Obstructive and Central Sleep Apnea (cont.)
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As described above, CPAP or continuous positive airway pressure is the cornerstone of the treatment for obstructive sleep apnea and most cases of central sleep apnea. This is a breathing machine which pushes air into the airways with adjustable intensities and pressures. This sleep apnea machine has tubing connected to a mask that is placed on the patient's nose (nasal CPAP) and is tightened by straps behind the head. The nasal masks come in different sizes and can be fitted individually. The airway pressures are determined based on the data from the polysomnogram and may be adjusted or titrated as needed. The pressure essentially helps keep airways open, reduces episodes of apnea and hypopnea, and improves oxygenation by constantly providing air.
The main problem with CPAP is patient adherence. The machine and mask may be bothersome, bulky, and restricting; thus, patients may not wear them all night or every night.
For some patients with central sleep apnea a noninvasive positive pressure ventilation device (NIPPV) may be more beneficial than a CPAP. The difference is that a NIPPV device can be set to provide a back-up respiratory rate in individuals who have central sleep apnea due to hypoventilation (breathing less than the normal rate). This assures that a minimum number of breaths are taken regardless of the patient's own respiratory drive.
Oral or mouth devices are also available for sleep apnea. In general, these oral appliances are made to keep the oral airway open by protruding the jaw forward, and preventing the tongue from falling on the back of throat and causing limitation of air flow. Some studies have shown clinical benefit with these mouth devices in mild to moderate (but not severe) obstructive sleep apnea by reducing the apnea-hypopnea index. It is best to have these oral devices made by a specially-trained dentist for adequate fitting and adjustment.
Studies comparing CPAP to mouth devices for sleep apnea have found more objective improvement of sleep based on polysomnographic data using a CPAP machine than with an oral device. However, subjective data (sleep quality and improvement of daytime symptoms reported by patients) favored the oral devices.
Custom fitted pillows for patients with sleep apnea have also been studied. These pillows work by extension (backward stretch) of the neck, thereby increasing the caliber of the oral airway and decreasing the degree of obstruction. At present, the available data fail to conclusively support their use or effectiveness; however, some studies suggest these sleep apnea pillows to be beneficial in mild obstructive sleep apnea based upon both subjective reports and overnight sleep studies. It is generally not recommended to use these pillows for moderate or severe sleep apnea or as a replacement for CPAP.
Apnea alarms are sometimes used in cases of central sleep apnea in infants. These alarms monitor episodes of apnea and make a sound when apnea is sensed. The sound wakes the child (and the parents) in order to resume normal breathing. Most infants outgrow this problem, and use of the alarm is discontinues at that time.
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