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Treatments Overview

Sleep can often be a barometer of your overall health. In many cases, people in good health generally tend to sleep well, whereas repeated sleeping problems may indicate an underlying medical or mental health problem, be it minor or serious.

It is not unusual to have trouble falling asleep, or feel sleepy and fatigued during the day. However, continuing sleep problems will get in the way of your daily routine and hamper your ability to function. Poor quality sleep can have a negative impact on your health. If you’re experiencing sleeping problems, learn about the signs and symptoms of common sleep disorders, what you can do to help yourself, and when to see a doctor.

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  • Self Help
  • Surgical
  • Oral
  • Cpap


Self Help Treatments

You can start by tracking your symptoms and sleep patterns, and then making healthy changes to your daytime habits and bedtime routine. If self-help doesn’t do the trick, you can turn to sleep specialists who are trained in sleep medicine. Together, you can identify the underlying causes of your sleeping problem and find ways to improve your sleep and quality of life

Keep a sleep diary

A sleep diary is a very useful tool for identifying sleep disorders and sleeping problems and pinpointing both day and nighttime habits that may be contributing to your difficulties. A Doctor my prescribe this at your first consultation so pre-empt this and move things along much quicker by keeping a record of your sleep patterns and problems will also prove helpful in finding a diagnosis and suitable treatment.

Your sleep diary should include

What time you went to bed and woke up
Total sleep hours and perceived quality of your sleep
A record of time you spent awake and what you did (“stayed in bed with eyes closed,” for example, or “got up, had a glass of milk, and meditated.”)
Types and amount of food, liquids, caffeine, or alcohol you consumed before bed, and times of consumption
Your feelings and moods before bed ­(e.g. happiness, sadness, stress, anxiety)
Any drugs or medications taken, including dose and time of consumption

The details can be important, revealing how certain behaviors can be ruining your chance for a good night’s sleep. After keeping the diary for a week, for example, you might notice that when you have more than one glass of wine in the evening, you wake up during the night.

Documents _ Sleep Diary Sheets

Improve your sleep hygiene and daytime habits

Regardless of your sleep problems, a consistent sleep routine and improved sleep habits will translate into better sleep over the long term. You can address many common sleep problems through lifestyle changes and improved sleep hygiene. For example, you may find that when you start exercising regularly and managing your stress more effectively, your sleep is much more refreshing. The key is to experiment. Use your sleep diary as a jumping off point.

Try the following simple changes to your daytime and pre-bedtime routine:

Simple tips for better sleep

The cure to sleeping problems and daytime fatigue can often be found in your daily routine. Making some simple lifestyle changes can help ensure you get the sleep you need.

Keep a regular sleep schedule, going to sleep and getting up at the same time each day, including the weekends.
Set aside enough time for sleep. Most people need at least 7 to 8 hours each night in order to feel good and be productive.
Make sure your bedroom is dark, cool, and quiet. Cover electrical displays, use heavy curtains or shades to block light from windows, or try an eye mask to shield your eyes.
Turn off your TV, smartphone, iPad, and computer a few hours before your bedtime. The type of light these screens emit can stimulate your brain, suppress the production of melatonin, and interfere with your body’s internal clock.

Excercise as a sleep therapy

Studies have shown that exercise during the day can improve sleep at night. When we exercise we experience a significant rise in body temperature, followed a few hours later by a significant drop. This drop in body temperature makes it easier for us to fall asleep and stay asleep. The best time to exercise is late afternoon or early evening, rather than just before bed.

Aerobic exercises are the best to combat insomnia as they increase the amount of oxygen that reaches the blood. Try exercise such as jogging, walking briskly, using a stationary bike or treadmill, dancing, or jumping rope. Check with your doctor first to make sure you are healthy enough for physical activity and remember to stretch before and after your workouts.

How much exercise will improve sleep?
One study by Stanford University of Medicine researchers concluded that people who performed regular, moderately-intense aerobic exercise for 30 to 40 minutes four times a week, slept almost an hour longer than those who did no exercise at all. As well as enjoying better quality sleep, the exercisers were also able to cut the time it took to fall asleep by half.

When to call a doctor about sleep disorders

If you’ve tried a variety of self-help sleep remedies without success, schedule an appointment with a sleep specialist or ask your family doctor for a referral to a sleep clinic, especially if:

Your main sleep problem is daytime sleepiness and self-help hasn’t improved your symptoms.
You or your bed partner gasps, chokes, or stops breathing during sleep.
You sometimes fall asleep at inappropriate times, such as while talking, walking, or eating.

At your appointment, be prepared with information about your sleep patterns and provide the sleep doctor with as much supporting information as possible, including information from your sleep diary.




Surgical Information Video

2 Sleep Apnea Treatment - How To Cure Sleep Apnea
Youtube Video reference to a US Based medical Program Talking about Sleep Apnea sugical treatments and cures.

Surgical Procedures

Different surgical procedures have been developed to treat the airway components that cause snoring and obstructive sleep apnea. The airway pattern and severity of obstruction vary greatly between individuals, which affects the success rate of a given surgical procedure. In general, as the severity of snoring / obstructive sleep apnea increases, so does the invasiveness of the required procedure to achieve a successful surgical outcome.

Surgical Sleep Solutions -Is Surgery Right For You?

The selection of a surgical procedure is based on numerous factors such as a patient’s preference as well as the health status can clearly influence outcomes and must be taken into consideration.

Although the majority of patients elect surgical treatment due to intolerance of non-surgical treatments, some patients may consider surgery in order to improve their ability to tolerate non-surgical treatments, such as the reduction of therapeutic CPAP pressure or improvement of nasal symptoms due to CPAP use.

In formulating a surgical plan, the most difficult task for the surgeon is to decide which procedure(s) should be utilized. Information gathered from the pre-operative/sleep study assessment, can provide useful information regarding the upper airway anatomy and the site(s) of obstruction. The severity of the obstructive sleep apnea will dictate the invasiveness of the procedures needed to achieve improvement.
The common surgical approach is to minimize surgical intervention and avoid unnecessary surgery while achieving a successful result. Therefore, the majority of surgeons favour a staged (Phase 1 or Phase 2) surgical approach. Least invasive types of surgery are attempted (Phase 1) uvulopalatopharyngoplasty or uvulopalatal flap and genioglossus/hyoid advancement are all rather limited procedures without significant surgical complications, after a healing period of four to six months, a post-operative sleep study is obtained to evaluate outcome.

In patients with persistent obstructive sleep apnea, a phase 2 maxillomandibular advancement can then be performed.

The staged approach may actually increase unnecessary surgical manipulation for some patients. Patients with factors that can negatively influence the outcome may have a low chance of success with phase I operation. Therefore, patients with severe obstructive sleep apnea, morbid obesity or significant hypopharyngeal obstruction such as severe mandibular deficiency, or patients who wish to have the best chance for a cure with a single operation can certainly be considered as candidates for maxillomandibular advancement as a primary surgical treatment option. Clearly, it is important to review all possible treatment options and explain the rationale for sleep apnea surgery. Successful surgical outcome depends on proper patient selection as well as the choice of surgical procedure. The adaptation of a logical and systematic approach to clinical evaluation, treatment planning and surgical execution is necessary in order to maximize safety and improve surgical results

Oral Appliances

Dentists specializing in sleep disorders can prescribe Oral Appliance Therapy (OAT). The oral appliance is a custom-made mouthpiece that shifts the lower jaw forward, opening up the airway. OAT is usually successful in patients with mild to moderate obstructive sleep apnea.

What is Oral Appliance Therapy (OAT)

Oral appliances, also called dental appliances or devices, may be an option for patients who cannot tolerate CPAP. Various medical associations recommend dental devices for patients with mild-to-moderate obstructive sleep apnea who are not appropriate candidates for CPAP or who have not been helped by it. (CPAP should be used for patients with severe sleep apnea whenever possible.)

Oral appliance therapy involves the selection, fitting and use of a specially designed oral appliance that maintains an open, unobstructed airway in the throat when worn during sleep. Custom-made oral appliances are proven to be more effective than over-the-counter devices, which are not recommended as a screening tool nor as a therapeutic option.

Dentists with training in oral appliance therapy are familiar with the various designs of appliances and can help determine which is best suited for your specific needs. A dental sleep specialist will work as a team with your doctor to provide diagnosis, treatment and ongoing care. A joint consultation will be required to determine the most effective treatment approach.

The initial evaluation phase of oral appliance therapy can take several weeks or months to complete. This includes examination, evaluation to determine the most appropriate oral appliance, fitting, maximizing adaptation of the appliance, and the function.

On-going care, including short- and long-term follow-up is an essential step in the treatment of snoring and Obstructive Sleep Apnea with Oral Appliance Therapy. Follow-up care serves to assess the treatment of your sleep disorder, the condition of your appliance, your physical response to your appliance, and to ensure that it is comfortable and effective.

How Oral Appliances Work
Repositioning the lower jaw, tongue, soft palate and uvula
Stabilizing the lower jaw and tongue
Increasing the muscle tone of the tongue

Types of Oral Appliances
With so many different oral appliances available, selection of a specific appliance may appear somewhat overwhelming. Nearly all appliances fall into one of two categories. The diverse variety is simply a variation of a few major themes. Oral appliances can be classified by mode of action or design variation



Continuous Positive Airway Pressure

Positive airway pressure P.A.P. (The generic term for this range of machines is CPAP) is a mode of respiratory ventilation used primarily in the treatment of sleep apnea, for which it was first developed. PAP ventilation is also commonly used for those who are critically ill in hospital with respiratory failure, and in newborn infants. CPAP is an acronym for "continuous positive airway pressure", which was developed by Dr. George Gregory and colleagues in the neonatal intensive care unit at the University of California, San Francisco.

Benefits of CPAP Therapy

Before Using CPAP

After Using CPAP

From excessive sleepiness during the day daytime alertness
From being easily annoyed being more calm
From having headaches in the morning not having them
From having memory and concentration problems being more focused
From having high blood pressure reduce or cancel the use of medication,
From depression improved quality of life.
From having weight gain problems helping lose weight.
From sexual problems in bed healthy sexual activity

How does CPAP therapy work?

Air is pushed from the flow generator through the tubing and mask. The air then passes through the nose and into the throat, where the slight pressure keeps the upper airway open. CPAP requires the user to wear a mask as it is imperative that a CPAP system must have an effective seal, and be held on securely.

The benefits

CPAP therapy side effects

Some people may find wearing a CPAP mask uncomfortable or constricting. Breathing out against the positive pressure resistance may also feel unpleasant to some patients. Some machines have pressure relief technologies that makes sleep therapy more comfortable by reducing pressure at the beginning of exhalation and returning to therapeutic pressure just before inhalation. The level of pressure relief is varied based on the patient’s expiratory flow, making breathing out against the pressure less difficult. Airflow required for some patients can be vigorous. Some patients will develop nasal congestion while others may experience rhinitis or a runny nose. However with persistance, patients adjust to the treatment within a few weeks. While CPAP side effects can be a nuisance, serious side effects very uncommon. Furthermore, research has shown that CPAP side effects are rarely the reason patients stop using PAP. There are reports of dizziness, sinus infections, bronchitis, dry eyes, dry mucosal tissue irritation, ear pain, and nasal congestion secondary to CPAP use.

CPAP Common Problems

The wrong size or style CPAP mask - Work closely with your CPAP supplier to make sure you have a CPAP mask that suits your needs and fits you. Everyone has different needs and face shapes, so the right style and size mask for someone else may not work for you. A range of CPAP masks are available. For example, some feature full face masks that cover your mouth and nose, with straps that stretch across your forehead and cheeks. These may make some people feel claustrophobic, but they work well at providing a stable fit if you move around a lot in your sleep. Other masks feature nasal pillows that fit under your nose and straps that cover less of your face. These can feel less cumbersome. And they may work well if you wear glasses or read with the mask on, because some nasal pillow systems obstruct vision less than do full face masks. However, they may not work if you move around a lot in your sleep or sleep on your side.

Pay attention to size. Most masks come in different sizes. Just because you're a certain size in one mask doesn't mean you'll be the same size in another. CPAP masks are usually adjustable. Ask your CPAP supplier to show you how to adjust your mask to get the best fit.

Getting accustomed to wearing the CPAP device

It may help to start by practicing wearing just the CPAP mask for short periods of time while you're awake, for example while watching TV. Then try wearing the mask and hose with the air pressure on, still during the daytime, while you're awake. Once you become accustomed to how that feels, shift to using the CPAP device every time you sleep — at night and during naps. Inconsistently wearing the CPAP device may delay getting used to it. Stick with it for several weeks or more to see if the mask and pressure settings you have will work for you.

Difficulty tolerating forced air

You may be able to overcome this by using a "ramp" feature on the machine. This feature allows you to start with low air pressure, followed by an automatic, gradual increase in the pressure to your prescribed setting as you fall asleep. The rate of this ramp feature can be adjusted.If this doesn't help, think about changing to a different type of device that automatically adjusts the pressure while you're sleeping. For example, units that supply bi-level positive airway pressure (BiPAP) or devices that have variable pressure contours are available. These provide more pressure when you inhale and less when you exhale.

Dry, stuffy nose

A CPAP device that features a heated humidifier, which attaches to the air pressure machine, can help. The level of humidification is adjustable. Using a nasal saline spray at bedtime also can help. Your doctor may prescribe a nasal steroid spray if your dryness doesn't respond to heated humidity. It's also important that your mask fit well. A leaky mask can dry out your nose.

Feeling claustrophobic

While you're awake, practice by first just holding the mask up to your face without any of the other parts. Once you're comfortable with that, try wearing the mask with the straps. Next, try holding on the mask and hose, without the straps, with the hose attached to the CPAP machine at a low pressure setting (turn the ramp feature on). And, finally, wear the mask with the straps and with the air pressure machine turned on while awake. After you're comfortable with that, try sleeping with it on.

Relaxation exercises, such as progressive muscle relaxation, also may help reduce your anxiety. If you're still feeling claustrophobic, talk to your doctor or CPAP supplier. It may help to get a different size mask or try a different style, such as one that uses nasal pillows.

Leaky mask, skin irritation or pressure sores

A leaky or ill-fitting mask means you're not getting the full air pressure you need, and you may be irritating your skin. It can also release air into your eyes, causing them to become dry or teary. Try adjusting pads and straps to get a better fit. If the device fits over your nose, make sure it doesn't sit too high on the bridge of your nose, which can direct air into your eyes.

You may need to ask your supplier to help you find a different size mask, particularly if your weight changes markedly, or try a different style device, such as a nasal pillow or a mask with an inflatable cushion that contours to your face. If you develop skin deterioration or sores, such as on your nose, tell your doctor promptly.

Difficulty falling asleep

This is a normal, temporary problem. Wearing the mask alone for some time during the day may help you get accustomed to how it feels. Using the ramp feature, which provides an automatic, gradual increase in the air pressure to your prescribed pressure setting as you fall asleep, also may help. And practice good general sleep habits — exercise regularly, avoid caffeine and alcohol before bedtime, and try to relax. For example, take a warm bath before you go to bed. Avoid going to bed until you're tired.

Dry mouth

If you breathe through your mouth at night or sleep with your mouth open, some CPAP devices may worsen dry mouth. A chin strap may help keep your mouth closed and reduce the air leak if you wear a nasal mask. A full-face-mask-style device that covers your mouth and nose also may work well for you. A CPAP-heated humidifier that attaches to the air pressure machine also may help.

Unintentionally removing the CPAP device during the night

It's normal to sometimes wake up to find you've removed the mask in your sleep. If you move a lot in your sleep, you may find that a full face mask will stay on your face better. You may be pulling off the mask because your nose is congested. If so, ensuring a good mask fit and adding a CPAP-heated humidifier may help. A chin strap also may help keep the device on your face. If this is a consistent problem, consider setting an alarm for sometime in the night, to check whether the device is still on. You could progressively set the alarm for later in the night if you find you're keeping the device on longer.

Annoyed by the noise

Most new models of CPAP devices are almost silent, but if you find a device's noise is bothersome, first check to make sure the device air filter is clean and unblocked. Something in its way may be contributing to noise. If this doesn't help, have your CPAP supplier check the device to ensure it's working properly. If the device is working correctly and the noise still bothers you, try wearing earplugs or using a white-noise sound machine to mask the noise. Time and patience key to success

Using a CPAP device can be frustrating as you try to get used to it, but it's important you stick with it. The treatment is essential to avoiding obstructive sleep apnea-related complications, such as heart problems and daytime fatigue. Work with your doctor and CPAP supplier to ensure the best fit and device for you, and try making adjustments if you're experiencing some of the common CPAP problems. It may take several months to find the correct settings for you and to adapt to the mask. With time and patience, CPAP can positively affect your quality of life and health.

How do i obtain a Cpap machine

In many countries, CPAP machines are only available by prescription. A sleep study at an accredited sleep lab is usually necessary before treatment can start. This is because the pressure settings on the CPAP machine must be tailored to a patient's treatment needs. A sleep medicine doctor, who may also be trained in respiratory medicine, psychiatry, neurology, paediatrics, family practice or otolaryngology (ear, nose and throat), will interpret the results from the initial sleep study and recommend a pressure test. This may be done in one night (a split study with the diagnostic testing done in the first part of the night, and CPAP testing done in the later part of the night) or with a follow up second sleep study during which the CPAP titration may be done over the entire night. With CPAP titration (split night or entire night), the patient wears the CPAP mask and pressure is adjusted up and down from the prescribed setting to find the optimal setting.

In the United Kingdom CPAP machines are available on National Health Service prescription after a diagnosis of sleep apnea or privately from the internet provided a prescription is supplied.



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