Topic Overview

What is sleep apnea?

Sleep apnea is a condition that occurs when you regularly stop breathing for 10 seconds or longer during sleep. It can be classified as mild, moderate, or severe, based on the number of times per hour you stop breathing (apnea) or have slowed breathing (hypopnea). Apnea episodes may occur from 5 to 50 times an hour.

There are three types of sleep apnea: obstructive sleep apnea, central sleep apnea, and mixed sleep apnea. This topic focuses on obstructive sleep apnea.

What causes obstructive sleep apnea?

Obstructive sleep apnea (OSA) usually is caused by a blockage (obstruction) in the nose, mouth, or throat (airway) from a structural problem, such as an enlarged tongue or tonsils. Other factors, such as smoking or obesity, often contribute to OSA. For example, you may have enlarged tonsils that partially block the airway. During the day when you are awake and upright, this may cause no problems. However, when you lie down at night, fatty tissue in the neck can press down on your airway, narrowing it and causing OSA.

See illustrations of normal and blocked airways during sleep.

What are the symptoms of OSA?

The main symptoms of OSA are loud snoring and sleepiness during the day. Your bed partner may notice periods when you stop breathing during sleep. Other symptoms may include:

Tossing and turning during sleep.
Feeling suffocated during sleep.
Feeling tired all the time.
Morning headaches.
Feeling irritated and unrested.
Falling asleep at inappropriate times, such as while eating, driving, or talking.
Problems on the job.
What happens in OSA?

During an apnea episode, your blood oxygen level may drop because you stop breathing. Over time, low blood oxygen levels can lead to serious health problems and early death. If you have OSA, you may be at increased risk for developing high blood pressure (hypertension), high blood pressure in the lungs (pulmonary hypertension), depression, difficulty with concentration, abnormal heart rate, heart failure, coronary artery disease (CAD), and stroke.

If you have OSA, you may feel tired throughout the day. You may fall asleep at inappropriate times, such as while driving or working, which can lead to a higher-than-average rate of automobile- and work-related accidents.

How is OSA diagnosed?

A medical history and physical examination are the first steps in diagnosing OSA. If these suggest you have this condition, a sleep study (polysomnographic study) is recommended. A sleep study is usually done at a sleep center, where you will spend the night. Sleep studies identify:

How often you stop breathing or have slower breathing during sleep.
How low your blood oxygen levels drop during sleep.
How often your sleep is disturbed and you wake up.
A number of other tests, such as measuring your eye movement, may also be done during the sleep study.

How is OSA treated?

If you have mild OSA, losing weight, developing good sleep habits, and avoiding alcohol and certain medications may cure the condition. If you have moderate to severe OSA, you may need to use a breathing device (continuous positive airway pressure [CPAP]) that prevents your airway from closing during sleep. If CPAP is not effective, or if enlarged tissues are causing the blockage, surgery may be needed.

Cause

Obstructive sleep apnea (OSA) usually is caused by a blockage (obstruction) in the nose, mouth, or throat (airway). This may be caused by:

Problems with the bone structure of the face, possibly resulting from a birth defect or injury affecting the head and face.
Enlarged tissues in the nose, mouth, or throat.
Other factors that may contribute to OSA include:

Drinking alcohol, which depresses the part of the brain that regulates breathing, affecting movement of the breathing muscles.
Obesity, which affects 70% of the people with OSA. 1
Some medications taken for conditions such as allergies, depression, or anxiety.
For more information on contributing factors, see the What Increases Your Risk section.

See illustrations of normal and blocked airways during sleep.

Symptoms

The most common symptoms of obstructive sleep apnea (OSA) in adults are loud snoring and excessive daytime sleepiness. Almost all people who have OSA snore, but not all people who snore have OSA. Other signs and symptoms of OSA include:

Episodes of not breathing (apnea), which may occur as few as 5 times an hour (mild apnea) to more than 50 times an hour (severe apnea). The number of episodes is used to determine the severity of sleep apnea.
Restless tossing and turning during sleep.
Nighttime choking spells, sweating, and chest pain.
Waking with an unrefreshed feeling after sleep, having problems with memory and concentration, feeling irritable and tired, and experiencing personality changes.
Morning headaches.
Heartburn or a sour taste in the mouth at night.
In obese adults, swelling of the legs.
Getting up during the night to urinate (nocturia).
Some pauses in breathing are normal during sleep. People vary in their ability to tolerate the low blood oxygen levels that occur during these pauses. However, if you snore frequently and are very sleepy during the day, or if your sleeping partner notices that you stop breathing during sleep, you need further evaluation.

Older adults may normally have periods when they stop breathing during sleep, making it hard to know whether they have OSA. Short lapses in breathing during sleep are common in older adults and usually do not cause a significant drop in the blood oxygen level.

Symptoms in children

In children, symptoms of obstructive sleep apnea (OSA) can include snoring, difficulty breathing during sleep, and restless sleep during which the child wakes up often. However, children may have subtle symptoms. They may not appear to be excessively sleepy during the day, a key symptom in adults. The only sign of OSA in some children may be failure to grow as quickly as they should for their age.

Other signs and symptoms include bed-wetting and poor performance in school.

Rare complications of OSA in children include developmental delay and cor pulmonale.

Other conditions with symptoms similar to sleep apnea include an underactive thyroid (hypothyroidism) and other sleep disorders, such as suddenly falling asleep (narcolepsy) or an intense urge to move the legs (restless legs syndrome).

What Happens

Obstructive sleep apnea (OSA) causes you to stop breathing (apnea) for 10 seconds or longer during sleep. When your breathing stops, you may make grunting, gasping, or snorting sounds and restless body movements. As breathing resumes, loud snoring starts. This sequence may be repeated numerous times during one night.

How many times you stop breathing determines the severity of sleep apnea.

OSA may be most severe during the rapid eye movement (REM) stage of sleep. REM sleep increases throughout the night, so sleep apnea usually is most severe after you have been asleep for several hours, such as very early in the morning.

A person who has OSA:

Has a greater-than-average chance of being involved in a car accident.
May perform poorly at school or work and may have difficulty concentrating. The person also may have memory problems.
May have personality changes, anxiety, and depression.
May lose the desire for sex.
Over time, if OSA is not treated, it can lead to complications including coronary artery disease (CAD) and high blood pressure (hypertension). According to one study, people with sleep-disordered breathing have 2 to 3 times the risk of high blood pressure compared with people who do not have the condition. 2

What Increases Your Risk

Risk factors you cannot change

Factors that may increase your risk of obstructive sleep apnea (OSA) include:

Aging. OSA is most common in people age 30 and older.
Male gender. OSA is more common in males. Some studies have indicated that about 2 to 3 times more men than women have OSA, while sleep laboratories report that 5 or 6 times more men than women have the condition. 1
Family history. A person who has a family history of OSA is more likely to develop the condition than someone without a family history of the condition.
Ethnicity. Blacks, Hispanics, and Pacific Islanders have a greater risk for OSA than white people. Blacks develop OSA at a younger age than whites. 1
Weakened muscle tone in the tongue and throat. Weakened muscle tone can increase the chances of OSA.
Deformities of the spine. Deformities of the spine, such as scoliosis, may interfere with breathing and contribute to sleep OSA.
Conditions that may cause head and face (craniofacial) abnormalities. Conditions such as Marfan's syndrome and Down syndrome may result in craniofacial abnormalities and increase the risk for OSA.
Menopause. Recent studies indicate that OSA occurs more frequently in women who have been through menopause than in those who have not. 1 Why or how menopause increases the risk of OSA is not known.
Risk factors you may be able to change

Some risk factors for obstructive sleep apnea (OSA) that you may be able to change include:

Obesity. About 70% of people with OSA are obese. 1
Neck circumference. People who are overweight may have extra tissue around their neck, adding to their risk for OSA. The risk increases for men who have a neck circumference greater than 17 inches and for women with a neck circumference greater than 16 inches.
Enlarged tissues of the nose, mouth, or throat. Enlarged tissues in the nose, mouth, or throat can cause narrowing or blockage of the airway, which may make it more difficult to breathe.
Bone deformities. Bone deformities of the nose, mouth, or throat can interfere with breathing, causing OSA. Some people with OSA have a small, receding jaw.
Use of alcohol or medications. Drinking alcohol or taking medications (especially sedatives) before sleep can increase the risk for OSA.
Sleeping on your back and using pillows. Sleeping on your back and using one or more pillows may worsen OSA symptoms.
Smoking. Smoking can increase your risk for OSA.
Poor sleep habits. Having a consistent bedtime may decrease your risk for OSA.
Disorders of the hormone (endocrine) system. Disorders of the endocrine system (such as hypothyroidism and acromegaly) may increase your risk for OSA.
When To Call a Doctor

Call your health professional if:

Your child snores, has difficulty breathing while sleeping, sleeps restlessly, wakes up often, and is very sleepy during the day.
You or your bed partner snores loudly and heavily and feels sleepy during the day.
You notice that your bed partner stops breathing, gasps, or chokes during sleep.
You have periods when you fall asleep at inappropriate times, such as while talking or eating.
Watchful Waiting

Watchful waiting is a period of time during which you and your health professional observe your symptoms or condition without using medical treatment. Watchful waiting may be appropriate if you snore but are not excessively sleepy during the day. If home treatment does not help your snoring and you are sleepy during the day, talk with a health professional about being tested for sleep apnea.

Watchful waiting may not be appropriate if you notice that your sleeping partner snores loudly and heavily, is restless during sleep, and is sleepy during the day. If you think your sleeping partner may have periods when breathing stops, suggest that he or she talk with a health professional.

Who To See

The following health professionals can evaluate people with symptoms of OSA:

Primary care physician
Internist
Pediatrician
Nurse practitioner
Physician assistant
If OSA is suspected, a health professional who specializes in treating sleep disorders (often a neurologist or pulmonologist) can help arrange and interpret a sleep study. The health professional can prescribe treatment for the condition, such as continuous positive airway pressure, if it is needed.

Other health professionals may be needed if you have problems caused by OSA. If you:

Have heart problems, you may be referred to a cardiologist.
Need surgery to remove excess tissue or to correct a defect or injury, you may be referred to an otolaryngologist.
Need oral devices, you may be referred to a dentist.
Exams and Tests

A medical history and physical examination are the first steps in diagnosing obstructive sleep apnea (OSA). If these suggest that you may have this condition, a sleep study (polysomnographic study) is recommended. 3

A sleep study measures how the activity of your body changes during sleep. Results are used to distinguish between OSA and sleep apnea that occurs when the brain fails to send electrical signals to the respiratory muscles (central sleep apnea). A complete sleep study is usually done in a sleep lab and is the only accurate way to diagnose sleep apnea. Sleep tests also are done after beginning treatment with continuous positive airway pressure (CPAP) to monitor its effectiveness and determine if it needs adjusting.

Should I have a sleep study to diagnose obstructive sleep apnea?

The following tests can help support a diagnosis of OSA.

Screening sleep study. A screening sleep study does not measure as many factors and may not take as much time as a complete sleep study. It can be done in your home, in a hospital room, or in a sleep lab. Occasionally a screening sleep study is done before a complete sleep study.
Overnight oximetry. Oximetry measures the amount of oxygen in the blood. Overnight oximetry is done to see whether there are times during sleep when blood oxygen levels are low. Low blood oxygen levels do not always mean that apnea is present. A normal level of oxygen at night does not rule out OSA if you have apnea symptoms.
Sleep videotape. A videotape of you sleeping may show behavior such as restless movements, choking, or gasping that indicates sleep apnea.
Multiple sleep-latency test. A multiple sleep-latency test measures how quickly you fall asleep during the day.
Sleep symptom history. Your health professional may ask questions (sleep symptom history) to find out how sleepy you feel during the day and how refreshed you feel after a night's sleep.
Other tests that may be done include:

Blood tests. Blood tests may be done to check for hypothyroidism, a high red blood cell count, or to check your blood oxygen and carbon dioxide levels (arterial blood gas).
Electrocardiography (EKG, ECG). An ECG may be done to see if your heart has been affected by OSA.
Echocardiography (ECHO). Echocardiography is one way of measuring how well the heart is working. It can evaluate the size, thickness, shape, and movement of the heart muscle. A person who has a long history of OSA is at increased risk for developing changes in the heart and lungs.
Lung function tests. Lung function tests may be done if lung disease is suspected.
If you have enlarged tissues in your mouth and throat that may be causing OSA, your health professional may do one or more tests before recommending surgery to remove the excess tissue. These tests may include:

Fiber-optic pharyngoscopy. Fiber-optic pharyngoscopy may be done to see whether your airway is too narrow or collapses during breathing.
Computed tomography (CT) scan of the head. A CT scan of the head can identify an overly large tongue and excessive soft tissue in the neck, as well as locate the narrowest part of your airway.
Other X-rays. A somnofluoroscopy is an X-ray picture of the neck taken during sleep that helps a health professional identify the site of a blockage. Cephalometric X-ray is a type of head X-ray that allows a health professional to see bone deformities of the skull. These X-rays sometimes are done but may not be available in every hospital.
Ultrasound. Ultrasound of the throat is being studied as a possible technique to examine the airway during sleep. 4
Children

According to American Academy of Pediatrics: 5

All children should be screened for snoring as part of a routine checkup.
A complete sleep study generally is necessary to confirm the child has OSA and is not just snoring.
If OSA is present, children with genetic disorders, lung disease, sickle cell disease, disorders of the head or face, Down syndrome, cerebral palsy, disorders of the facial disorders, or severe heart or lung problems should be evaluated by a specialist.
Treatment Overview

Treatment for obstructive sleep apnea (OSA) consists of lifestyle changes, continuous positive airway pressure (CPAP) (to prevent the airway from closing during sleep), and surgery.

Treatment for OSA may be based on its severity. Treatment is aimed at relieving symptoms such as snoring and excessive daytime sleepiness and preventing or treating complications. Generally, treatment stresses lifestyle changes and progresses to surgery only if a preceding treatment does not work. Lifestyle changes include losing weight (if necessary), improving sleep habits (such as going to bed at the same time every night and sleeping on your side), and avoiding the use of alcohol and sedatives before bed.

If you have moderate to severe sleep apnea, CPAP generally is tried before considering surgery. Research shows that continuous positive airway pressure (CPAP) decreases daytime sleepiness, limits depression, improves mental function, provides greater energy, and improves quality of life, especially in those with moderate to severe OSA and daytime sleepiness. 6, 7

If you use CPAP to treat OSA, you need to use it every night. If it is not used every night, your symptoms will return immediately.

Less common treatments for OSA include oral breathing devices that push the tongue and jaw forward. Medications generally are not recommended for OSA.

In children, surgery (tonsillectomy and adenoidectomy) generally is the first choice. After surgery, children are checked to see if additional surgery is necessary. Children are treated using CPAP if surgery is not possible or does not work.

Other health problems may need to be treated before treatment for obstructive sleep apnea (OSA) treatment can begin. For example, people who also have infections need to be given antibiotics. Those who have an underactive thyroid gland (hypothyroidism) need to take thyroid medication.

Initial treatment

Initial treatment for obstructive sleep apnea (OSA) consists of making lifestyle changes. These include:

Losing weight (if necessary). One study reports that in people with mild OSA, a weight loss of 10% resulted in a 26% decrease in the number of times per hour that breathing stopped (apnea) or slowed (hypopnea). 7
Going to bed at the same time every night.
Sleeping on your side. Try sewing a pocket in the middle of the back of your pajama top, putting a tennis ball into the pocket, and stitching it closed. This will help keep you from sleeping on your back. Sleeping on your side may eliminate mild OSA. 8
Avoiding the use of alcohol and sedatives before bed.
Quitting smoking.
Raising the head of your bed 4 in. (10 cm) to 6 in. (15 cm) by putting bricks under the legs of the bed (using pillows to raise your head and upper body will not work).
Promptly treating breathing problems, such as a stuffy nose caused by a cold or allergies.
These measures may reduce daytime sleepiness and be all that is necessary for mild OSA. They are recommended for all people who have OSA.

Some people use nasal strips, which widen the nostrils and improve airflow. Although these strips may decrease snoring, they are not considered to be effective for treating OSA.

Continuous positive airway pressure (CPAP) is the preferred treatment for moderate and severe OSA and may also be used in mild cases. In CPAP, a machine helps you breath at night. However, CPAP may not be as effective for people who have mild OSA or moderate to severe OSA but no daytime sleepiness. Other machines, with automatically adjustable air pressure or different air pressures when breathing in and out, also may be tried.

Oral breathing devices sometimes can treat OSA, especially if it is caused by jaw position during sleep.

Surgery is considered in initial treatment when a blockage is clearly reversible (such as having overly large tonsils).

Should I have surgery to treat obstructive sleep apnea?

Ongoing treatment

Ongoing treatment for obstructive sleep apnea (OSA) includes maintaining continuous positive airway pressure (CPAP) and lifestyle changes. Lifestyle changes include losing weight (if necessary), improving sleep habits (such as going to bed at the same time every night and sleeping on your side), avoiding the use of alcohol and sedatives before bed, and stopping smoking.

If CPAP is not working, you may need another sleep study to determine whether your CPAP machine needs readjustment. You may also need to consider surgery. Surgical choices include:

Uvulopalatopharyngoplasty, which is the most common surgery to treat OSA in adults.
Tonsillectomy and adenoidectomy, which may be used if you have enlarged tonsils and adenoids that are blocking your airway during sleep.
Other surgical procedures, which are used to repair bone and tissue problems in the mouth and throat.
Should I have surgery to treat obstructive sleep apnea?

Laser-assisted uvulopalatoplasty may be used to treat snoring. It is sometimes used to treat mild to moderate OSA, although it does not benefit all people. This procedure is not approved by the American Academy of Sleep Medicine to treat OSA. 9

Treatment if the condition gets worse

If your obstructive sleep apnea (OSA) gets worse, talk to your health professional. You may need another complete sleep study, and your continuous positive airway pressure (CPAP) machine may need to be adjusted. You may also need to be treated for the complications of OSA, such as high blood pressure. In some cases, surgery may be necessary. Surgical options include:

Uvulopalatopharyngoplasty, which is the most common surgery to treat sleep apnea in adults.
Tracheostomy, which may be the most effective surgery for sleep apnea. It is rarely used.
Tonsillectomy and adenoidectomy, which may be used if you have enlarged tonsils and adenoids that are blocking your airway during sleep.
Other surgical procedures, which are used to repair bone and tissue problems in your mouth and throat.
Should I have surgery to treat obstructive sleep apnea?

Laser-assisted uvulopalatoplasty may be used to treat snoring. It is sometimes used to treat mild to moderate OSA, though it does not benefit all people. This procedure is not approved by the American Academy of Sleep Medicine to treat OSA. 9

Prevention

You can help prevent obstructive sleep apnea (OSA) and snoring by:

Avoiding the use of alcohol and medications, such as sleeping pills and tranquilizers, that slow your breathing.
Eating sensibly, exercising, and maintaining a weight as close as possible to a healthy body weight.
Sleeping on your side. Sleeping on your back can increase snoring. Try sewing a pocket in the middle of the back of your pajama top, putting a tennis ball into the pocket, and stitching it closed. This will help keep you from sleeping on your back. Sleeping on your side may eliminate mild OSA. 8
Quitting smoking, which may decrease your risk of developing OSA.
Raising the head of your bed 4 in. (10 cm) to 6 in. (15 cm) by putting bricks under the legs of the bed (using pillows to raise your head and upper body will not work).
Promptly treating breathing problems, such as a stuffy nose caused by a cold or allergies. Breathing problems can increase the risk of snoring. Avoid taking antihistamines, because they can cause drowsiness and worsen apnea episodes. Instead, use decongestants, which decrease drainage.
Home Treatment

Obstructive sleep apnea (OSA) may be treated at home if you have only 5 apnea episodes per hour (mild sleep apnea). Home treatment for OSA includes:

Losing weight. Many people who have OSA are overweight. Weight loss can decrease the number of apnea episodes, increase the amount of oxygen in the blood, and decrease the number of awakenings during the night. One study reports that in those with mild OSA, a weight loss of 10% resulted in a 26% decrease in the number of times per hour that breathing stopped (apnea) or slowed (hypopnea). 7
Limiting the use of alcohol and medications. Drinking excessive amounts of alcohol or taking certain medications, especially sleeping pills or tranquilizers, before sleep may worsen symptoms.
Getting plenty of sleep. Apnea episodes may be more frequent when you have not had enough sleep.
Sleeping on your side. Try sewing a pocket in the middle of the back of your pajama top, putting a tennis ball into the pocket, and stitching it closed. This will help keep you from sleeping on your back. Sleeping on your side may eliminate mild OSA. 8
If you are using a continuous positive airway pressure (CPAP) machine to help you breathe, use it every night. If you don't use it all night, every night, your symptoms will return immediately.

Be sure the mask or nasal prongs fit properly. Air should not leak around the mask.
Mild discomfort in the mornings is expected when you first use CPAP. Talk with your health professional if you do not feel comfortable after a few days.
If your nose feels dry or bleeds when using the machine, talk with your health professional about increasing moisture in the air in your bedroom.
If your nose is runny or congested, talk with your health professional about using decongestants or corticosteroid nasal spray medications.
Medications

Medications are not generally recommended for obstructive sleep apnea (OSA).

However, in some cases, medications may be helpful. Modafinil (Provigil) has been approved by the U.S. Food and Drug Administration (FDA) to improve wakefulness (reduce daytime sleepiness) in people with obstructive sleep apnea.

A recent study reports that modafinil (Provigil) may help reduce daytime sleepiness in OSA when continuous positive airway pressure (CPAP) is reducing apneas—the number of times you stop breathing at night—but daytime sleepiness continues. 10 Modafinil may be a useful additional treatment for some people with OSA; it should not be considered a substitute for CPAP.

Surgery

Surgery for adults

In general, surgery for obstructive sleep apnea (OSA) is considered only after other treatments have failed or when you are unable or choose not to use other treatments.

Surgery is used to: 11

Remove excess soft tissue from the throat to widen the upper airway. This may involve removing the tonsils and adenoids and other tissues in the back of the throat (uvulopalatopharyngoplasty).
Correct an abnormally shaped wall (septum) between the nostrils or nasal polyps that block airflow through the nose.
Change the position of the bony structures in the upper airway, allowing air to flow more freely, especially during sleep. More than one surgery may be needed to make these changes.
Create an opening for breathing below the area where airflow is blocked (tracheostomy). A tracheostomy is a permanent opening in the windpipe (trachea) into which a breathing tube can be inserted. Tracheostomy is rarely used as the first method to treat OSA because of cosmetic concerns and an increased risk of complications. However, when other techniques have failed, almost all people treated with tracheostomy will be cured of their OSA.
Surgery for children

In children, surgery (tonsillectomy and adenoidectomy) may be an appropriate first choice for treating obstructive sleep apnea (OSA).

Removal of the tonsils and adenoids can clear a blockage of the upper airway that often causes OSA in children.
Surgery may be needed to correct birth defects that can cause sleep apnea symptoms.
Surgery Choices

The following surgical procedures may be used to treat OSA:

Uvulopalatopharyngoplasty is the most common surgery to treat OSA in adults.
Tracheostomy may be the most effective surgery for OSA. It is not used as often as other procedures because it creates a permanent opening in the windpipe (trachea) and can cause problems. Other, less invasive treatments also are available and are nearly as effective as tracheostomy for most people.
Tonsillectomy and adenoidectomy may be used if you have enlarged tonsils and adenoids that are blocking your airway during sleep.
Other surgical procedures may be used to repair bone and tissue problems in the mouth and throat.
Should I have surgery to treat obstructive sleep apnea?

What To Think About

If you are thinking about having surgery to treat obstructive sleep apnea (OSA), talk with your health professional about having a sleep study done first. Trying continuous positive airway pressure (CPAP) before surgery is generally recommended. CPAP is a machine that increases air pressure in the throat, preventing tissues in the airway from collapsing when you inhale.

In adults, uvulopalatopharyngoplasty (UPPP) is the most common surgery used to treat OSA.

There is no clear evidence on the outcome of using UPPP for OSA. 12
UPPP may stop snoring, but apnea episodes may continue. 1
About 40% to 60% of people who have UPPP have an improvement in their symptoms, but it is impossible to say who will benefit from the surgery and who will not. 8
Other forms of treatment, including continuous positive airway pressure (CPAP), may still be needed after surgery.
Sleep studies are done shortly after surgery and later on to make sure periods of apnea do not continue or return.
UPPP usually is not used to treat sleep apnea in children.
Tracheostomy is used only when all other treatments for severe OSA have failed or when you cannot tolerate other treatments. The use of tracheostomy has declined since CPAP has been available.

Rarely, repositioning of facial bones (maxillofacial reconstruction) is done when you are unable to benefit from CPAP and UPPP. This surgery is designed to increase the size of the bones around the tongue and to create pull (traction) on the base of the tongue, enlarging the airway. More than one surgical procedure usually is needed to reposition the facial bones in a way that will cure OSA.

More than one procedure may be done at the same time or in stages. When the procedures are done in stages, it is important to monitor OSA after each procedure to determine when symptoms are relieved and to avoid unnecessary surgery. 13

Laser-assisted uvulopalatoplasty may be used to treat snoring. It is sometimes used to treat mild to moderate OSA, although not all people benefit. This procedure is not approved by the American Academy of Sleep Medicine to treat OSA. 9

Other Treatment

Other treatment for obstructive sleep apnea (OSA) includes continuous positive airway pressure (CPAP) and oral breathing devices.

If you have moderate to severe OSA, continuous positive airway pressure (CPAP) is the preferred treatment. In CPAP, a machine helps you breath at night. Overall, research demonstrates that CPAP decreases daytime sleepiness, limits depression, improves mental function, provides greater energy, and improves quality of life, especially in those with moderate to severe OSA and daytime sleepiness. 6, 7

However, CPAP may not be as effective for people who have mild OSA or moderate to severe OSA but no daytime sleepiness. Other machines that have automatically adjustable air pressure or different air pressures when breathing in and out may be tried.

If you use continuous positive airway pressure (CPAP) to treat OSA, you need to use it every night. If it is not used every night, your symptoms will return immediately.

If you have moderate to severe OSA, CPAP generally is tried before considering surgery.

Oral breathing devices sometimes can treat OSA, especially if it is caused by jaw position during sleep.

Nutritional counseling also can help people who are overweight and who have OSA.

Other Treatment Choices

The following options may be used to treat OSA:

Continuous positive airway pressure
Oral breathing devices
What To Think About

Research shows that continuous positive airway pressure (CPAP) decreases daytime sleepiness, limits depression, improves mental function, provides greater energy, and improves quality of life, especially in those with moderate to severe OSA and daytime sleepiness. 6, 7

If you use CPAP to treat OSA, you need to use it every night. If it is not used every night, your symptoms will return immediately.

Nasal strips to decrease snoring are available in most pharmacies. Nasal strips widen the nostrils and improve airflow. Although these strips may decrease snoring, they are not considered to be effective for treating OSA.

Some people who have obstructive sleep apnea (OSA) get better when they use oral breathing devices. Talk with your health professional if you want to try one of these devices.

Other Places To Get Help

Organizations

American Sleep Apnea Association (ASAA)
1424 K Street, N.W.
Suite 302
Washington, DC 20005
Phone: (202) 293-3650
Fax: (202) 293-3656
E-mail: asaa@sleepapnea.org
Web Address: http://www.sleepapnea.org

This organization provides education and support for people who have sleep apnea.

National Institutes of Health, National Center on Sleep Disorders Research (NIH/NHLBI/NCSDR)
6705 Rockledge Drive
One Rockledge Centre
Suite 6022
Bethesda, MD 20892-7993
Phone: (301) 435-0199
Fax: (301) 480-3451
E-mail: ncsdr@nih.gov
Web Address: http://www.nhlbi.nih.gov/about/ncsdr/index.htm

The Web site for this center includes current information about the diagnosis and treatment of sleep disorders, fact sheets about various sleep disorders, and links to other organizations to help you find more information. You also can take an interactive sleep quiz.

National Sleep Foundation
1522 K Street, N.W.
Suite 500
Washington, DC 20005
Phone: (202) 347-3471
Fax: (202) 347-3472
E-mail: nsf@sleepfoundation.org
Web Address: http://www.sleepfoundation.org

The National Sleep Foundation, an independent nonprofit organization, can provide you with brochures on sleep disorders and a list of accredited sleep disorder clinics.

References

Citations

Malhotra A, White DP (2002). Obstructive sleep apnea. Lancet, 360: 237–245.
Peppard PE, et al. (2000). Prospective study of the association between sleep-disordered breathing and hypertension. New England Journal of Medicine, 342(19): 1378–1384.
Ross SD, et al. (1999). Systematic Review of the Literature Regarding the Diagnosis of Sleep Apnea. Evidence Report/Technology Assessment No. 1 (AHCPR Publication No. 99-E002). Rockville, MD: Agency for Health Care Policy and Research.
Siegel H, et al. (2000). Obstructive sleep apnea: A study by simultaneous polysomnography and ultrasonic imaging. Neurology, 54(9): 1872.
American Academy of Pediatrics (2002). Clinical practice guideline: Diagnosis and management of childhood obstructive sleep apnea. Pediatrics, 109(4): 704–712.
Wright J, White J (2003). Continuous positive airways pressure for obstructive sleep apnea. Cochrane Database of Systematic Reviews (1). Oxford: Update Software.
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