Sleep Disorder Treatments

Sleep Disorder Treatments - GBMC Sleep Center

Nasal CPAP and BiPAP

Nasal CPAP (Continuous Positive Airway Pressure)  is the most commonly prescribed therapy for patients who have obstructive sleep apnea. It is a particularly important for those patients who have moderate to severe disease or patients who have severe daytime sleepiness. In using this therapy, the patient is fitted with a nasal mask (also referred to as "nasal interface") that is worn during sleep. This mask is attached via tubing to a small generator that sits at the bedside and directs pressure to the nasal interface. When properly fitted and when the pressure is properly adjusted, this therapy alleviates any blockage in the nasal or oral passages that may lead to obstruction of the airway thereby relieving apneas during sleep. This therapy may require an acclimatation period that may last anywhere from several days to several weeks for the patient to be adequately comfortable with the therapy. The equipment may require adjustments; these adjustments will be coordinated through the physician or the equipment company.

Nasal BiPAP (bilevel positive airway pressure)  is a therapy very similar to nasal CPAP (above) with the following exception. Unlike nasal CPAP (during which the pressure is delivered "continuously"), patients on nasal BiPAP will have a certain pressure delivered during inspiration and a lesser pressure during exhalation. This therapy is generally more expensive but in many patients is significantly more comfortable, particularly if high pressures are required via nasal CPAP. This therapy also can prove helpful to patients who have other pulmonary problems by actually assisting breathing during sleep by assisting inspiration by providing extra pressure when the patient is taking in a breath. In general, patients who are able to tolerate nasal CPAP usually do not require BiPAP therapy when treating obstructive sleep apnea

Surgical Options

In patients with sleep apnea, the most common initial therapies utilized are weight loss and nasal CPAP therapy. In carefully selected patients, surgical treatment options are appropriate, particularly in children who have large tonsils or in patients who have nasal obstruction or obstruction of the oral airway (often caused by a markedly enlarged uvula).

A variety of surgical treatment options are available to patients with either obstructive sleep apnea or patients who have snoring without obstructive sleep apnea. In general, surgical therapies are more successful in patients who have snoring without sleep apnea. These surgical treatments are performed by an ear, nose, and throat (ENT) specialist. This physician recommends whether such therapies would be appropriate and discusses specific risks and benefits with each candidate.

Since Tracheostomy (a surgical opening to the trachea created in the front of the neck) is now used much less frequently as treatment for severe sleep apnea, one of the most aggressive surgical treatments for sleep apnea therapy is now the uvulopalatopharyngoplasty. This surgery involves the removal of the tonsils, the uvula, and part of the soft palate.

Laser Assisted Uvuloplasty is a less invasive and more cost-effective resection that is performed in the office, usually on three or four sessions involving laser ablation of the tonsils, the uvula, and part of the soft palate. Generally, this procedure is reserved for patients with snoring in whom apnea has been excluded.

Somnoplasty is a rather new procedure, where radio frequency waves are directed in the deep nasal passages or at the base of the tongue. These radio waves can cause shrinking of tissue in carefully selected areas.

A variety of nasal procedures, including Septoplasty (the repair of a deviated nasal septum), can improve nasal airflow. This may help reduce snoring, improve sleep apnea, or allow a patient better tolerate other therapies such as nasal CPAP.

Weight Loss

Weight loss is one treatment option for OSAS in overweight patients. Even a modest 10% weight loss may decrease the number of nighttime apneas. However, this treatment option is usually not successful because only a small percentage of patients can permanently lose weight.

Behavior Modification

Good Sleep Habits / Tips

1. Avoid excessive daytime napping.
2. Have set wake-up times and bedtimes.
3. Avoid extended periods of time in bed.
4. Avoid alcohol, tobacco, and caffeine in the period prior to bedtime.
5. Avoid exercise too close to bedtime.
6. Avoid engaging in exciting or emotionally upsetting activities too close to bedtime.
7. Avoid use of bed for non-sleep-related activities (e.g., watching television, reading, studying, eating, etc.).
8. Make the bed as comfortable as possible (comfortable mattress, adequate blankets).
9. Sleep in a comfortable environment (not too bright, too stuffy, to cluttered, too hot, too cold).
10. Avoid performing activities demanding high levels of concentration before bed.
11. Try to avoid allowing mental activities, such as thinking, planning, reminiscing, etc., to occur in bed.

Medications

Several classes of medications have proven to be useful in patients with certain sleep disorders. Although there are many medications that have been used successfully in patients with conditions such as restless leg syndrome and periodic limb movements of sleep (PLMS), other sleep disorders do not have any specific pharmacologic treatment. Perhaps of most disappointment is that there are no medications effective for patients with sleep apnea. Accordingly, the treatment for this disorder remains fairly complex and sometimes frustrating. Therefore, it is very important for patients who are on these medications to be followed regularly by their physician or sleep specialist.

Hypnotic medications (sleeping pills)  as medications with much more favorable properties and less addictive properties have become available. These medications historically comprised of medications of the "benzodiazepine" category, including Valium (diazepam), Ativan (lorazepam), and Restoril (temazepam). Newer agents that have similar pharmacologic properties to these but with less addiction potential and less morning sedating effects are now available. These include Ambien (zolpidem) and Sonata (zaleplon), which is even shorter acting and usually helpful in patients that simply have difficulty initiating sleep.

Wake promoting agents  are medications that improve the level of wakefulness through the day. The medications have become important additions to the list of medications to treat sleep disorders. Historically, these agents have included amphetamines, a class of drugs whose usefulness is limited by their addiction potential. More recently, Ritalin (methylphenidate) and Cylert (pemoline) have become good alternatives to traditional amphetamines in patients with narcolepsy and other conditions of excessive sleepiness. Provigil (modafinil), a wake promoting agent that does not show a significant propensity for addiction or dependence and which is associated with very few side effects has been clinically useful as a wake promoting agent.

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