Weight loss, breathing devices still best for treating obstructive sleep apnea

Experts continue to emphasize the importance of lifestyle modifications—especially weight loss—for treating obstructive sleep apnea.

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.

The importance of weight loss

The link between excess weight and sleep apnea is well established. People who are overweight are more likely to 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 overweight and obese people lose weight, it would make both sleep apnea and other health problems [such as heart disease] go away. 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.

Other options

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. 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.

A continuous positive airway pressure (CPAP) machine prevents sleep apnea by blowing air into a mask that covers the nose and mouth. The stream of air keeps the airways open.

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.

Sleep apnea isn’t like pneumonia. You can’t try one treatment and expect your symptoms to disappear. Instead, treatment requires individualization. “The best CPAP device is the one you’re going to use.