Patients with OSA Do's and Don'ts
Facts about OSA in the Workplace
OSA Treatment:
There are several OSA treatment options for mild to moderate OSA, especially if the OSA occurs primarily in the supine position (i.e., when sleeping on the back). For severe sleep apnea and pregnancy-related OSA, continuous positive airway pressure (CPAP) is the primary treatment of choice. CPAP treatment is also recommended for drivers of commercial vehicles with severe OSA. A brief description of treatment options and issues are presented below.
Weight Loss: The most common cause of OSA is obesity, so losing weight is important for those who are overweight regardless of OSA severity. For mild sleep apnea, this might be enough.
Sleep Position Restriction: Gravity promotes sleep apnea when a person sleeps on his or her back (supine). The ARES measures OSA by position, so if it is shows difficulty only or mostly on the back, then simply avoiding sleeping on the back may be successful. Patients who have OSA primarily while on their back are also more likely to be helped by an oral appliance.
Oral Appliance: An oral device is fitted by a dentist and worn much like a retainer or sport mouth-guard. They are designed to keep the mandible (jaw) and/or tongue in a forward position that allows the airway to remain open. Generally, oral devices work best for patients with mild to moderate OSA, patients who experience OSA mostly in the supine position (when sleeping on their backs), and for those who are not obese and do not have a large neck. In ABM's clinical study, the ARES showed a 96% efficacy rate across all patients, even in patients who suffered from severe OSA but had failed CPAP therapy.
Surgery: A variety of surgical techniques have been used to reconfigure the upper airway so that it remains open during sleep, but these procedures may not be helpful in every patient, and their long term effectiveness is unproven. The most common surgery to treat OSA, uvulopalatopharyngoplasty (UPPP), has a short-term success rate of about 50% in unselected cases. Removing the tonsils and/or adenoids may be effective in some patients.
Continuous Positive Airway Pressure (CPAP):
Nasal Continuous Positive Airway Pressure, or CPAP treatment,
requires the patient to wear a mask over the nose during sleep. The mask
is connected by a hose to a small air pressure generator. When the mask
is worn, the air pressure inside the throat is increased. The air pressure
is adjusted so that it is just enough to prevent the throat from collapsing
during sleep. The CPAP eliminates a person's snoring, gasping, and choking
during the night. The CPAP prevents airway closure while it is worn, but
apnea episodes will return when CPAP is stopped or if it is used improperly.
CPAP technology has improved considerably in the past five years. The
devices are much quieter and there are numerous mask options that improve
the fit and comfort.
Treatment with CPAP requires adjustment (or titration) of the amount of
pressure needed to keep the airway open. Patients who have an ARES study
no longer need to have a CPAP pressure setting determined in the laboratory.
Multiple studies have shown that auto-adjusting CPAPs, which automatically
deliver the correct pressure, are as effective as in-laboratory determined
pressure. Alternatively, the CPAP pressure can be predicted using a formula
and the pressure adjusted until the snoring subsides. CPAPs units are
obtained from Durable Medical Equipment providers with a prescription
provided by your physician.
Treatment Follow-up: For all treatments options other than CPAP, it is recommended that a follow-up ARES study be performed approximately 1 to 3 months after initiation to ensure that the selected procedure was effective. After any significant weight loss or weight gain, your treatment may need to be reevaluated.