Obstructive sleep apnea (OSA) is a disorder that occurs when you can't get enough air into the lungs during sleep because of a collapsed airway. OSA can be serious, with each pause in breathing lasting ten to twenty seconds, and these can happen frequently in one hour, even as many as thirty times. OSA can be managed, and treatment has gotten better and more comfortable.
CPAP, which stands for continuous positive airway pressure, is breathing therapy prescribed for those with OSA. It works to blow pressurized air into a face mask; the pressure acts as a wedge to open the airway. The old CPAP machines were clumsy to uncomfortable to wear, but in the past few years there have been innovations in comfort, says Frank Trgovich, respiratory therapy manager for Fairmeadows Home Health in Schererville.
"There was limited use of a heated humidifier," he says. "Over the course of a few hours or the whole night there is a lot of air going into the lungs and that's going to decrease moisture, which is hard for the body to replenish. The heated humidifier reduces the possibility of damage to the lungs. The warmer the air, the more humidity you have."
Another feature tapers the flow of air when you exhale, which allows a more natural exhalation. The machine also includes variable pressure. You can start with low pressure and build up to the prescription pressure. Trgovich says there's also been a big improvement with the noise level of the machine and the size has shrunk to about the length of a box of tissues.
An alternative to the CPAP is a dental appliance called the mandibular advancement device. The device is an adjustable oral appliance that fits over the top and bottom teeth, advancing the jaw and tongue forward and stabilizing the soft palate to prevent the airway from collapsing and allowing for more air. Dr. James Lipton, diplomate of the American Board of Dental Sleep Medicine in Highland, says this is an exquisitely precise device that requires an impression of the mouth and careful calibration. And it's important that the dentist making it is highly trained and knowledgeable in dental sleep medicine.
The American Academy of Sleep Medicine (AASM) states that patients should be given the option of an oral appliance with mild or moderate sleep apnea. Dr. Lipton says that those with severe obstructive sleep apnea should start with a CPAP, and if they cannot tolerate the machine, the oral appliance can be a secondary option. "It is possible to treat someone with severe sleep apnea and have success with the mandibular advancement device," he says.