New guidelines from the American College of Physicians (ACP) emphasize lifestyle modifications—especially weight loss—for treating obstructive sleep apnea. Though the guidelines don’t offer any radical treatment updates, they do reinforce the effectiveness of tried and true therapies.
Obstructive sleep apnea is a disorder in which the airway becomes blocked during sleep, interrupting breathing—sometimes dozens of times during a single night. Having obstructive sleep apnea puts you at risk for a number of other conditions, including high blood pressure and stroke.
After researchers from the ACP Clinical Guidelines Committee reviewed studies on the effects of various sleep apnea treatments, “their conclusion was that current therapies are effective and there wasn’t a lot of new evidence to suggest doing anything different,” says Dr. Lawrence Epstein, assistant medical director of clinical sleep medicine at Harvard-affiliated Brigham and Women’s Hospital.
The importance of weight loss
The ACP’s first recommendation centers on weight loss for people who are overweight and obese. The link between excess weight and sleep apnea is well established. People who are overweight have extra tissue in the back of their throat, which can fall down over the airway and block the flow of air into the lungs while they sleep.
Though losing weight is easier said than done, it can yield real results. “If we can get people to lose weight, it would make both sleep apnea and other health problems [such as heart disease] go away,” says Dr. Epstein. Losing just 10% of body weight can have a big effect on sleep apnea symptoms. In some cases, losing a significant amount of weight can even cure the condition.
The ACP also strongly recommends continuous positive airway pressure, or CPAP. This is typically the first-line treatment for people with sleep apnea, because weight loss can be so hard to achieve. CPAP is a mask or device that fits over the nose and mouth. It blows air into the airways to keep them open at night.
CPAP works well—but not everyone who needs it is willing to commit to wearing the clunky apparatus. Half or more of people who try CPAP don’t stick with the treatment, research has found. “It takes some getting used to,” Dr. Epstein acknowledges. The good news is, changes to the technology are making CPAP much easier to tolerate. “When CPAP therapy was introduced, it was one-size-fits-all. As we’re looking for more ways to improve patients’ ability to use it, there are a whole variety of mask styles being developed.”
Another alternative to CPAP is an oral appliance. These plastic inserts fit into the mouth and prevent the tongue and tissues in the back of the throat from collapsing over the airway during sleep.
CPAP and oral appliances work well, but they’re not cures for sleep apnea. The only sure way to rid yourself of the condition for good is to either lose weight or have surgery to remove excess tissue from the palate or throat. Surgery can have side effects, which is why it’s usually viewed as a last resort. But if you can’t tolerate CPAP or oral appliances and you’re struggling to lose weight, it is an option.
Treatment is personal
Before you can decide on a treatment, you first need to identify that you even have sleep apnea. Because the breathing pauses happen during sleep, most people with apnea have no idea they’ve got it.
Important clues are nighttime snoring and daytime sleepiness. Your doctor can do a sleep study, checking your breathing while you sleep in a laboratory or are attached to a monitoring device at home. “It’s important to get an objective measure like a sleep study, because the treatment you select will depend on how severe the sleep apnea is,” says Dr. Epstein.
Sleep apnea isn’t like pneumonia. You can’t try one treatment and expect your symptoms to disappear. Instead, treatment requires individualization. “When patients ask me which CPAP device is best, I tell them, ‘The one you’re going to use.’” says Dr. Epstein.
He recommends choosing a doctor who is experienced in treating sleep apnea—someone who can help you find the treatment you’re most likely to stick with, and teach you how to use it correctly.