Self-Remedies And Conservative Treatments For Sleep Apnea

The following overview of treatment options for patients with sleep apnea was prepared by Dr. Samuel A. Mickelson, M.D.

• Self-Help Remedies
• Devices
• Nasal Surgery
• Upper Airway Surgery
• Lower Airway Surgery
• Surgical Bypass of the Airway

Self-Help Remedies

These remedies may or may not be applicable to you. They may be reasonable options by themselves or may be combined with other treatments.

Weight Loss

If you are overweight, weight reduction may improve your snoring or sleep apnea. Weight gain deposits fat into and around the soft palate, tongue and neck structures. Weight loss can reduce these fat deposits and enlarge the airway size.

Sleep Positioning Maneuvers

Elevating the head of your bed and avoiding sleeping on your back may be helpful. A common way to train you to not sleep on the back is to place a tennis ball in the middle of your back during sleep. The ball is placed in a sock that is pinned to the back of a sleep shirt or placed in a pocket sewn into the shirt.

Improve Amount and Regularity of Sleep

You should go to sleep and wake up at approximately the same time every day. You should try to get at least 7 1/2 to 8 hours of sleep a night. Snoring and sleep apnea is often worse if you are overtired.

Avoid Drugs and Habits That Worsen Airway Narrowing

Alcohol and most sleeping pills relax the muscles of the throat and can worsen snoring and sleep apnea. You should avoid alcohol for at least 3 hours prior to bedtime. Smoking can also worsen snoring and sleep apnea, due to swelling of the nasal tissues.

Nasal Dilators

Internal or external devices that dilate your nasal passages may help your snoring.

Devices

Devices must be worn all night and every night in order to control the sleep disorder. Devices may be difficult to use and are not always tolerated. The main advantage of a device is that there are usually minimal risks associated with their use.

CPAP, BiPAP

CPAP (continuous positive airway pressure) is a device that controls apnea and snoring in most patients and is the most common and successful treatment prescribed for sleep apnea. CPAP is an air compressor that blows air through a corrugated tube attached to a mask that is placed over your nose. The mask is held in place by elastic straps around the back of your head. The air blows up your nose and down your throat and prevents the throat from closing up.

BiPAP (Bilevel Positive Airway Pressure) is a similar device that blows a higher pressure for inhaling and a lower pressure for exhaling. BiPAP is generally used for patients who can not tolerate high constant air pressure with CPAP.

Both of these devices currently require a sleep study (polysomnogram) to determine the proper pressure to use. If the pressure is too low, the airway may still collapse and obstruct, and if the pressure is too high, the device may not be tolerated or a different type of apnea (central apnea) may occur.

Oral Appliance

An adjustable oral appliance is a custom-fit device that is worn over the teeth and pulls the lower jawbone forward. Since the tongue is attached to the jaw, moving the jaw forward will open up the airway and may help snoring or sleep apnea. Once tolerated the entire night, the device can be adjusted until breathing improves.

Nasal Surgery - Septoplasty

The goal of surgery is to enlarge the airway and prevent snoring and airway collapse. Surgery is site-specific (performed to enlarge a certain portion of the airway). Due to risks associated with anesthesia or an operation, surgery may not be considered as a first option. The main advantage of surgery is that it may achieve a permanent cure for the problem.

The septum is the divider between the two nasal passages. A deviated (crooked) septum may obstruct the nasal airway. A septoplasty is performed through the nostrils. A small incision is made just inside one nostril and the cartilage and bone of the septum is straightened.

Turbinate Reduction

The turbinates within the nose are made of bone surrounded by soft tissue whose function are to warm up and moisturize the air as you breath. There are three turbinates in each nostril (lowest, middle, and upper). Reduction of the size of an enlarged turbinate can improve the size of the nasal airway. Turbinate reduction may be performed with surgical instruments, lasers, radio-frequency energy, or a cautery unit.

Removal of Polyps, Endoscopic Sinus Surgery

When polyps obstruct the nasal airway or sinus infections contribute to nasal obstruction, sinus surgery or removal of the polyps may be necessary. These surgeries are typically performed through the nostrils with magnifying scopes so as to avoid external incisions.

Upper Airway Surgery

The goal of surgery is to enlarge the airway and prevent snoring and airway collapse. Surgery is site-specific (performed to enlarge a certain portion of the airway). Due to risks associated with anesthesia or an operation, surgery may not be considered as a first option. The main advantage of surgery is that it may achieve a permanent cure for the problem.

Upper airway surgery is used for narrowing the upper part of the airway involving the soft palate, uvula, tonsils, or adenoids.

Uvulopalatopharyngoplasty (UPPP)

An enlarged uvula and elongated soft palate may cause sleep apnea and snoring. Uvulopalatopharyngoplasty, or UPPP, is a surgical procedure performed in the operating room under general anesthesia. The operation is performed either with a laser or standard surgical instruments. The uvula is removed, the lower edge of the soft palate trimmed, tonsils are generally removed (if present), and tissues are trimmed around the tonsils. Stitches are placed and dissolve away in several weeks.

Laser-Assisted Uvulopalatoplasty (LAUP)

Laser-assisted uvulopalatoplasty (LAUP) is a surgical procedure for the treatment of habitual loud snoring or obstructive sleep apnea. The procedure involves a progressive removal of the back edge of the palate and size of the uvula. When tonsils are present and are contributing to the snoring, they can be serially vaporized with the laser at the same time.
LAUP is most frequently performed with a carbon dioxide (CO2) laser in the office under local anesthesia. Treatment continues every 4-6 weeks until symptoms improve. Each treatment takes about fifteen minutes. Most patients require between one and 3 treatments.

Radio-frequency Tissue Ablation of the Palate (Somnoplasty)

Radio-frequency tissue ablation palatoplasty, also called somnoplasty, delivers radio-frequency waves by a needle electrode placed under the surface of the soft palate and causes contraction of excessive tissues that are causing snoring. Radio-frequency tissue ablation involves a progressive shrinkage of the soft palate and uvula. The procedure is virtually painless when used for the treatment of habitual loud snoring.

The procedure takes about 15 minutes and is performed in the office under local anesthesia. If symptoms persist, the next treatment is performed 4-6 weeks later. Most patients require between 1 and 4 treatments.

Tonsillectomy and Adenoidectomy

The tonsils are tissues on the sides of the upper throat and when enlarged may narrow the width of the upper airway. The adenoids are at the back of the nose and may obstruct the nasal airway. Removal of tonsils and adenoids are performed most often in children with snoring or sleep apnea. Since the adenoids usually shrink with age, they only rarely require removal in adults. Tonsillectomies and adenoidectomies are generally performed under general anesthesia in the operating room.

Lower Airway Surgery

The goal of surgery is to enlarge the airway and prevent snoring and airway collapse. Surgery is site-specific (performed to enlarge a certain portion of the airway). Due to risks associated with anesthesia or an operation, surgery may not be considered as a first option. The main advantage of surgery is that it may achieve a permanent cure for the problem.

Lower airway surgery is used to narrow the lower part of the airway, located behind the back of the tongue.

Genioglossus Advancement

The genioglossus muscle is a muscle that attaches from the back of the tongue to a spot on the back of the chin. The purpose of this operation is to pull the back of the tongue forward, enlarging the air space behind the tongue. Genioglossus advancement is performed in the operating room under general anesthesia through an incision inside the lower lip. A rectangular or circular segment of chin bone (just below the front 4 teeth) is pulled forward and held in place with a titanium screw or plate. The operation produces a minimal change (several millimeters) in the appearance of the chin.

Hyoid Advancement

The hyoid bone is a C-shaped bone in the upper neck that sits just above the Adam's apple. The hyoid bone has muscle attachments to the back of the tongue, as well as the sides of the lower throat. Hyoid advancement is performed in the operating room by making an incision in the neck just above the Adam's apple. The hyoid bone is moved forward and either attached to the Adam's apple or to the jawbone. This operation also enlarges the air space behind the tongue.

Midline Glossectomy, Lingualplasty, and Lingual Tonsillectomy

When the tongue is enlarged, surgery may be performed to make it smaller. The back of the tongue may be reduced in size by excising a V-shaped portion of the center part of the tongue (midline glossectomy). A more aggressive resection with additional removal of side wedges is termed lingualplasty. When enlarged, the lingual tonsils (tonsil-like tissue on the back part of the tongue) may also be removed with a laser. A temporary tracheostomy is frequently performed along with these operations to avoid breathing difficulty that could result from temporary swelling. By reducing the tongue size, the air space behind the tongue is enlarged.

Bimaxillary Advancement (Lafort 1 Maxillary Osteotomy with Bilateral Sagittal Split Mandibular Osteotomy)

The upper and lower jawbones can be moved forward along with all of the teeth in order to pull soft tissue structures forward and make more room for the tongue. The advanced portions of the jawbones are held in place with titanium metal plates and screws. This surgical procedure is performed for patients with a small jaw structure or in those who have failed other "soft tissue" surgeries. The surgery is performed under general anesthesia in the operating room. Orthodontic work prior to or following the advancement procedure may be necessary to maintain proper alignment of the teeth. The degree of change in facial appearance relates to the amount of advancement performed.

Tongue Base Radio-frequency Tissue Ablation (Somnoplasty)

When the tongue is enlarged, radio-frequency treatments may be performed to make it smaller. Radio-frequency tongue reduction, also called somnoplasty, is performed by a needle electrode placed under the surface of the tongue that causes contraction of excessive tissues. The procedure takes about 45 minutes and is performed in the office under local anesthesia. Each treatment results in a progressive shrinkage of the back of the tongue. If symptoms persist, the next treatment is performed about 4 weeks later.

Tongue Suspension Suture

A tongue suspension suture ("Repose") may prevent the tongue from falling back during sleep. A titanium screw is placed at the back of the chin. A permanent stitch attached to this screw is placed through the back of the tongue and is tied so that the tongue is pulled forward. This prevents collapse of the airway during sleep. Tongue suspension suture is performed under general anesthesia in the operating room

Surgical Bypass Of The Airway

Tracheostomy (Tracheotomy)

The goal of surgery is to enlarge the airway and prevent snoring and airway collapse. Surgery is site-specific (performed to enlarge a certain portion of the airway). Due to risks associated with anesthesia or an operation, surgery may not be considered as a first option. The main advantage of surgery is that it may achieve a permanent cure for the problem.

Instead of enlarging the narrowed portions of the airway, a tracheostomy, also called a tracheotomy, may be performed in order to bypass the narrowed segments or any obstruction associated with sleep apnea. In this operation, an opening is created in the front of the neck to the windpipe (trachea) and a plastic or metal tube is inserted. This tube keeps the tracheostomy from closing up. During sleep, the patient breathes through the tracheostomy tube. While awake, the tracheostomy tube is covered to allow for normal speech and breathing. Tracheostomy is usually performed for severe life-threatening sleep apnea or along with multiple airway reconstructive surgeries.

The material in this article was prepared by:

Dr. Samuel Mickelson, M. D. Dr. Samuel A. Mickelson, M.D.
Atlanta Ear, Nose & Throat Associates, P.C.
Director, Preferred Diagnostic Sleep Centers
Diplomat, American Board of Sleep Medicine
Fellow, American Academy of Otolaryngology - Head & Neck Surgery
Atlanta, Georgia

For more information about Sleep Apnea, see our Sleep Apnea topic in our Sleep Disorder Section.