A specialist should consider what has caused the problem and if there is a specific remedy for that. New styles of mask come on the market every few years and a mask which fits well is one of the key issues. Sometimes changing to different styles of CPAP machine may help. Self setting Autoset machines adjust the pressure so there is extra pressure when you're deeply asleep [REM or dream sleep] - a time when your muscles are very relaxed, or while you are lying on your back. There are several styles machine, which drop the pressure while you breathe out, such as C-Flex, VPAP or Bi PAP.
The sleep apnoea will go away if there is significant weight loss. This often needs to be at least 7 kg. If you subsequently gain weight, the problem will come back. Often you will need to avoid sleeping on your back, to get a reasonable result when slimmer. A mandibular advancement splint may work quite well for mild to moderate cases of sleep apnea. Often people who lose weight would need both the splint and to keep off their back at night.
If weight loss is not practical, then surgery may help. The common surgery for snoring: uvulopalatopharyngoplasty is of little practical use with major apnea. Two thirds are unchanged, one in six worse and one in six being helped somewhat.
The more complex and expensive machines are particularly useful where the required pressure is relatively high. The most common pressure is around 10 cm of water : most will cope well on the standard constant level device at up to 10 or 12 cm of water pressure. Adding a heated humidifier will give a similar result to an added 1 cm of water pressure. Heated humidifiers are particularly useful if it gets cold and dry night [eg Ipswich] or if you have grumbling nose problems like sinusitis.
It is uncommon to miss important sleep apnoea, if the sleep study includes sleep while lying on the back and dreaming. [1 in 300 cases].
Snoring can be treated by avoiding sleeping on your back, weight loss or use of a mandibular advancement splint. We often suggest that people sow 2 pockets in the pajama shirt over their lower back- each slightly off one side with Velcro to hold them closed. Place a plastic practice golf ball in each pocket. Sometimes loss of 5 kg will help snoring, often, you need to lose more than 7 kg and keep it off to stop snoring a lot.
A mandibular advancement splint will pull the tongue forward when in place and help to free up the narrow airway. This will pull the tounge foreward with it. The lower jaw can move back and forth almost 12 mm. Many styles are available. Your own dentist or a dental specialist can provide one. Cost is often $1200 some start around $500: extra cover with health funds will often pay a rebate of $120.
If there is air leak through the mouth or around the mask, while on CPAP, nose irritation may result. You are less likely to have trouble with a blocked nose if using a heated humidifier. Steroid nose sprays of the type used for hayfever such as Nasonex, Rhinocort, Budamax, Omnaris or Beconase may help. Decongestant sprays can only be used for one or two days per week - otherwise, there will be irritation of the blood vessels within the nose, causing a blocked nose by different mechanism.
Structural problems with the nose such as a deviated septum or nasal polyp may benefit from review by an ENT surgeon. In practice, surgery on the nose happens where CPAP was poorly tolerated needing higher than usual pressures, say over 12 cm water pressure.
Where a diagnostic sleep study has shown significant sleep apnoea, and you have been started on CPAP following a pressure setting sleep study, government assistance is available. You need to demonstrate two months use of a hired CPAP machine first. The mask and tubing will be at your expense. An outpatient appointment with a doctor from the public hospital sleep disorders unit will be necessary: eg. at Princess Alexandra Hospital or RBH.
Government assistance information for cost of CPAP is only relevant to QLD residents.
Where apnoea is very frequent or associated with severe drops in oxygen levels then the most effective treatment practical, such as CPAP is routine. In mild or moderate sleep apnoea CPAP is used where people have annoying symptoms particularly excessive sleepiness. Mild to moderate apnoea without sleepiness would usually be offered a combination of weight loss with posture modification and possibly also a mandibular advancement splint. ENT surgery may have a role, but often it is not adequate as sole treatment. Uvulopalatopharyngoplasty "uppp" will reduce snoring in 80%, but only one in six will have a meaningful reduction in apnoea frequency.