Obstructive sleep apnea can be effectively treated. Depending on whether your OSA is mild, moderate or severe, will allow us to determine available treatment options. In addition to formal treatment options in many cases, Behavior Modification (Lifestyle changes) can also be successful in treating sleep. If you are diagnosed with mild sleep apnea, weight loss; avoiding alcohol, caffeine and heavy meals within two hours of bedtime; avoidance of sedatives; and a change in sleeping positions may be effective in treatment. In mild cases, these practical interventions may improve or even cure snoring and sleep apnea. There are other treatment options and combinations of options not discussed on this site and could be discussed as options during one on one conversations.
Oral Appliances – If you have mild to moderate sleep apnea, or are unable to use a C-PAP, recent studies have shown that an oral appliance can be an effective first-line therapy. The oral appliance is a custom designed device that is placed in the mouth at night to hold the lower jaw and bring the tongue forward. By bringing the jaw forward, the appliance elevates the soft palate or retains the tongue to keep it from falling back in the airway and blocking breathing. This improves breathing and reduces snoring and apnea.
Our orthotic appliances are designed to realign the jaw and/or tongue in relation to the airway. This small acrylic device fits over the upper and lower teeth or tongue (similar to an orthodontic retainer or mouth guard). The appliance is fabricated and customized for each patient by Dr. Pomerantz who is experienced in the treatment of snoring and sleep apnea. The appliances are comfortable and well tolerated by our patients. They are easy to place and remove, easy to clean and are convenient for travel. Your device is comfortably worn each night to produce the desired effect. Our orthotic appliances are the most comfortable treatment for sleep apnea and snoring. This custom fit appliance is simple and easy to use. No awkward mask or painful surgery is utilized.
This graphic below shows the appliance in place, see how the lower jaw is moved forward to keep the airway open.
C-PAP (Continuous Positive Airway Pressure) and Bi-PAP (Bi-Level) – A C-PAP device is an effective treatment for patients with moderate OSA and the first-line treatment for those diagnosed with severe sleep apnea. Through a specially fitted mask that fits over the patient’s nose, the C-PAP’s constant, prescribed flow of pressured air prevents the airway or throat from collapsing. In some cases a Bi-PAP device, which blows air at two different pressures, may be used.
While C-PAP and Bi-PAP devices keep the throat open and prevent snoring and interruptions in breathing, they only treat your condition and do not cure it. If you stop using the C-PAP or Bi-PAP, your symptoms will return. Although C-PAP and Bi-PAP are often the first treatments of choice, they may be difficult for some patients to accept and use. If you find you are unable to use these devices, do not discontinue their use without talking to your doctor. Unfortunately, for a multitude of reasons, long term compliant of the CPAP is low.
Surgical intervention may be a viable alternative for some OSA patients; however, it is important to keep in mind that no surgical procedure is universally successful.
Here are a few of the more common surgical options
Uvulopalatopharyngoplasty (UPPP) – If the airway collapses at the soft palate, a UPPP may be helpful. UPPP is usually performed on patients who are unable to tolerate the C-PAP. The UPPP procedure shortens and stiffens the soft palate by partially removing the uvula and reducing the edge of the soft palate.
Hyoid Suspension – If collapse occurs at the tongue base, a hyoid suspension may be indicated. The hyoid bone is a U-shaped bone in the neck located above the level of the thyroid cartilage (Adam’s apple) that has attachments to the muscles of the tongue as well as other muscles and soft tissues around the throat. The procedure secures the hyoid bone to the thyroid cartilage and helps to stabilize this region of the airway.
Genioglossus Advancement (GGA) – GGA was developed specifically to treat obstructive sleep apnea, and is designed to open the upper breathing passage. The procedure tightens the front tongue tendon; thereby, reducing the degree of tongue displacement into the throat. This operation is often performed in tandem with at least one other procedure such as the UPPP or hyoid suspension
Maxillomandibular Advancement (MMA) – MMA is a procedure that surgically moves the upper and lower jaws forward. As the bones are surgically advanced, the soft tissues of the tongue and palate are also moved forward, again opening the upper airway. For some individuals, the MMA is the only technique that can create the necessary air passageway to resolve their OSA condition.
Dental Appliance Therapy