A good night’s sleep is the key to a good day’s work, play and healthy living. But for people with obstructive sleep apnea, getting an adequate amount of restful sleep is a challenge. This serious – but common – condition affects people of all ages but especially middle-aged and older adults as well as those carrying excess weight (1).
Obstructive sleep apnea involves temporary blockages of the airway, caused when the tongue and throat muscles relax. Sufferers stop breathing until the need for oxygen causes them to wake briefly to gasp for air. This occurs several times a night, usually accompanied by loud snoring. The brief but frequent awakenings mean that people don’t get the deep uninterrupted sleep they need* so they feel drowsy during the day. They may have low energy, be listless and/or irritable, and be prone to accidents. The problem also affects their partners, the ones most likely to notice and be disturbed by the snoring, choking and gasping.
Fortunately, there are treatments. In an effort to determine which are most effective, a 2013 systematic review examined the results of 132 randomized controlled trials, published over a 45-year period (2). All of the participants had obstructive sleep apnea, with an apnea-hypopnea index (AHI) of at least five. The AHI is the number of times in an hour breathing stops or is reduced during sleep.
One of the treatments studied was continuous positive airway pressure (CPAP): a mask worn over the nose delivers a steady air flow to keep the airway from closing during sleep. Other treatments included dental devices (mandibular advancement devices) that fit over the teeth and hold the jaw forward to keep the airway open, weight loss, surgery and medications. The effectiveness of each treatment was measured by comparing AHI scores as well as ratings from the Epworth Sleepiness Scale, which assesses the likelihood of dozing in certain situations.
And the winner is...
As CPAP is widely considered the standard treatment for obstructive sleep apnea, it is not surprising that it proved to be the most effective. CPAP reduced both the AHI and sleepiness scores by a moderate amount compared to no treatment and reduced AHI more than mandibular advancement devices. But while not quite as effective, dental devices did reduce both AHI and sleepiness scores more than no treatment. There was also some evidence that weight loss can help to improve AHI. The data regarding medication and surgery was inconclusive.
Notwithstanding the results, the best treatment for anyone with obstructive sleep apnea is the one he or she can stick with. For example, many people cannot tolerate CPAP, finding it uncomfortable and restrictive (3) so are advised to try one of the other options. What is most important is that they (and their long-suffering partners) get the sound sleep they need to live out their dreams in their waking hours!
* Wondering how much sleep you need? Click here to find out more.