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Based on conventional medicine, what advice should a physician give a patient who experiences breathing difficulty during sleep that is not determined to require a CPAP machine and for which the root cause of such difficulty is determined to be the narrowing or closing of their airway during sleep?

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    Can you explain how narrowing or closing of the airway during sleep is not obstructive sleep apnea, which generally benefits from CPAP? – Carey Gregory Jul 20 '18 at 1:07
  • No sir, I am not a medical professional, but I am curious what other methods are used. I think maybe it would be best if I also include that caveat in the title question. On the other hand, a lot of things are spectrum disorders. Sleep breathing problems certainly aren't black and white, right? – Ryan Mortensen Jul 20 '18 at 1:38
  • I was asking why you say it would not benefit from CPAP. What you described is OSA, so what do you base that on? – Carey Gregory Jul 20 '18 at 14:25
  • @CareyGregory Not sure if this is what OP has in mind, but at least in the US CPAP is only covered by insurance and technically diagnosed as OSA if it meets sufficient severity criteria. – Bryan Krause Jul 20 '18 at 16:28
  • In the hospital, oxygen administered via nasal cannulas is used to keep SpO2 at least above 90%. This works for narrowed airways and impaired lungs, but obviously not for closed airways. This is more of a temporary work-around bough. – Narusan Jul 20 '18 at 22:28
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Breathing difficulties during sleep determined to be caused by the narrowing or closing of their airway

Breathing difficulties during sleep indicates suffering of Obstructive Sleep Apnoea (OSA). Support is available in the UK from the charity called The Sleep Apnoea Trust Association (SATA)

There are two types of breathing interruption characteristic of OSA (NHS, 2016):

  • apnoea
    where the muscles and soft tissues in the throat relax and collapse sufficiently to cause a total blockage of the airway; it's called an apnoea when the airflow is blocked for 10 seconds or more
  • hypopnoea
    a partial blockage of the airway that results in an airflow reduction of greater than 50% for 10 seconds or more

Treatment Methods

There are 3 main forms of treatment available (NHS, 2016 & SATA, n.d.):

  • lifestyle changes
    such as losing excess weight, cutting down on alcohol and sleeping on your side
  • wearing a mandibular advancement device (MAD) - also known as mandibular splints
    this gum shield-like device fits around your teeth, holding your jaw and tongue forward to increase the space at the back of your throat while you sleep

    There are 2 forms of mandibular splints available
    • One bought in the high street
      (Cost is cheap in comparison to other methods but by personal experience, they only last a month or so at best before having to by another one.)

      These are moulded to the shape of your jawline by warming up in hot water and clenching your teeth together with the splint in place with your bottom jaw forward whilst the mould cools and sets.
    • One bought through your dentist
      (More expensive than through the high street, but said to last a few years)

      These are created and provided through your dentist in order to be custom made to fit your jaw perfectly. There are different types which you can discuss with your dentist in order to select the right one for you.
  • using a continuous positive airway pressure (CPAP) device
    (These are generally for more severe/chronic OSA and some models can be more expensive than others)

    these devices prevent your airway closing while you sleep by delivering a continuous supply of compressed air through a mask

References

NHS (2016). Obstructive sleep apnoea [Online]
Retrieved from: https://www.nhs.uk/conditions/obstructive-sleep-apnoea

SATA (n.d.). Treatment of Sleep Apnoea The Sleep Apnoea Trust Association [Online]
Retrieved from: http://www.sleep-apnoea-trust.org/sleep-apnoea-information-patients/treatment-sleep-apnoea

  • Thanks Chris. In my research, I have also come across APAP and tongue retaining devices. – Ryan Mortensen Jul 28 '18 at 15:46
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Reducing risk factors like overweight, alcohol, sedatives and smoking is important and it can sometimes be minimized by sleeping on the side rather than supine. But obstructive sleep apnea causes major health problems due to increased blood pressure (especially cardiovascular events like stroke or heart attacks) so CPAP should definitely be considered. Otherwise a good blood preassure control with medication (and with the lifestyle changes mentioned above) are essential.

You can read about it in this article: Obstructive sleep apnoea syndrome and its management

There is a section Alternatives to PAP which might be the most relevant for your question.

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