Can Sleep Apnea Be Cured? What Can Make It Go Away and What Keeps It Controlled

01Basics

What causes obstructive sleep apnoea

During sleep the muscles of the throat relax. In people with OSA, the airway behind the tongue, soft palate or tonsils narrows enough to reduce (hypopnoea) or stop (apnoea) airflow for at least 10 seconds. Oxygen levels fall, the brain briefly wakes the person to restart breathing, and sleep becomes fragmented, often without the person noticing.

Main contributing factors include excess weight around the neck, a narrow airway or small jaw, enlarged tonsils or tongue, nasal blockage, sleeping on the back, alcohol and sedatives, smoking, ageing and menopause. Severity is measured by the apnoea-hypopnoea index (AHI) in a sleep study: mild (5 to 14 events per hour), moderate (15 to 29) and severe (30 or more).

02Cure

When sleep apnoea can go away

• Children with large tonsils and adenoids: removing them (adenotonsillectomy) resolves sleep apnoea in most otherwise healthy children.
• Adults with very large tonsils: tonsillectomy, sometimes with palate surgery, can resolve OSA when the tonsils are the main obstruction.
• Weight loss: losing a significant amount of weight reduces OSA severity in proportion; some people with obesity no longer have OSA after major weight loss, including after weight loss surgery.
• Positional OSA: if apnoeas occur only when lying on the back, sleeping on the side can control it, although this depends on continuing the habit.
• Jaw surgery: maxillomandibular advancement moves the upper and lower jaws forward and has high success rates in carefully selected patients.
• Removing contributing factors: stopping alcohol before bed and sedatives can reduce mild OSA.

OSA can return if weight is regained or with ageing, so a repeat sleep study is often advised after treatments intended to cure it.

03Control

Treatments that control sleep apnoea

• CPAP (continuous positive airway pressure): a machine delivers air through a mask to keep the throat open. It is the most effective treatment for moderate and severe OSA, works from the first night and improves sleepiness, snoring and blood pressure. It only works while it is used.
• Mandibular advancement device: a custom-made mouthguard that holds the lower jaw forward; effective for mild to moderate OSA and snoring. See mandibular advancement device.
• Positional devices: wearable devices or special pillows that discourage sleeping on the back.
• Nasal treatment: treating nasal blockage, allergies or a deviated septum improves comfort and CPAP tolerance, though it rarely cures OSA alone; see deviated septum.
• Hypoglossal nerve stimulation: an implanted device that moves the tongue forward during sleep, for selected people with moderate to severe OSA who cannot use CPAP.
• Medicines: newer weight-loss medicines can reduce OSA severity in people with obesity, as part of a medical plan.

04Lifestyle

Lifestyle changes that make a real difference

• Lose weight if you are overweight; even 10 per cent weight loss can reduce severity noticeably.
• Avoid alcohol in the three to four hours before bed.
• Avoid sleeping tablets and sedatives unless prescribed with your OSA in mind.
• Stop smoking, which inflames the airway.
• Exercise regularly; it helps sleep apnoea independently of weight loss.
• Keep regular sleep hours and get enough sleep.
• Treat a blocked nose.

05Sleeping

The best way to sleep with sleep apnoea

• Sleep on your side rather than on your back.
• Use a pillow that keeps your head and neck aligned; some people benefit from raising the head of the bed slightly.
• Use a tennis ball sewn into the back of a pyjama top or a positional device to stop rolling onto your back.
• If you use CPAP, make sure the mask fits well and use the humidifier if your nose or mouth gets dry.
• Keep the bedroom cool, dark and quiet.

For snoring without apnoea, see snoring remedies and snoring with the mouth closed.

06Why treat

Why treatment matters

Untreated moderate to severe sleep apnoea is associated with high blood pressure, heart rhythm problems, heart disease, stroke, type 2 diabetes, depression and road accidents caused by sleepiness. Treatment improves daytime alertness, mood and quality of life, and reduces blood pressure, particularly in people whose blood pressure is hard to control. In many countries, people with sleep apnoea that causes excessive sleepiness must inform the driving licence authority until it is treated.

07ENT

What an ENT specialist checks

An ENT assessment looks for treatable obstruction: the nose and septum, the tonsils, the soft palate, the tongue base and the jaw. A camera examination through the nose shows the airway, and in selected patients a drug-induced sleep endoscopy shows exactly where the airway collapses during sleep. This helps decide between CPAP, an oral device, surgery or a combination. A sleep study, at home or in a sleep laboratory, confirms the diagnosis and severity. Central sleep apnoea, in which the brain does not send the signal to breathe, is a different condition; see central sleep apnea.

09Summary

Key points to remember

• Sleep apnoea can be cured when a specific cause such as large tonsils or excess weight is corrected.
• For most adults it is a long-term condition that treatment controls very effectively.
• CPAP is the most effective treatment for moderate and severe OSA.
• Side sleeping, weight loss, avoiding alcohol and treating the nose all help.