Patient information on Obstructive Sleep Apnoea (OSA) – Part II

Who is this information for?

This information is for patients, families and carers of patients with Obstructive Sleep Apnoea.

How is OSA treated?

• Sleep apnoea is best treated by a knowledgeable sleep medicine specialist, in collaboration with your GP and often, an ENT surgeon.
• Goal of Treatment: maintain an open airway during sleep.
• Effective Treatment will:
  • eliminate the symptoms of sleep disturbance.
  • reduce the long-term health consequences.
• Most non surgical treatments require nightly use.
  • The challenge for the clinician and the patient is to select an effective therapy that is appropriate for the patient’s problem and that is acceptable for long term use.

1. 1. Lifestyle Changes
      1. Improve sleep hygiene
         • Try to have a regular sleep time, and obtain an adequate amount of sleep every night (this varies from person to person)
         • Minimise pre sleep activities such as TV, exercise
      2. Adjust sleep position
         • Adjusting sleep position (to stay off the back) may help improve sleep quality in people who have OSA when sleeping on the back.
         • However, this is difficult to maintain throughout the night and is rarely an adequate solution in isolation.
      3. Weight loss
         • Weight loss may be helpful for obese or overweight patients.
         • Weight loss may be accomplished with dietary changes, exercise, and/or surgical treatment.
         • However, it can be difficult to maintain weight loss; the five-year success of nonsurgical weight loss is only 5 percent, i.e. 95 percent of people regain lost weight.
      4. Avoid alcohol and other sedatives
         • Alcohol can worsen sleepiness, potentially increasing the risk of accidents or injury.
         • People with OSA are often counseled to drink little to no alcohol, even during the daytime.
         • Similarly, people who take anti-anxiety medications or sedatives to sleep should speak with their healthcare provider about the safety of these medications.
      5. Personal and public safety
         • People with OSA must notify all healthcare providers, including surgeons, about their condition and the potential risks of being sedated.
         • People with OSA who are given anesthesia and/or pain medications require special management and close monitoring to reduce the risk of a blocked airway.
   2. Devices:
      1. Continuous positive airway pressure (CPAP)
         • The most effective treatment for sleep apnea uses air pressure from a mechanical device to keep the upper airway open during sleep.

1. 1. 1. • A CPAP (continuous positive airway pressure) device uses an air-tight attachment to the nose, typically a mask, connected to a tube and a blower which generates the pressure. Devices that fit comfortably into the nasal opening, rather than overthe nose, are also available.
           1. CPAP should be used any time the person sleeps (day or night).
           2. The CPAP device is usually used for the first time in the sleep lab, where a technician can adjust the pressure and select the best equipment to keep the airway open.
           3. Alternatively, an “auto” device with a self-adjusting pressure feature, provided with proper training, can get treatment started without another sleep test.
           4. While the treatment may seem uncomfortable, noisy, or bulky at first, most people accept the treatment after experiencing better sleep.
              • However, difficulty with mask comfort and nasal congestion prevent up to 50 percent of people from using the treatment on a regular basis.
           5. Continued follow up with a healthcare provider helps to ensure that the treatment is effective and comfortable.
           6. Information from the CPAP machine is often used by physicians and therapists to track the success of treatment.
           7. CPAP can be delivered with different features to improve comfort and solve problems that may come up during treatment. Changes in treatment may be needed if symptoms do not improve or if the person’s condition changes, such as again or loss of weight.
         • Dental devices
           • A dental device, called an oral appliance or mandibular advancement device (MAD),can reposition the jaw (mandible), bringing the tongue and soft palate forward a swell. This may relieve obstruction in some people

1. 1. • • This treatment is excellent for reducing snoring, although the effect on OSA is sometimes more limited.
        • As a result, dental devices are best used for:
          • mild cases of OSA when relief of snoring is the main goal.
          • Failure to tolerate and accept CPAP is another indication for dental devices.
        • While dental devices are not as effective as CPAP for OSA, some patients prefer a dental device to CPAP.
        • Side effects of dental devices are generally minor but may include changes to the bite with prolonged use.
2. Surgical treatment
   • Surgery is generally reserved for patients who cannot tolerate or do not improve with non-surgical treatments such as CPAP or oral devices.
   • Surgical procedures can reshape structures in the upper airways such as the nasal passages,soft/hard palate, tongue and tonsillar tissue. Procedures can also surgically reposition thefacial bones.
   • Surgery may be indicated in select OSA patients who have:
     • An inability to tolerate adequate CPAP or other device treatments
     • Ongoing OSA despite adequate CPAP treatment
     • Additional upper airway symptoms such as – recurrent tonsillitis, or nasal obstruction
   • The nature of the surgery considered/offered depends on:
     • Severity of OSA
     • Anatomical level of obstruction – e.g. palate, vs tongue, vs pharynx.
   • The surgeries involved can often be painful and the success rate is highly variable.
   • There is also a relatively high rate of relapse.

Concerns or questions?

You can contact your ENT Specialist at the Melbourne ENT Group (MEG):

• Phone: 1300- 952-808
• Email: admin@melbentgroup.com.au
• Website: www.melbentgroup.com.au

Your GP is also the best contact for ongoing care and concerns.

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