How is sleep apnea treated?

Treatment of sleep apnea may vary depending on the cause of the apnea. If sleep apnea is caused by an obstructive respiratory tract, the following treatment methods are applied:

• Non-invasive mechanical ventilation
• Behavioral treatments
• Intraoral vehicle application
• Surgical methods
• Oxygen support
• Pharmacological treatments

How is sleep apnea treated with non-invasive mechanical ventilation?

For sleep apnea, positive airway pressure (PAP) devices are used to meet your need for air during periods of shortness of breath. Thus, it will be tried to ensure a continuous openness in your airways. You will need to use a respirator at home for a while. This reduces breathing difficulties and complications.



In sleep apnea patients, it is aimed to use PAP at a rate of at least 70% at night and for at least 4 hours in the first month of treatment with respiratory support devices. The expected outcomes for effective treatment are summarized below:

• The frequency of apnea attacks (AHI) within 24 hours should be below 5
• Improvement in daytime sleepiness
• Improvement in quality of life assessments
• Patient satisfaction
• Ensuring adequate time and quality sleep
• Ensuring proper sleep hygiene
• Observation of weight loss in obese patients

With effective PAP treatment, a significant reduction can be achieved in the patient’s cardiological, neurological and metabolic complications.

There are 3 types of PAP devices used today;

• CPAP
• APAP
• BPAP

Treatment with CPAP device

Such devices provide air support to the patient at a constant pressure both during inhalation (inspiration) and exhalation (expiration). It is the most commonly used treatment option in the treatment of moderate and severe obstructive sleep apnea diseases. It is also used in patients with mild obstructive sleep apnea who have additional disease or discomfort. In such patients, additional disorders such as excessive daytime sleepiness, deterioration in quality of life, ischemic heart disease, stroke or hypertension are observed.



In 10%-20% of some patients, apneas originating from the central nervous system may begin to occur, independent of the causes of occlusive apnea, while CPAP therapy continues. This condition is called complex sleep apnea syndrome. While this situation may resolve spontaneously with continuation of CPAP therapy in some patients, the use of ASV (adaptive-serve ventilation) may be necessary in the remaining patient group.

Treatment with BPAP device

In this form of treatment, it is ensured that the breaths given and taken by the sleep apnea patient are treated by providing air support at different pressures. This treatment is generally a more appropriate treatment option in patients with severe obesity (morbid obesity), additional lung diseases (obstructive or restrictive lung disease), and nocturnal hypoventilation.

Treatment with the APAP device

APAP devices are required in some patients. For example, in patients with partial or total airway obstruction during sleep, this device can automatically provide airway patency by providing varying air pressures according to need. Such devices are used in patients who are in need, as the physician deems appropriate. For example, if the patient cannot adapt to the CPAP device, or in patients who have undergone bariatric surgery, the APAP device can be used. However, the use of APAP devices is not recommended in patients with additional congestive heart failure, chronic obstructive pulmonary disease, central sleep apnea syndrome or hypoventilation syndromes. In addition, the APAP device is not recommended for patients with infrequent breathing problems caused by obesity, which causes low blood oxygen saturation during sleep, and for patients who do not snore.

Are there risks of respiratory support devices in sleep apnea patients?

Problems during the use of PAP devices are usually seen in the first month. For this reason, it is very important for the patient and the physician to be in frequent contact and communication. The most common problems when using PAP devices:

• Problems with the mask . The patient may not be able to adapt to the selected mask.
  • There may be a mask leak.
  • Skin damage may occur where the mask comes into contact with,
  • Conjunctivitis may occur
  • The patient may develop claustrophobia.

These problems can be eliminated by choosing the appropriate mask and adding nasal airbags, antihistamines, nasal steroids, and a humidifier unit.

• Problems with PAP pressure. The patient may be uncomfortable due to the pressure inconsistency. It is possible to relax the patient by re-adjusting (increasing or decreasing) the pressure of the device. Sometimes a device change may be required. Sometimes, it is possible for the patient to lose weight and adapt to the device more easily.

What is the behavioral treatment in sleep apnea patients?

With behavioral therapy, it is aimed to fulfill the correctable behaviors that cause the patient to develop sleep apnea. These are briefly:

• Weight loss: It is the most effective behavioral treatment option. Weight loss causes a significant decrease in disease severity in these patients.
• Prevention of smoking and alcohol use : Smoking causes upper airway inflammation. Alcohol, on the other hand, causes an increase in the duration and frequency of apnea, a decrease in blood oxygen levels, and sleep disruption. Therefore, prevention of smoking and alcohol use is important in reducing the severity of the disease.
• Positional therapy : Sleep position affects upper airway patency. In particular, the supine position causes narrowing of the airway. This treatment is usually applied in addition to other treatments. It is ensured to sleep in positions that will ensure the continuity of the airway opening during sleep.
• Avoidance of taking sedative-hypnotic agents at bedtime
• Providing sleep hygiene

How is the treatment using an intraoral device in sleep apnea patients?

Some sleep apnea patients may have airway obstructions due to the position of the jaw or tongue. For this reason, the patient may be experiencing apnea. In such patients, the position of the lower jawbone or tongue is changed to keep the upper airways open. Although this form of treatment is not as effective as airway assist devices, it can be used in patients with mild to moderate obstructive sleep apnea. It can be used as an alternative treatment option, especially in patients who do not benefit from the PAP device or do not improve with behavioral therapy.



Detailed oral examination will be required before starting intraoral vehicle therapy. First of all, the patient should be evaluated by the dentist. Intraoral device is not used if the patient has the following findings:

• Temporomandibular joint disease
• Periodontal disease
• Insufficient number of teeth
• Mandibular protrusion limitation (<6 mm)
• Stenosis in joint range of motion

How is the surgical treatment in sleep apnea patients?

If there is an anatomical disorder that causes obstruction in the upper airways in sleep apnea patients, they are evaluated in terms of surgical treatment. Especially in patients with mild sleep apnea, if there is any anatomical disorder causing obstruction, surgical treatment can be considered as the first choice. In addition, surgical treatment can be applied as an alternative treatment method in patients who cannot adapt to PAP device treatment and do not benefit from intraoral device therapy. This is a decision that can be taken as a principle for the detailed evaluation of your physician.

Common surgical procedures used in the treatment of OSAS are as follows:

• Upper airway by-pass procedure
  • Tracheotomy
  • Nasal procedures
  • Septoplasty
  • Functional rhinoplasty
  • Nasal polypectomy
  • Endoscopic procedures
  • Oral, oropharyngeal and nasopharyngeal procedures
• Uvulopalatopharyngoplasty and equivalents
  • Palatal advancement, pharyngoplasty
  • Tonsillectomy,
  • Aenoidectomy
  • Palatal implant
• Hypopharyngeal processes
  • Language reduction
  • Language advancement/stabilization
• Laryngeal processes
  • Epiglottoplasty
  • Hyoid suspension
• Broad airline operations
  • Maxillomandibular advancement
  • Bariatric surgery

While benefiting from tracheotomy and maxillomandibular advancement surgery, it has been observed that surgical options other than these provide clinically positive effects in patients with obstructive sleep apnea, although they are not definitively curative. Although it has been shown that it is not therapeutic for OSA, it has been shown that it can have a positive effect on the clinical symptoms and complications of the disease.

Bariatric surgery is recommended in patients with obstructive sleep apnea with a BMI > 40 or BMI > 35 and comorbidity. Bariatric surgery can result in full or partial recovery, and even the need for a PAP device can be eliminated.

How is oxygen therapy in sleep apnea patients?

Oxygen therapy is not used as the main treatment in patients with obstructive sleep apnea. If there is a decrease in blood oxygen level during sleep in patients using PAP device, it can be added to the treatment. However, if the patient has additional lung disease, it may cause the patient to be more uncomfortable by prolonging the duration of sleep apnea. Your doctor’s evaluation is very important in this regard.

What is the pharmacological treatment in sleep apnea patients?

Unless there is a medical condition such as hypothyroidism or acromegaly that causes obstructive sleep apnea, pharmacological treatment is not used much in sleep apnea. Sometimes it can be used to correct rhinitis by using nasal decongestants in nasal congestion.

Modafinil can be recommended as an additional treatment in patients with ongoing sleep apnea treatment if daytime sleepiness is present despite the correction of PAP pressure or mask air leakage.

What is radiofrequency somnoplasty in the treatment of sleep apnea?

Sleep apnea Research is ongoing for treatment. In cases of mild sleep apnea that cannot be successful with other treatment methods, or as an alternative to other treatments, a method that works with radiofrequency waves, called somnoplasty, has been developed recently. Long-term consequences are not yet known. It is seen that radiofrequency somnoplasty is also used in the treatment of simple snoring.

In radiofrequency somnoplasty, radiofrequency waves are given to the soft palate and the scar tissue formed during healing is used. Fibrosis and volume reduction are expected in the soft palate. 700 joules of energy is given to the palate of the patient from 3 different points. Each application takes 2 minutes. Thus, the soft palate is pulled up and the respiratory tract is relieved. This result is not expected in all applications.

This treatment is currently used only in simple snoring and mild apnea patients. This method, which is applied for a short time, has very little pain. It is not yet effective for moderate and severe apnea patients. However, in mild apnea cases, it draws attention as a painless treatment compared to painful laser treatments. In the application of somnoplasty, a 60% reduction in the severity of snoring can be observed in 2 or 3 applications. Significant progress can be achieved in the treatment of sleep apnea with surgical intervention for obstructive areas following the application of somnoplasty.