What treatment is available for sleep disordered breathing

Author: Sharon Jang | Reviewer: Viet Vu | Published: 10 March 2020 | Updated: ~

CPAP and BiPAP are powered by a machine which regulates the flow of air. These machines are connected via a tube to a mask worn over the nose and mouth..⁹

The first line of treatment for sleep disordered breathing generally includes lifestyle changes consisting of weight loss and the avoidance of alcohol and smoking. These lifestyle changes are normally done in conjunction with the use of a continuous positive airway pressure (CPAP) machine. CPAP machines act as a “pneumatic splint” that holds the airway open using a continuous pressure of air. To use a CPAP machine, a mask or nasal pillows are worn over the face/nose overnight.

CPAP machines are commonly used to address sleep apnea, and their effectiveness for the SCI population is supported by some weak evidence research studies. Although CPAP machines can help with breathing, multiple weak evidence research articles report poor adherence in using CPAP machines. Some of these reasons include:

• Difficulties putting on the mask, especially among individuals with limited hand function
• Mask discomfort
• Feelings of claustrophobia
• Decreased sleep quality/hard time falling asleep with it on

Although CPAP machines have the potential to help with sleep disordered breathing, more research is required to determine how helpful CPAP machines are to individuals with SCI, and how we can improve adherence to this treatment.

Bilevel positive airway pressure (BiPAP) machines operate similarly to CPAP machines in that air pressure is acts as a “pneumatic splint”. however, BiPAP machines do not deliver a constant pressure of air. Exhaling when using a CPAP machine may be difficult, as breathing against an inflow of air requires effort. The BiPAP machine is unique as the pressures it exerts varies with inhalation/exhalation. Normally, the BiPAP machine will be set to a higher pressure for inhalation, and to a reduced pressure during exhalation to facilitate this process. While there have been some thoughts that BiPAP machines may benefit the able-bodied population, more research is required to determine the effectiveness of BiPAP machines in an SCI population. It is worth a discussion with your doctor if you are not tolerating a CPAP machine to trial a BiPAP machine to treat sleep apnea.

An example of a dental appliance. A gap exists between the teeth to help promote airflow when sleeping.¹⁰

Dental appliances are sometimes an alternative to CPAP if an individual exhibits mild sleep disordered breathing. Dental appliances fit in the mouth like a mouth guard, and help pull the jaw and the tongue forward to prevent obstructive sleep apnea by opening up the airway. Although there has been a lot of literature supporting the use of dental appliances in an able-bodied population, more research needs to be conducted in an SCI population.

In the UVPPP surgical procedure, extra tissue is removed from the roof of your mouth and/or from your throat.¹¹

Surgical interventions for sleep disordered breathing are often the last resort, after CPAP or BiPAP fail to work. There are a variety of surgical procedures that are used to aid obstructive sleep apnea, many of which involve reducing or repositioning the soft tissue at the back of the throat. One of the most common surgical procedures is an uvulopalatopharyngoplasty (UVPPP), whereby the soft tissues at the back of your mouth and throat are reduced and removed. However, the success rate for this procedure is variable, and there is only weak evidence to support this technique in able-bodied populations. Moreover, sleep disordered breathing in SCI may result from complex interactions between a variety of factors including level of injury, weight, sleep position, and medications. Although obstructive sleep apnea is common in SCI, researchers are unsure whether it stems from the structure of the throat or changes accompanied by an SCI. The evidence for surgical procedures to aid obstructive sleep apnea after SCI is sparse and requires more research.