Non-surgical therapy (CPAP & Co)

Measurement at the sleep clinic
There the quality of your sleep and the function of your throat is examined with help of measuring apparatuses. To ensure that you feel comfortable the sleep clinic has modern furnished single rooms with bathroom.

Treat or not?
A treatment becomes necessary when episodes of apnea are detected during an examination at the sleep clinic or your sleep is so disturbed by snoring that you become tired during the day. Here the treatment methods can differ.

How to treat?
The treatment must be aimed at your individual results and wishes. Basically, non-surgical and surgical procedures come into question.

If you have a lot of respiratory standstills the treatment with a nose mask often facilitates sleep (CPAP). Here, air is gently brought into the throat in order to stabilise it. Respiratory standstills can thus be avoided. 
Even the use of state-of-the-art cannules or nightly wearing a splint can be successful. Under certain circumstances an operational reduction of the soft tissue in the pharynx can be useful.


CPAP (BiPAP), nightly rescue breathing

One such successful therapy implies the correct use of ventilatory support: every night for the whole duration of sleep.

The treatment with a so called CPAP (Continuous Positive Airway Pressure)-device counts to the most prescribed therapy methods for obstructive sleep apnea syndrom. CPAP devices have been used with great success since 1981. By now, a variety of types are available that differ in comfort, volume and design.
Basically, the so called BiPAP (Bilevel Positive Airway Pressure)-devices are completely identical with the CPAP-devices in use, function and effect. However, BiPAP-devices work with lower pressure during the exhalation than during the inhalation (two-phased pressurisation level) and are therefore more compatible for some patients. They are particularly recommended for sleep apnea patients that suffer from diseases of the heart or lung.

The goal: mechanical stretching of the upper airways

illustration_cpap

CPAP

The name of the device already provides insight into the functioning of the CPAP (Continuous Positive Airway Pressure)-device. The patients wear comfortable nose mask during the night that is connected to an air hose which is attached to a fan. The fan continuously transmits room air into the upper airways, gently.

Through this – generally simple – process the upper airways are widened, a so called „Luftschienung“ follows. Constriction and closures are prevented, snoring and the feared respiratory standstills (apnea) obviated.

The A & O: Individual adjustment

The sleep clinic mask and device are suited exactly to the individual needs of the sleep apnea patient so that the CPAP-device can work properly and the risk of side effects is kept as low as possible. Thereby it is not only essential to have a high fitting accuracy of the mask, but also the precise determination of the pressure-altitude which is necessary to counteract the occlusion of the upper airways. 

To determine the required pressure levels for the patients sleep and breathing the CPAP-device is used to record it, since this value differs for all patients. Depending on sleep phase and body position the required pressure level can vary considerably during a single night. When measuring, not only all the sleep stages, but also as many different sleep positions as possible must be considered. Following this, the highest pressure value required during the night is firmly set on the CPAP-device. Patients with very high pressure values possibly manage better with a BiPAP-device. Here a lower value can be set for exhalation, to lower the resistance for the inhalation.

Effectiveness

To this day, CPAP/BiPAP-devices count to the most effective methods against obstructive sleep apnea syndrome. Numerous studies show that sleep apnea patients who wear their mask regularly have the same life expectancy as people without sleep apnea. Although some patients face this form of therapy with skepticism, the majority becomes used to the device relatively fast – not least because they quickly and clearly observe a noticeable increase in their quality of life. In many cases, sleep apnea patients (Schlafapnoiker/innen) can since again actively participate in day-to-day events. High blood pressure often drops – without taking medication – to normal range.

Side effects

Despite a high effectiveness it should be stressed that CPAP/BiPAP-devices – comparable to glasses – can significantly improve the quality of life, however it definitively does not have a healing effect. So, whoever wants to seriously avoid consequential damages of obstructive sleep apnea syndrom and therefore substainably increase their life expectancy, must absolutely wear the device regularly, meaning every night.

Although about 50% of all patients complain about runny noses or itching in the nose at the beginning, however these symptoms mostly disappear after a few weeks. Now and then pressure points on the face or dry mucus membranes can also be observed. Pressure points can frequently be minimised through a still more precise mask adjustment and the dry mucus membranes can be cured through a liquid nebuliser. The feared volume of the fan was reduced to a minimum for many devices of the younger generation. We will gladly inform you in detail about further tips on how to faster familiarise yourself with a CPAP/BiPAP-device.


Protrusion splints

When does this method of treatment come into question? 

protrusionsschienenIn general, they should only be used after a sleep apnea syndrom according to valid international recommendation when the treatment cannot be executed by means of nightly nasal pressure ventilation. For the use of the treatment for snoring (primary snoring) it can be applied without restriction. 

Active principle

Protrusion splints are worn at night. They fasten the lower jaw to the upper jaw and in this way ensure that more space is created in the back area of the throat. It will also achieve an advancement of the lower jaw. Since the tongue muscle is attached to the lower jaw it moves further away from the rear throat wall. The prerequisite is the presence of a healthy dental apparatus.

Chances of success

The chances of success depend on many different factors. Wether this therapy will be promising, generally cannot be predicted. So, the splints must to be made by a dentist and the effect of a practice-phase of 1 week in the sleep clinic must be reviewed. Although the experienced doctor of sleep generally knows essential conditions that must be fulfilled to improve the probability of success.
The probability of success can be improved further when a so called Pcrit Messung is executed in a sleep clinic. The sleep clinic of the Somnolab group are able to carry out such a measurement.

Possible side effects

This method of treatment is not entirely free of side effects. They include the possibility of pain in the jaw joints with the development of an arthrosis in these joints and are not only limited to these side effects. The prerequisite for minimising side effects is the adjustment through an experienced dentist, who has knowledge in sleep medicine.

Costs 

Generally the cost of a protrusion splint made by a dentist is over 1000€. Splints that have not been adjusted individually, like the ones available on the internet, are urgently advised against. They normally don’t have a therapeutic effect.