David B. Rosen, D.M.D.- Practice Limited to Periodontics & Dental Implants
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David B. Rosen, D.M.D.- Practice Limited to Periodontics & Dental Implants
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Treatments: nCPAP [OPAP], Oral Appliance, Surgery, Rx Multiple treatments are available for obstructive sleep apnea including, but not limited to, n.C.P.A.P. (nasal continuous positive airway pressure), biPAP, throat or facial surgery, as well as oral appliances, and pharmacological treatment. It is generally agreed, by the medical community, that the most effective treatment, when used properly, is nCPAP or biPAP. Often many treatments are used before the best one is found. nCPAP (nasal Continuous Positive Air Pressure)Nasal continuous positive airway pressure (nCPAP) is the most common
effective treatment for sleep apnea. In this procedure, the patient wears a mask
over the nose during sleep, and pressure from an air blower forces air through
the nasal passages. The air pressure is adjusted so that it is just enough to
prevent the throat from collapsing during sleep. The pressure is constant and
continuous. Nasal CPAP prevents airway closure while in use, but apnea episodes
return when CPAP is stopped or used improperly. nCPAP uses a mask that is worn over the nose while sleeping. It is connected to a hose that in turn is connected to a unit which supplies a constant push of air, the degrees of which can be controlled. The idea behind nCPAP is to pressurized the nasal passages and the trachea, so that they don't collapse. There is a relatively new device, called BiPAP, which is the same as nCPAP, but, upon exhalation, the pressure of incoming is significantly reduced, so that a person can exhale with less effort. Variations of the nCPAP device attempt to minimize side effects that sometimes occur, such as nasal irritation and drying, facial skin irritation, abdominal bloating, mask leaks, sore eyes, and headaches. Some versions of nCPAP vary the pressure to coincide with the person's breathing pattern, and others start with low pressure, slowly increasing it to allow the person to fall asleep before the full prescribed pressure is applied. Besides feeling better during the day, patients with sleep apnea may live longer when using nCPAP. A nCPAP machine blows air into the patient’s nose. Air pressure holds the airway open and prevents snoring and apnea events (periods of not breathing). Sucking hard on a thin paper straw when drinking a thick milkshake may cause the straw to collapse. This is similar to what happens to the airway during an apnea event. Blowing into the straw will cause it to open. Likewise, blowing air into the upper airway during sleep also holds it open. It is already established that nCPAP is the gold standard treatment for OSA, although the literature reports that some patients have nCPAP intolerance, or that this device is inefficient in decreasing the respiratory events. The CPAP efficacy in a group of patients was examined with clinical and polysomnographic diagnosis of OSA. They considered efficacy when the apnea-hipopnea index (AHI) was below than 20% or had a 50% reduction of the baseline value in the Pre-CPAP study.
Oral appliances presently in use and properly researched now
fall into two categories. The first category Patients must be aware that treatment with an oral appliance is not universally successful for patients with obstructive sleep apnea. An oral appliance is "site-specific" and will have no effect on obstructions high in the upper airway or low in the upper airway. Nasal Continuous Positive Airway Pressure (nCPAP) is not "site-specific" and is the only treatment now available which is effective, regardless of the location of the obstruction, and the severity of the disease. Patients much prefer to use an oral appliance rather than nCPAP, but nCPAP is better at reducing the number of apneas and increasing the patients' oxygen level.
A surgical method is UUUP, a paring away of the upper palate, near the Uvula, in the back of the mouth. Excessive tissue here can close off the airway; Surgery to enlarge the nasal cavity or to correct a deviated septum; and in extreme cases, actually performing a tracheotomy and to a more extreme treatment, actually moving the jaw forward surgically (mandible advancement).
There are quite a few pharmacological treatments used in Sleep Medicine. Antidepressants are sometimes prescribed, but are marginally effective. Triptil, Vivactil, and Klonopin have been used. However there is little research that supports a pharmacological treatment for OSA. |
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This appliance has recently received FDA acceptance.
It is a "combination" therapy which combines a nonadjustable
MRD with continuous positive airway pressure (nCPAP). Instead of
using nasal nCPAP, which delivers air pressure through a mask over the
nose or the nose and mouth, the air pressure is delivered through a
small conduit that fits across the roof of the patients mouth. Thus,
the more effective nCPAP can be used by patient without the need to
wear a nasal mask, have elastic straps around the head, or sleep on
one's back.
is
that of the Tongue Retaining Device