Definition

The sleep apnea syndrome is defined as a pattern of repeated episodes of obstruction of
the upper airway, causing oxygen desaturation, with efforts to resume inspiratory
breathing to normalise the airflow of the upper airway. This can cause unconscious
awakenings throughout the night and results in disturbance of the sleep patterns.
There are various degrees of obstruction but once the diagnosis has been finalised, a
treatment plan needs to be arranged so that the patient has a road map to improve
quality of life and breathing when asleep.

Obstructive sleep apnea treatments:
• Conservative measures;
• Pharmacological treatments;
• Surgical treatments;
• Intra-oral prosthesis;
• C-Pap (continuous positive pressure devices).

Conservative measures
The general measures are indicated in cases of patients with mild obstructive sleep
apnea that are not serious and that the modification of certain hygienic-dietary habits
has achieved remission of clinical symptoms. These measurements promote healthy
living habits to correct situations that may favour the collapse of the airway.
These include:

  • Weight loss. An effort must be made to get closer to the optimal BMI for each
    patient.
  • Reduction or suppression of Tobacco products, alcohol and sedatives. These
    promote airway obstruction.
  • Regular physical exercise. Not only does it reduces weight but also reduces the
    obstructive breathing pattern.

Weight reduction
Excess weight is present in 60% to 90% of patients diagnosed with obstructive sleep
apnea, therefore, weight reduction is the first action to be recommended. In many
patients, a reduction of 5% to 10% weight leads to a significant decrease in the number
of apneas and a normalisation of the hypoxia. Obesity is associated with the
accumulation of fat in the neck, which affects the reduction of the size of the upper
airway.

Sleep Hygiene
Healthy sleep routines are some guidelines to which time is the most restful sleep
possible. It is suggested that sleep is mostly induced at the same time at night. No
exercise must be done for at least two hours prior to sleep. Avoid heavy meals two hours
prior to sleeping. Avoid sleeping tablets or an abundance of alcohol as well as smoking
at this time. A dark room with good ventilation is also optimal. It is always easier to
sleep if the background is not noisy.

Positional therapy
In some cases patients snore mostly when lying on their backs. The gravity pulls the
soft tissue of the neck backwards and blocks off the airway. Postural therapy works for
patients to remain during sleep in positions where the actions of gravity does not cause
displacement.

Nasal dilators
The use of nasal dilators as treatment in obstructive sleep apnea has mixed support in
the medical publication. Some logical treatments as advertised are mostly ineffective.

Pharmacological treatments

There is no drug on the market with a proven track record to reduce snoring. The lower
prevalence of obstructive sleep apnea in woman is related to the effect of progesterone
that protects women in their childbearing years. Lower levels of sex hormones could
explain the increase of the disease in postmenopausal woman.

Surgical treatment
Watch this space for our next talk…..