Sleep apnea is a disorder that affects breathing while we sleep, which can have serious health consequences if left untreated. There are several therapeutic approaches depending on the severity of the case, the origin of the problem and the personal characteristics of each patient.
At Instituto Maxilofacial, we always try to rule out the least invasive treatments before moving on to the most definitive ones. Here we explain the main treatments available and when each one is recommended:
1- Lifestyle changes
This is usually the first step when apnea is mild or related to certain habits. Among the most common changes are:
- Losing weight: Excess weight, especially in the neck area, can obstruct the airways.
- Sleeping on your side: This position can reduce apnea episodes.
- Avoiding alcohol and tobacco: These substances relax the throat muscles and worsen apnea.
When is it recommended?
This approach is suitable for mild cases and as a complement to other treatments.
2- Positional therapy
In some cases, sleep apnea only occurs when the person sleeps on their back. Positional therapy consists of techniques to train the patient to sleep on their side, using special devices or clothing designed to prevent them from lying on their back.
When is it recommended?
It is suitable for people with mild positional apnea, that is, when episodes only occur in certain positions.
3- Mandibular advancement devices (MAD)
MADs are dental appliances that adjust the position of the jaw and tongue to prevent them from blocking the airway. In our Advanced Dentistry Unit we can design one to suit you using the latest technologies.
When is it recommended?
They are effective in cases of mild to moderate apnea. This treatment may also be suitable if the patient has apnea related to the tongue collapsing backwards while sleeping.
4- Continuous positive airway pressure (CPAP) devices
This device blows air through a mask while you sleep, keeping your airways open, although it can be quite uncomfortable at bedtime and disruptive to the patient's partner, so about half of people who try a CPAP stop using it.
When is it recommended?
For patients with moderate or severe apnea. It should be noted that this is a palliative treatment and not a curative one, since sleep apnea does not decrease with the use of this device.
5- Hypoglossal nerve stimulation
This is a treatment that consists of the implantation of a device that stimulates the hypoglossal nerve, which controls the movement of the tongue. The stimulation helps keep the airways open during sleep.
When is it recommended?
This treatment is indicated for patients with moderate to severe apnea for whom other options have not been effective, although it may take about a year to reach its full potential usefulness for a person.
6- Surgery
If the above treatments are not effective or if the apnea is caused by a physical obstruction in the airway, then it is time to move on to surgical solutions. There are different types of surgery, depending on the cause of the apnea and the patient's anatomy:
- Uvulopalatopharyngoplasty (UPPP)
This procedure involves removing or reducing excess tissue at the back of the mouth and throat. This includes the uvula (the hanging piece of tissue at the back of the mouth) and part of the soft palate. By removing this excess tissue, the airway is widened and air can pass through more easily.
When is it recommended?
It is common in patients who have obstructive apnea caused by excess soft tissue in the throat. However, its effectiveness can vary and it is not always a definitive solution.
- Septoplasty and Nasal Surgery
In some cases, sleep apnea may be caused by a nasal obstruction, such as a deviated septum or nasal polyps. Septoplasty is a surgery that corrects a deviated septum, improving airflow through the nostrils.
When is it recommended?
This type of surgery is performed on people who have difficulty breathing through their nose due to anatomical problems. It improves nasal breathing, which can reduce episodes of apnea.
- Tonsil and adenoid reduction surgery
In some patients, especially children, enlarged tonsils or adenoids may be the primary cause of airway obstruction. Tonsillectomy or adenoidectomy removes this obstructive tissue.
When is it recommended?
It is more common in children with obstructive apnea, as enlargement of these glands is often the primary cause in this group. However, you can also do and in adults.
- Genioglossus and hyoid advancement
This procedure is designed to reposition the muscles of the tongue and lower airway. The genioglossus muscle anchors in the mandible, and the surgery involves moving this muscle forward to prevent the tongue from moving backward during sleep.
When is it recommended?
It is ideal for patients whose apnea is due to the tongue collapsing into the airway while they sleep. It is usually part of a combined surgical strategy.
- Maxillomandibular advancement (orthognathic surgery)
In this surgery, the jaw and maxilla bones are repositioned to widen the airway space. Based on scientific literature and empirical evidence, this is the most effective and immediate treatment for severe obstructive apnea.
When is it recommended?
It is suitable for patients with structural abnormalities in the mandible or maxilla that narrow the airway. It is also used when other surgical treatments have not worked, as it has proven effective in correcting sleep apnea in thousands of people, as well as presenting other advantages, such as occlusal improvement and improved facial harmony.
As we can see, the appropriate treatment for sleep apnea depends on many factors, including the severity of the disorder, the patient's anatomy and their lifestyle. At Instituto Maxilofacial we have a multidisciplinary team specialized in diagnosing and offering personalized solutions for each case of sleep apnea. If you suspect that you suffer from apnea, do not hesitate to consult us to find the most suitable treatment for you.
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