Therapy

CPAP involves using a machine that administers a gentle air pressure via a small mask which fits on the nose or nose and mouth. This air pressure keeps the airway open and prevents collapse of upper airway tissue that causes snoring and obstructive sleep apnoea.

CPAP is the most effective treatment for obstructive sleep apnoea and the decision to use treatment can be life changing. Other therapy choices may not control your apnoea quite as well, resulting in some persistent symptoms such as daytime fatigue.

It is possible to have severe sleep apnoea but have no noticeable symptoms. Despite the lack of symptoms, if left untreated, sleep apnoea can impact on general health, particularly high blood pressure and cardiovascular disease.

CPAP is not a cure for sleep apnoea but rather a long term treatment and should be used every night for a minimum of four hours.

Adjustment to CPAP therapy does require some degree of commitment and perseverance. Motivation often comes from waking refreshed and feeling better during the day. A four week trial is recommended. It is important during this trial, to ask questions and have open conversations with the CPAP therapist.
If the sleep apnoea is severe, a second sleep study may be advised to assess how effectively CPAP is working.

Funding for a CPAP machine may be available through Medicare or Department of Veteran Affairs. CPAP users should have regular follow up with their therapy provider or Sleep Physician.

If you are interested in learning more about CPAP therapy, or currently use CPAP therapy and are looking for machine/mask support and troubleshooting, contact our therapy rooms directly on 9200 4432.

Bi-level Positive Air Pressure (BiPAP) is the gold standard and most effective form of treatment for obesity hypoventilation and complex forms of sleep apnoea. BiPAP machines and masks look nearly identical to CPAP machines and masks. The primary difference in therapy is that BiPAP provides two levels of air pressure therapy: a higher amount of pressure is delivered during inhalation and a lower amount of air pressure is administered during exhalation.

In patients with obesity hypoventilation, the bi-level pressure opens the airway, increases lung expansion and prevents hypoventilation (shallow breathing). For patients with more complex sleep apnoea, BiPAP Servo Controlled Ventilation (SCV) is the most effective therapy. BiPAP SCV maintains the airway and employs pressure support to regulate the breathing.

PEEP valves are a treatment for mild Obstructive Sleep Apnoea (OSA), upper airway resistance and snoring. PEEP valves are a small wearable device that is inserted into the nostrils and is not attached to any machine or power.

We highly recommend patients interested in this form of therapy, discuss it with their doctor first to ensure it is the right choice for them.

Posture modification means avoidance of supine sleep. In most cases, Obstructive Sleep Apnoea (OSA) is worse when a person sleeps on the back (in the supine position). In some cases, the OSA occurs exclusively in the supine position and a person will have essentially normal breathing when sleeping laterally.

For patients with mild sleep apnoea or where the majority of apnoea events occur in the supine position, posture modification may be a valid treatment option. Special backpacks, belts and sleep shirts are available to ensure that a patient sleeps on his or her side during sleep.

Posture Modification with Nightshift Device

The Nightshift device is worn around the neck or chest (see picture) and works by administering subtle vibration at the back of the neck or chest when a person rolls into the supine position during sleep. The vibration causes a gentle awakening and then ceases when the person rolls back into the lateral position. The device also collects data that may be downloaded into a report containing the following information: percentage of supine sleep, percentage of left and right-side lateral sleep, number of attempts to roll into the supine position and level of noise (i.e. snoring) during the night, as measured in decibels (dB).

Significant weight loss can decrease the severity of Obstructive Sleep Apnoea (OSA); however it is not always a ‘cure’ for OSA, especially when the OSA is severe. Weight loss is certainly recommended for OSA patients who are overweight in combination with other therapies. Often OSA patients lose weight once their OSA is treated with CPAP, a MAS, or PEEP valves because sleep is improved, energy levels are increased and patients are consequently able to exercise more regularly.

Lifestyle modification such as avoidance of alcohol and sedatives, weight loss, or quitting smoking can reduce the severity of Obstructive Sleep Apnoea (OSA). Thus, patients with OSA are encouraged to avoid alcohol and sedatives before bed, as these substances further relax the muscle and tissues of the upper airway and worsen OSA and snoring. Weight loss and smoking cessation (quitting smoking) will also improve respiratory health.

Upper airway surgery is available for patients with OSA who cannot tolerate CPAP or other medical management of OSA. Surgery of the upper airway involves removal of excess tissue at the back of the mouth and throat. This may include removal of tonsils and/or adenoids. Another type of surgery, Radio Frequency Tissue Ablation (RFTA) shrinks the size of the tongue and/or palate. Multiple procedures may be required and surgical intervention of OSA typically includes a long recovery period.

Also of note, surgical improvements in OSA are limited, typically diminish over time and various complications may occur. For these reasons, surgery to treat OSA is considered a second-line therapy for those who have first tried CPAP, a Mandibular Advancement Splint (dental appliance), or Provent nasal Microvalves. A Sleep Specialist will help determine if surgery is an appropriate option based on sleep study results and examination of one’s upper airway. Physicians who perform surgery for OSA are most commonly otolaryngologists (Ear, Nose and Throat Physicians) or oral and maxillofacial surgeons. Bariatric (weight loss) surgery is another type of surgery that may be appropriate for patients with OSA secondary to obesity