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Wednesday, May 25, 2011

Treatment for sleep apnea

So if you are diagnosed with sleep apnea, or are an RT or RN taking care of such a patient, you should be aware of the treatment for this condition.

1. Weight reduction: This often decreases the severity of the condition because it reduces fat tissue in the throat area.

2. Sleep posture: Sleep on sides instead of on back.

3. Quit smoking: Smoking is believed to increase inflammation in the lungs and also increase fluid retention in your throat and upper airway*

4. Avoid alcohol: Alcohol relaxes muscles of the throat and may interfere with breathing. This explains why people are more likely to snore after drinking*.

5. Avoid sleeping pills: These also relax throat muscles*.

6. Avoid sedatives: These too relax throat muscles*.

7. Avoid Caffeine: Within 2 hours of going to bed*.

8. Avoid Heavy Meals: Within 2 hours of going to bed*.

9. Maintain regular sleep hours: This will help you relax and sleep better. This keeps your circadian rhythm in sync.

10. Elevate head of bed 4-6 inches:

11. Keep nasal passages open: Use a dilator, airway sprays, decongestants, breathing strips. See a doctor if you have chronic nasal congestion.

12. Don't be stubborn: I find many sleep apnea patients don't get the treatment they need for no other reason that they are martyrs. Be willing to seek help, and be willing to accept help options when they are presented to you.

13. Supplemental oxygen: To help offset hypoxia that might occur and prevent hypoxia induced arrhythmias and pulmonary hypertension

14. Decreasing REM sleep: Decreasing REM may decrease apnea episodes. One medicine that does this is protriptylinee, which is a tricyclic antidepressant tht markedly reduces REM sleep.

15. Reduce daytime somnolence: Central nervous system stimulants such as methylphenidate may help in this area for obstructive or central sleep apnea.

16. Surgical interventions:
  • Tracheostomy: Emergency management of severe onset
  • Palatopharyngoplasty: Posterior section of palate and the uvula are resected (taken out), as well as tonsils and lateral posterior wall of the pharynx to remove soft tissue that might obstruct the airway.
  • Mandibular advancement: If mandibular abnormalities are believed to be the cause, this can be corrected with surgery
  • CPAP: Continuous Positive Airway Pressure helps keep the airways open from the tiniest alveoli to the soft upper airway tissue. It's effective only in obstructive sleep apnea. Other names for CPAP are EPAP (End Positive Airway Pressure) and PEEP (Positive End Expiratory Pressure).
  • BiPAP: Bilevel Positive Airway Pressure. This is CPAP plus air that helps the patient take in a deep breath, more commonly referred to as pressure support (PS). The CPAP helps keep the airways open, and the PS helps the patient take in an effective breath. This is more commonly used when obstructive sleep apnea is more advanced, or when it is combined with COPD (particularly end stage COPD).
  • Mechanical Ventilation: This is a short term solution for when the obstructive or central sleep apnea causes respiratory failure.
  • Chest cuirass: May help a patient with central sleep apnea breathe.

Egans Fundamentals of Respiratory Care (6th Edition, 1995)


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