.

Nocturnal oxygen

Low flow oxygen via a nasal cannula during sleep has proven to be very helpful for some people with lung disease, central apnea or heart failure.

It is also often a viable alternative for people who refuse or can't tolerate CPAP-type devices.

Oxygen will not prevent obstructive apnea, but in some people, it will raise the oxygen levels enough when the person is breathing so that the levels stay high enough during the apneas when they are not breathing.

Medication implementation or adjustment

Many of the medications used to treat depression, insomnia, or leg cramps, particularly those of the benzodiazepine family, may actually cause, contribute to, or even mask a sleep disorder.

They may cause prolonged grogginess, prevent or delay the onset of the vital, restorative phase of Delta sleep and actually suppress (keep you from getting into) REM sleep.

For example, excessive daytime sleepiness, lethargy and grumpiness, symptoms of a sleep disorder such as OSA, can be mistaken for the symptoms of depression.

However, once on an anti-depressant medication that alters Delta sleep and suppresses REM sleep, the person is even more tired than before and therefore possibly more depressed.

In addition, with REM sleep reduced or eliminated, the OSA is masked and therefore would not be evident were a sleep study to be done.

Most of these medications have to be out of the system for two weeks to be sure all residual effects are gone.

Also keep in mind that most medications used to treat insomnia - difficulty falling asleep or staying asleep - are actually approved for short term use only and often list insomnia as a side effect.

Read The Guide to Better Sleep Naturally, order the Personalized Sleep Analysis or ask your pharmacist if any of your medicines, alone or in combination with each other, or food or drink, could be affecting your sleep.

The addition of theophylline to the regimen of those being treated for heart failure has proven to helpful in treating the central apneas that are commonly associated with heart failure, but often go undetected or overlooked.

A similar protocol is followed for babies who suffer from apnea of prematurity.

Ironically, theophylline acts like pure caffeine and can cause insomnia.

Positive pressure airway devices, i.e., CPAP

CPAP stands for Continuous Positive Airway Pressure.

A CPAP is a small, relatively quiet, electrically powered machine that blows pressurized air through a six-foot long hose.

The hose is attached to a mask-like device that is usually worn just over the nose and is secured with a headstrap.

It acts like an air splint to keep the upper airway from collapsing.

Proper fitting of the mask is vital.

There are dozens of styles available but since insurance companies generally only pay for a new one every 4 to 6 months, be sure to choose one that is comfortable enough to be worn night after night.

Ask the sleep lab or home care company if you can try samples for a night or two before you settle on one.

Patience and perserverance are the other keys to successful CPAP therapy.

It takes the body up to 4 weeks to become accustomed to the sensation of cool, dry air being blown up your nose.

But for most obstructive apnea sufferers, it is worth it.

CPAP is a wonder cure for many, but not for everyone.

It is possible that sleep apnea is not your only sleep disorder.

If you are successfully using your CPAP but are still tired,

you may need to change some

bad habits that you have acquired.

To get better sleep naturally, without drugs,

read The Guide to Better Sleep Naturally

or work with a Personal Sleep Trainer.

If you are having trouble adjusting to your CPAP, read on:

Some people think that sex and CPAP don't get along.

But please don't let vanity get in the way of your health.

There can still be normal sexual relations (and often even better ones once the body gets healthy sleep!) because the CPAP needs to be worn only when SLEEPING, not while just BEING in bed.

There are many tricks to try if dryness is an issue.

The simplest is to use an over-the-counter saline spray several times a day, and especially at bedtime.

Another is to place a room humidifier near the CPAP machine.

Wrapping a heating pad set on low around the tubing can also be useful, as warm air is less irritating than cold air.

Using an extra length of six foot tubing and running as much of the tubing as possible under the covers so that it warms up, is another suggestion.

The final solution is to ask the company who provided the machine about an un-heated or heated humidifier designed for the CPAP machine.

If a stuffy nose is the problem and the tricks mentioned up above don't work, nasal decongestants or steroid nasal sprays, used only during the first couple weeks while your body adjusts can also be helpful.

If you are unable to fall asleep while using the CPAP device because you feel the pressure from the machine is too high, ask the homecare company about a ramp setting.

This timed feature allows the pressure to start low and then ramp up gradually so that the CPAP doesn't reach the maximum pressure until you are asleep.

Or, a newer type of CPAP device, an autoadjust, is designed to constantly determine the minimum pressure level that is needed to splint your airway open and deliver that.

This is a very user-friendly system because during light sleep, such as when you are falling asleep, less pressure is needed than during REM, when you are so soundly asleep you won't notice how high the pressure has become.

If you are still not able to tolerate CPAP, a slightly more sophisticated device, a bilevel positive airway pressure (PAP) device is available.

Breathing in on a PAP device is usually not the problem; it's breathing out that causes the discomfort, like swimming upstream or against the tide.

The bilevel PAP devices can be set with whatever pressure your airway requires on inspiration and a lower one on expiration, thus avoiding this issue.

A doctor's order is required for any of these devices.

If weight gain was the cause of your sleep apnea, there is the possiblity that once you are sleeping well and have the energy to exercise and lose weight, that you will be able to put the CPAP in the closet.

It makes a nice incentive to not gain the weight again.

But if weight control is beyond your ability or not the magic cure, you need to have a positive attitude about your CPAP.

Make it your best friend.

Your bed partner, family and friends will all thank you when your previous sunny disposition returns!!

Oral appliances

Usually fitted and supplied by oral surgeons or dentists, these devices may be useful for treating snoring or mild sleep disordered breathing.

Surgery

This surgery is generally performed by ENT's: doctors who specialze in ear, nose and throat medicine.

Nasal reconstruction surgery for nasal polyps, deviated septums and the like, is useful in re-opening nasal passages that were blocked or deformed.

A UPPP (Uvulopalatopharyngoplasty - also known as a UVPP) and other laser procedures, are primarily useful in the treatment of snoring and mild sleep disordered breathing.

They remove the uvula, the little flap that hangs in your airway to help prevent food and drink from going into your lungs, if it has become enlarged.

Or they tighten flabby tissue or remove fatty tissue that may have built up and block the air passage during sleep.

Tonsilectomies, the once routine surgery that has all but become extinct, is often the simple cure for obstructive sleep apnea in adolescents as well as in adults, whose tonsils are often overlooked as a cause of obstruction.

Tracheostomies, although drastic, can be life saving for people with severe obstructive apnea who are morbidly obese and cannot tolerate CPAP type devices.

The new opening in the trachea is below the area which obstructs the airway during sleep, so the person can get quality sleep with adequate oxygen levels at night.

During the day, the opening is covered over so they can follow a normal lifestyle, including a vigorous exercise program since they now have the energy and motivation to stick to one.

Once enough weight is lost, the tracheostomy can generally be allowed to close over.