Most experts agree that there are simple steps you can take in your every day life that can impact your situation. The following suggestions, in concert with your physician prescribed treatment may not rid you of Apnea but can help you better cope with it:

Weight loss

Excess weight contributes to obstructive sleep apnea in two ways: 1. Fat deposits in the neck tissue compress the airway and make it more likely to collapse. 2. Excess weight in the abdomen makes the breathing muscles operate inefficiently, which contributes to breathing difficulty when sleeping.

Weight loss by itself is very difficult (as many of us know). Sometimes people are only able, or much better able, to lose their excess weight after treatment for sleep apnoea has begun, they are able to be more awake and vigorous, and increase their energy use.

Smoking

As with the loss of excess weight, this is, of course, just a good idea in general. However, quitting might also help your sleep apnea in addition to its countless other health benefits, by returning lung capacity to normal. Try using the patch in your effort to eliminate your smoking habit.

Alcohol

Eliminate alcohol in the evening. Alcohol depresses your breathing reflexes and significantly worsens sleep apnea.

Apnea sufferers should be very careful about excessive drunkenness. It's possible that if you depress your reflexes enough, you might not wake up at all. The same thing goes for sleeping pills, drugs, or anything that might affect your breathing.

Allergies and respiratory infections

These cause nasal congestion, which narrows the airway and contributes to apnoea. Consult your physician for medications to treat these which will not interfere with sleep.

Medications:

Many common medications interfere with either the breathing reflex or sleep or both. Some of the most common are "sleeping pills", tranquilizers, and short-acting beta blockers. Consult your sleep specialist about seeking alternative medications. A list of medications that affect breathing or sleep can be found in "Snoring and Sleep Apnoea: Personal and Family Guide to Diagnosis and Treatment," by Pascualy and Soest, Demos Vermande Publishing: New York, 1995.

Breathing-assistance devices

Continuous Positive Airway Pressure (CPAP)

"Nasal CPAP" is the treatment of choice for most people with obstructive and mixed apnoea. It is the most reliable and effective treatment in most cases. Hundreds of thousands of CPAP devices are now in use treating obstructive sleep apnea.

It involves using a small air blower device connected via a hose to a nose mask you wear while you sleep - much like a regular oxygen mask, with straps to keep it in place. Essentially, this devices blows air into your nose to keep your airway from collapsing and creating an obstruction by increasing the air pressure in your airways. It isn't as unpleasant as it sounds - most people get used to the sensation fairly quickly.

Admittedly, having to wear a face mask to bed isn't the most attractive thing in the universe. All I can say about that is: you have to live with it. Also, most bed partners are usually happy to live with that rather than snoring! And it is infintely preferable to the effects of apnoea, both the fatigue and the other physical effects (additional strain on the heart, &c.). The exact results vary, but great many people report significant changes in their lives when they start using CPAP - they feel more awake, more alive - "like a whole different person", in some cases.

Bi-Level Positive Airway Pressure

Bi-level positive airway pressure (BiPAP™ is one such device) is a variation on CPAP. Instead of providing air at a constant, steady pressure all night, the machines "senses" how much air a person needs, based on inspiration and expiration, and varies its level of pressure accordingly. On inspiration, a higher pressure is needed to prevent apneas, hypopneas, or snoring. But on expiration the patient typically requires several centimeters less of pressure.

What is the purpose of this? Well, some people find that they simply cannot sleep with regular CPAP due to the constant air pressure. Bi-level pressure helps this problem by providing less pressure when you are breathing out (exhaling) , and more when you are breathing in (inspiring).

I would like to comment at this point that people probably should not view bi-level pressure devices as a cure-all if you're not happy with your current CPAP. I suggest that you spend some time getting used to regular CPAP. Don't give up on it because it feels weird for the first few nights. One gets used to it after time. Just because CPAP is annoying at first does not necessarily mean you need bi-level pressure. Give it time.

Several manufacturers make bi-level airway pressure devices. BiPAP™ is a trademark of Respironics.

Bi-level pressure devices are significantly more expensive than regular CPAP, and I've heard that most insurance companies will not pay for it unless your doctor essentially demands it.

Responsive and "smart" airway pressure devices(JH)

In the belief that the reduction of total airway flow would provide greater comfort to the patient and encourage patients to use the airway pressure treatment on a regular basis, several manufacturers have begun to offer a new generation of treatment devices. These devices incorporate flow and pressure sensors and automatic regulation systems. There are three basic approaches. One approach tries to keep overall pressure requirements low by using high pressure only when there is a specific problem, but this requires a very rapid increase in pressure when a problem is detected. The second approach (Horizon AutoAdjust™, Virtuoso™ )varies the pressure delivered, providing less when problems are absent, and raising the pressure gradually when problems appear. The third approach (Sullivan AutoSet™) gradually raises and lowers the pressure as conditions require, but also changes the pressure within a specific breath if an emerging problem is detected.

DPAP (demand positive airway pressure) uses a low base pressure and rapidly ramps up the pressure after an airway obstruction or flow limitation occurs. This rapid ramp-up of pressure is used for each breath in which a breathing problem is detected. This product is no longer manufactured.

In the approach taken by several other manufacturers, pressure changes are designed to be smooth and gradual, although each device has unique characteristics. These include: Horizon AutoAdjust™ by DeVilbiss, the Sullivan AutoSet™ by ResMed, and the Virtuoso™ Smart CPAP system by Respironics.

In the Horizon AutoAdjust™ by DeVilbiss, pressure changes are designed to be gradual. Thus, in response to airway obstructions or flow limitation, these devices gradually increase pressure over a period of several breaths until the problem is overcome. Then the devices gradually reduce the pressure.

The Virtuoso™ Smart CPAP system by Respironics monitors the airway for vibrations which typically preceed apneas and responds by increasing pressure to help prevent airway collapse. In the absence of such vibrations, pressure is reduced.

The Sullivan AutoSet™ by ResMed uses flow information to increase pressures rapidly enough to pre-empt an emerging problem and thus prevent significant flow limitation, while using a history of recent breaths to gradually raise and lower overall pressures.

Devices like the Horizon AutoAdjust™, the Sullivan AutoSet™, or the Virtuoso™ Smart CPAP system by Respironics can be used in the laboratory or home to titrate (determine) individual pressure requirements and thus be used to determine the prescription for a CPAP device. The professional doing the titration receives extensive data on the patient, equivalent to a home sleep study. The devices (sometimes in special configurations for long-term home use may also be used as an alternative to CPAP or bi-level airway pressure.)

Compared to CPAP, 'smart' devices may offer greater patient comfort insofar as the overall pressure is reduced, providing that the changes in pressure reduce or eliminate apnea, snoring, or flow limitation, and also provided that the changing pressures are tolerated by the patient. They may be used for patients whose pressure requirements may vary during the course of a night, from night-to-night, and over longer periods of time.

As professionals in the field of sleep disorders gain experience with these devices and their appropriate applications, they may provide an additional path to relief for selected patients. As with any new form of treatment, physicians and patients may need to review studies of each device before selecting the one most appropriate to the needs of the specific patient.

Clinical research on these devices is being presented at professional meetings. In one study of treatment , a comparison was made among three conditions: untreated; treated based on professionaly determined pressure settings applied to a manual or traditional CPAP; and pressure determined by the 'smart' CPAP. Both the manual and auto treatments reduced obstructions to breathing, with the manual being more effective in reducing apneas or hypopneas, but the auto system operated at a 35% lower average airway pressure than manual CPAP.

Tongue-Restraining Devices (TRDs)

This is a suction cup that is gripped with the teeth and which sucks the tongue forward, thus opening the airway behind the tongue. People who snore only when lying on their back, and whose tongue is the main source of obstruction, sometimes find this device helpful.

Surgeries

Uvulopalatopharyngoplasty (UPPP) surgery

This surgery removes the uvula and tightens up the soft tissue of the palate and upper throat (pharynx). It can be done separately or in conjunction with other treatments, depending on where in the airway the obstructions occur. There are the usual surgical risks involved with this surgery. Notable ones are general anesthetic (depresses breathing reflex and can be risky in people with breathing problems like sleep apnoea), swelling of the airway, need for pre- and post-operative medications (may depress the breathing reflex), bleeding, and significant pain lasting up to several weeks.

Is it effective? Will it free me from having to wear a CPAP machine for life?

This surgery seems to have a history of being about 50% effective in about 50% of patients who have it. In other words, many of the people who have UPPP will end up having to use CPAP anyway. It is almost never a "cure-all." In the author's personal opinion (and remember: this is not medical advice!), the risks and side effects of the surgery are usually not worth it. No, I have not had it. However, I have yet to hear from a person who was happy that they had the surgery, though of course there probably are some. This is a decision that each person has to make, but I advise you give it a great deal of thought beforehand. Surgery is not something to be undergone on a whim, and certainly not for the sole (and somewhat vain, in my opinion) reason of ridding yourself of the need for CPAP.

Laser-Assisted Uvulaplasty (LAUP)

LAUP is a relatively new laser surgery on the uvula and soft palate that is reported to diminish snoring, but no controlled studies have been done to show that it reduces sleep apnoea. Because it is less extensive than UPPP, it is unlikely to be any more effective than UPPP in treating obstructive apnoea. It is usually done in several steps, and is an outpatient procedure. For that reason it is less risky than UPPP.

LAUP is a relatively new procedure, and there is little data as yet concerning its effectiveness. Since this procedure has been developed, it has been somewhat heavily advertised as a "cure for snoring" in magazines and newspapers. This is, in the author's personal opinion, somewhat misleading and potentially dangerous. While the procedure may sometimes be effective in helping people who snore but do not have apnoea, the main danger from LAUP is that people may eliminate their snoring and assume that their problems are solved, when in fact they may still have untreated sleep apnoea which may continue to get worse but be ignored because its primary alarm signal (snoring) has been silenced. Potential patients should be careful that they don't see an ad in the paper, call the doctor, and rush into a LAUP procedure without research and consideration.

The American Sleep Disorders Association has published standards of practice for LAUP. Their recommendations are as follows:

"Because adequate peer-review objective data do not exist regarding the effectiveness of LAUP for the treatment of sleep-related breathing disorders, including OSA [sleep apnoea], LAUP is not recommended for the treatment of these disorders. [emphasis added]

Surgical condidates for LAUP as a treatment for snoring should undergo preoperative clinical evaluations that include an objective measure of respiration during sleep. Asignificant number of patients who present with a symptom of snoring will have underlying, undetected, sleep-related breathing disorders.

Patients should be informed that the risks, benefits and complications of LAUP have not been established.

Patients who elect to undergo LAUP for the treatment of snoring may be at risk of incurring a delay in the diagnosis of OSA, may be obviated by this surgical procedure. Patients must be specifically informed of this risk and should be evaluated on a biennial or preferably, annual basis.

The perioperative use of narcotics may pose risks for patients who have undergone LAUP operations; therefore, careful clinical judgment should be used when prescribing pain medications. Patients should avoid the use of sedative medications, sleeping pills, and alcohol during the perioperative period."

Reference: SLEEP Volume 17(8):pages 744-748.

Also see another article on LAUP.

Nasal Surgery

May be done to open nasal passages, to correct a deviated septum, or to improve the ability to use CPAP.

Jaw Surgeries