Depending on the severity of the sleep apnea, there are various treatments available. The condition of sleep apnea is diagnosed in three main levels of severity based on the number of “apnea” episodes that occur during an hour.
The severity index used to diagnose sleep apnea is the Apnea-Hyopopnea-Index, or AHI. “Apnea” is from Greek, meaning “without breath.” In “hypopnea,” more than 50% of the airflow through is reduced, in other words, partial apnea.
Most people suffer from “Obstructive Sleep Apnea” (OSA)— about 85%, plus about another 15% suffer from Mixed Sleep Apnea.
Sleep Apnea Severity Index
AHI 5-15/hour Mild OSA
AHI 15-30/hour Moderate OSA
AHI >30/hour Severe OSA
Approximately 70% of sleep apnea sufferers are overweight. Weight affects various factors which can cause or contribute to sleep apnea, including the neck size, the amount of fatty tissue in the airway, etc. However, there are few formal studies of the effectiveness of weight loss in reducing sleep apnea and there is no guarantee that it will fully handle your symptoms.
Many of our patients use other therapies while they work on losing weight.
Sleep Positional Therapy
In some patients sleeping on one’s back can cause obstructive sleep apnea. You can learn to sleep on your side and devices can be used to induce side-sleeping, such as a tennis ball in a sock pinned to your pajama top. Studies show, however, that positional therapy only works in mild cases of OSA. In more severe cases the airway collapses anyway.
CPAP, or Continuous Positive Airway Pressure, therapy is considered the gold standard of treatment for obstructive sleep apnea, especially for severe cases. Short of surgery or perhaps weight loss, the CPAP is the only effective treatment for those suffering from severe sleep apnea.
CPAP therapy consists of a mask worn tightly over the nose, or sometimes nose and mouth, during sleep. A continuous supply of air is supplied by the CPAP machine, which keeps the airway open and prevents apnea episodes.
However, a large amount of sufferers are either intolerant to the CPAP or find it difficult to use. Various studies report non-adherence to CPAP therapy anywhere from 29% to 83%, and even amongst those who are compliant the actual usage of the CPAP is only approximately 50% of the time.
Typical problems encountered by patients include difficulty of wearing the tight mask all night or dealing with the high pressure of air blown into their nose.
While there are various tips given to increase the ability to tolerate CPAP therapy, an alternative recommended by the American Academy of Sleep Medicine is the use of oral appliances for mild to moderate sleep apnea sufferers.
Surgery is often used to treat snoring but it is less commonly used in treating sleep apnea, as there are many locations in the upper airway* that could be obstructing the airflow. Surgical treatment is usually considered for OSA patients who are unable to tolerate other treatment and/or who have a physical cause for their condition. It is especially recommended for severe sleep apnea.
The surgery we recommend moves the lower jaw (mandible) forward so that the airway is permanently enlarged. Jaw movement is done with a combination of braces and surgery.
Dr. John works in conjunction with our orthodontist, Dr. Deborah Sema. Dr. Sema sets the treatment path and fits the patient with the braces. To see if you are a candidate for jaw surgery, please call 205-267-5111 to schedule a consultation.
* Upper airway: from the nose and mouth to the larynx, the beginning of the air passage to the lungs
“I was a heavy snorer and my wife noticed my breathing was pausing. I went to the doctor and was diagnosed with severe sleep apnea and put on CPAP treatment, which did handle my condition. Three years ago I became aware of a jaw surgery to correct sleep apnea. I was excited that there was a solution that would permanently handle my sleep apnea and take away the necessity of CPAP treatment.
“I went to Dr. Sema who fitted me with braces to start the jaw movement. She did a great job, she had to anticipate how the teeth would look after the surgery as well as plan the movement necessary, and at the end of it I got the added bonus of straighter teeth!
“The braces and jaw surgery brought my upper jaw forward 8 mm and my lower jaw 11 mm. My surgeon showed me my before and after profile x-rays and I could see that my airway had opened up 2 ½ times.
“I don’t have to use the CPAP anymore and I am healthier now. Some nasal allergies are also less. My quality of life definitely has increased and I can enjoy my retirement. I love the outdoors, hiking and so on. I love traveling and recently we went on a river cruise through southern France to Paris and to South America. And I didn’t have to carry a CPAP machine around.”
– Jeff McDonald
Oral Appliance Therapy
Oral appliances look like mouth guards and position the lower jaw slightly forward of its usual position, keeping the airway open during sleep. Some appliances keep the tongue from falling backward and blocking the airway. Patients generally find oral appliances comfortable to use.
Oral appliances are custom-made based on the condition of the patient. They must be prescribed and fitted by a dentist.
Oral appliance therapy is most effective in treating mild to moderate sleep apnea. It is recommended by the Academy of Sleep Medicine.
“For patients with mild to moderate OSA [Obstructive Sleep Apnea] who prefer OAs [oral appliances] to Continuous Positive Airway Pressure (CPAP), and in all cases for those who do not respond to CPAP, are not appropriate candidates for CPAP, or who fail treatment attempts with CPAP or treatment with behavioral measures such as weight loss or sleep position change.”
American Academy of Sleep Medicine
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