How does my doctor know if I have OSA?

• Your doctor may ask you questions about whether you have symptoms of OSA.
• Your doctor or health care provider may ask you to do a “sleep study.” This is an overnight stay at a special clinic where trained professionals watch your breathing, heart rate, and other vital signs while you sleep.
• Your doctor may use a home monitor to check how often you pause or stop breathing or have less airflow when you sleep.
  • Some research found that home monitors can tell doctors if someone has OSA, though not as well as overnight sleep studies in a special clinic.
• If you have moderate or severe sleep apnea, your doctor may refer you to a Sleep Medicine Specialist. This person may be a “pulmonologist” (pronounced pul-man-OL-o-jest), an internist, or an Ear, Nose, and Throat (ENT) doctor.

Continuous positive airway pressure machine (CPAP)

• A CPAP machine pushes a stream of air through a mask you wear when you sleep. The air flows through the mask into your nose or mouth to keep your throat and airway open.
• There are many kinds of CPAP machines and masks. Some masks fit over your nose, and others cover both your nose and mouth.
• CPAP is the most common and most researched treatment for OSA. It is usually the first treatment that a doctor will suggest for OSA.

Mandibular advancement device (MAD)

• A MAD is a mouthpiece you wear when sleeping.
• There are many types of MADs. Most are made of hard plastic that covers your upper and lower teeth. Some devices also hold your tongue in place.
• The mouthpiece keeps your jaw forward and your airway open.
• These devices are sold and fitted by a dentist, or an orthodontist, who makes a mold of your mouth.

How do these two options compare to one another?

Some studies have found that:

• Both CPAP and MAD reduce daytime sleepiness and lower the number of times you pause or stop breathing while you sleep.
• CPAP is better than MAD in lowering the number of breathing pauses to less than five per hour, which is normal.
• Both CPAP and MAD have some side effects.
  • CPAP: Feeling trapped, dry nose and mouth, nosebleeds, sore gums or lips, chest discomfort and skin or nose irritation are the most common.
  • MAD: Loose or damaged teeth and jaw pain. Many people who use a MAD have to do jaw stretches in the morning or see a dentist regularly to check for teeth problems.

How long will I need to use either of these treatments?

• Both treatments need to be used every time you sleep to be effective.
• Most people will need to use a CPAP or a MAD for their entire lives.

Can losing weight help my OSA?

• Some obese (very overweight) people have reduced or cured their OSA by losing weight.
• Some studies found that weight-loss programs are an effective treatment for OSA in people who are overweight.

Are there other treatment options?

• Surgery.
  • Some people with OSA may have one or more surgeries to remove tissue from the back of the throat. This makes the airway wider.
  • Some people with severe OSA who are overweight have surgery to limit the amount of food that can be taken into the stomach. This is called “bariatric” (bear–ee –AT–rik) surgery. This helps people lose weight.
  • All surgeries come with risks, including bleeding and infection, nerve damage, and even death.
  • There may be difficulty swallowing, change in speech or voice, or narrowing of your airway after the surgery.

There is not enough research to compare surgery to the other treatments for sleep apnea. Researchers believe that surgery can improve sleep apnea, but they do not know how well and who might benefit from it most.

There are many other treatments and products you may hear about that say they can stop snoring or sleep apnea. There is not enough research to know if or how well these work.

What are the costs of treatment?

The cost to you for each treatment option depends on the type of health insurance that you have.

CPAP

• CPAP machines and supplies are considered “durable medical equipment,” which may be covered differently than medicines or other medical services. Ask your health plan administrator how much your health insurance will pay for the CPAP equipment.
• Some health plans require that you use a specific type or brand of CPAP machine and mask. Other plans will let you choose from among several brands.
• Some CPAP machines come with humidifiers, which make them cost more. Some people find that humidifiers lower side effects and make the CPAP more comfortable.
• The retail cost (before insurance payment) for most CPAP machines is between $300 and $2,000.
• The average cost of CPAP supplies (mask, tubes and filters) is between $300 and $800 per year.

MAD

• Your health plan may also cover MADs as “durable medical equipment.”
• Some health plans may not cover these devices, and other plans may cover these devices under your dental plan. Check with your health plan administrator.
• MADs may need to be adjusted or replaced. This may cost more.
• Using a MAD may require that you visit a dentist more often to check for teeth and jaw problems.
• The retail cost (before insurance payment) for a MAD is between $300 and $2,500.
• The Internet advertises mouthpieces for snoring and sleep apnea that are less expensive, but these may not help your sleep apnea. Talk to your doctor before using these devices or mouthpieces.

Weight-loss programs

• These programs range in price from several hundred dollars to several thousand dollars a month.
• Your health plan may not cover the cost of these programs, but your employer may offer discounts as part of your benefit plan.

How will these treatments fit my lifestyle?

• CPAP needs to be tested in an overnight sleep study to make sure it is helping. MAD may need to be adjusted several times by a dentist.
• It may take time to get used to either the CPAP or the MAD. They may be uncomfortable at first.
• Weight-loss programs may make you change your eating habits and will take time to show results.
• People with apnea should avoid alcohol and narcotic medications.

Ask Your Doctor

• What do you think about the research on OSA treatments?
• Which treatment option do you think is best for me?
• Are there ways to make these treatments more comfortable?
• What can I do if I cannot use the treatment every day?
• Are there less-expensive options to try first? Why or why not?

Write the answers here:

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