Severe Sleep Apnea Treatment

Are you in the severe range of obstructive sleep apena? What type of severe sleep apnea treatment can help you sleep better?

There are numerous treatment options for obstructive sleep apnea. These treatments range from behavioral modifications and positional therapy to nightly use of positive airway pressure devices to surgical treatments that alter airway anatomy.

If your doctor told you have severe sleep apnea, then you have the Apnea Hypopnea Index (AHI) - measured on the overnight sleep study - greater than 30. You can learn more about apnea hyponea index on this page.


You can recognize a patient with severe sleep apnea if he has the following symptoms:

• stop breathing in sleep more than 30 times per hour!


• very loud and irregular snoring


• choking during sleep


• sitting up or fighting for breath


• abnormal motor activities (thrashing about in bed)


• decreased libido and impotence in men


• excessive daytime sleepiness


• increased blood pressure


• increased risk of heart attack and stroke (from the constant cycling in and out of hypoxia and increased blood pressure)


• nocturia (because the increased pressure in the right heart ventricle makes the body think there is too much blood volume so urine is produced)


• weight gain (sleep deprivation causes weight gain for several physiological reasons, one being the alteration of the hormones leptin and ghrelin)


• diabetes mellitus


• there is a also link to GERD, night sweats, depression, anxiety (each apneic event is a true suffocation and elicits the "Fight or Flight" adrenalin response)


• Fibromyalgia-like symptoms


• pulmonary hypertension


• cardiac arrhythmias

So, what severe sleep apnea treatment can help a patient in this situation?

As you probably know, the positive airway pressure is recognized as the most effective treatment for obstructive sleep apnea - if you can tolerate wearing the device.

The CPAP is most useful in moderate to severe sleep apnea, and it should be the first option for severe sleep apnea treatment.

It is appropriate for every patient with moderate or severe OSA to try the CPAP treatment before undergoing other methods of therapy.

The next severe sleep apnea treatment is surgery, which is typically effective, sometimes reversible, widely available, but...it has a few side effects.

The surgical therapy for obstructive sleep apnea can be classified in three categories:

1. surgery on the upper airway - which may improve CPAP use and compliance.

This type of surgery is often useful if a patient with sleep apnea doesn't receive the right CPAP pressure due to airway obstruction, such as:

• nasal obstruction,
• large tonsils and adenoids,
• turbinate hypertrophy,
• deviated septum,
• nasal polyps.

So, if your airway is the cause for a difficult CPAP therapy, consider the surgical treatment including tonsillectomy, adenoidectomy, or nasal surgery. These surgeries may improve compliance for CPAP treatment.




2. surgery without altering the upper airway, such as bariatric surgery and tracheotomy.

Tracheotomy is typically reserved only for morbidly obese patients with Pickwickian Syndrome or who are unable to tolerate positive airway pressure.

Since obesity is a major cause for severe sleep apnea, bariatric surgery has the potential to significantly reduce the patient's weight and to improve sleep apnea. However, there are also some side effects.

Fortunately, this surgery has the significant advantage of treating other health problems associated with obesity, such as diabetes and cardiovascular disease.

You can consider bariatric surgery if you have Body Mass Index (BMI) > 40.




3. the third category includes surgery that directly alters the upper airway to reduce obstruction of breathing during sleep, such as:


• Laser-assisted uvulopalatoplasty (LAUP)
• Uvulopalatopharyngoplasty (UPPP)
• Transpalatal advancement pharyngoplasty
• radiofrequency tongue base reduction
• Hyo-mandibular suspension
• and others

Bottom line...There really is no better severe sleep apnea treatment out there besides CPAP. Well, a surgery, even a tracheostomy, but I personally would have to give the CPAP a REALLY, really good try before I choose that route.

Of course there are some people who simply will never be able to make CPAP work, and therefore a tracheotomy or bariatric surgery is a saver.

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