Management Options for Obstructive Sleep Apnoea (OSA)

What are my options?

So you’ve been diagnoses with obstructive sleep apnoea (OSA) or you think you may have obstructive sleep apnoea. There are loads of different treatment options and if you are motivated and have realistic expectations, it’s likely you will find a treatment that suits you. 

Firstly, you should have a sleep study detailed enough for a diagnosis and this should also include some additional information. The information needed includes the severity and the positional nature of your OSA (such as is it much worse on when you lay on you back?).

There are lots of different types of sleep test but for a diagnosis in the UK you should have a test which is NICE (national institute of clinical excellence) approved for diagnosis.

I recommend you look through this test with your clinician to begin to design a treatment

Do I have to have a CPAP mask/machine?

Positive airway pressure (PAP) and Continuous positive airway pressure (CPAP) are excellent treatments for OSA. These involve a machine on the bedside and some type of mask or nasal pillow. If you can tolerate this, it is an excellent treatment. You should not be scared of the technology. There are excellent devices available which are fairly small and comfortable. Masks come in lots of different shapes and sizes. You may be suitable for a nose only mask which can be soft and fit just under your nose. If you don’t like the idea of PAP/CPAP I completely understand your hesitation. However, please find a clinician you trust and explore the different options and mask types.

If you are not tolerating PAP and have tried lots of masks and troubleshooted thoroughly, there may be some other options.

What are the other treatments for OSA?

Other options include positional training, mandibular advancement devices, weight loss in some patients, and sometimes surgery including hypoglossal nerve stimulator devices.

In some patients there may be very large obstructing tonsils.

Mandibular Advancement devices (MADs) are oral appliances a little bit like a ‘gum shield’ or dental mould and are designed to bring your jaw forward.

If you have significant nasal blockage with objective structural abnormalities, correcting your nasal health and promoting nasal breathing at night can improve your sleep quality. This may also improve your ability to have a nasal CPAP devices which some patients find more tolerable. However, it’s important to note your AHI score is unlikely to be significantly changed by nasal surgery alone.

Are there operations that can Cure OSA?

Treatment needs to be tailored to individual patients. The Obstruction can often be at multiple levels. Furthermore, the obstruction is usually dynamic so that during sleep and muscle relaxation, the relaxation leads to obstruction. It can be difficult to see where this obstruction is occurring when you are awake.

A drug induced sleep endoscopy can be used to look at the level of obstruction in some patients. In others it can be fairly clear from history and examination that there is a anatomical reason significantly contributing to the obstruction.

It is not uncommon to find multiple areas of airway collapse which can mean surgical treatments need to target multiple areas.

There are a large range of different operations offered for OSA and snoring. This represents the different areas of airway collapse. As a professional of ENT and sleep surgeons, we are carefully collecting data on the operation which have the best effect. OSA is a notoriously challenging area to treat surgically and some patients have much better outcomes. You should have realistic expectations and an operation should be tailored to your anatomy and your goals.

Recommendations range from fairly routine ENT operations such as tonsillectomy or nasal turbinate reduction. Increasing in complexity to pharyngoplasties, tongue base reductions, multilevel surgery or hypoglossal nerve stimulators.  

Can I have a hypoglossal nerve implant?

Hypoglossal nerve stimulators are a new technology which act to stiffen and push your tongue forward during the night. The stimulation is intermittent (when you breathe in or every few seconds).

The clinical trials have shown good results in reducing the AHI score and good safety data. The results suggest there is a good chance of a significant reduction in your sleep apnoea if you fit the eligibility criteria and have suitable anatomy. Patients who feel very sleepy before the surgery also tend to have an improvement in their sleepiness score after.

However, to get good results there is a significant recovery period and getting used to the stimulation takes some work over a few months. It is an operation and all procedures carry some risks. In the UK, you must try CPAP first and have evidence of trying CPAP thoroughly with attempts at optimisation.

If you fit the strict criteria, have tried CPAP optimisation and have realistic expectations about the recovery and long-term use of the device. This may be a good option for you.