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Does Sleep Apnea Go Away?

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Updated August 01, 2013

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Question: Does Sleep Apnea Go Away?
Answer:

It is a common question raised by many people with the diagnosis: Does sleep apnea go away? Learn a little about the underlying causes of sleep apnea, whether there is a potential for it to go away, and what risk factors can be modified that might improve the prognosis.

Considering the Causes of Sleep Apnea

Obstructive sleep apnea occurs when any part of the airway from the tip of the nose to the lungs collapses during sleep and disrupts breathing. As such, it is often due to a person’s underlying anatomy. A deviated nasal septum or enlarged turbinates in the nose may disrupt airflow. A floppy soft palate, big tonsils or adenoids, or a large tongue may block the passage at the throat.

The lining of the airway itself may prove to be an obstruction. Chronic snoring leads to vibration of the airway and damage. This may contribute to swelling along the passage that narrows it even further. In time, nerve receptors may become less responsive, and the muscles may not be able to keep sufficient tone to support the airway. Weight gain, especially when it leads to a large neck, may also worsen the situation.

Sleeping on your back may allow the tongue to fall back into the airway, further contributing to obstruction and sleep apnea. The use of alcohol, especially in the few hours prior to sleep, may make the airway muscles more collapsible as well. All of these various contributions must be taken into account when considering whether sleep apnea can go away.

Can Sleep Apnea Go Away?

For the most part, sleep apnea is a chronic condition that does not go away. Anatomy tends to remain fixed, especially after adolescence has ended. Therefore, children with sleep apnea may retain hope for the condition bring successfully and definitively treated. The removal of tonsils and adenoids with tonsillectomy and adenoidectomy may be very beneficial in children. The treatment of allergies and expansion of the hard palate with an orthodontic therapy called rapid maxillary expansion may prove helpful. After growth has ended, there remain additional treatment options.

Teenagers who have completed puberty and other adults have surgical options available to them that may prove useful. The most successfully is jaw advancement surgery. This procedure, also called maxillo-mandibular advancement, can be highly effective, resolving sleep apnea in upwards of 80% of people. It involves major surgery in which the jaw bones are surgically broken, moved forward, and then fixed in place, typically with titanium screws and plates. This changes the facial profile. Recovery typically takes several months.

Other surgeries can also be used to change the anatomy, but, in general, these procedures are less effective. These options include surgery on the soft palate such as the uvulopalatopharyngoplasty (UPPP) as well as septoplasty to repair a deviated septum. In addition, radiofrequency ablation of the nasal turbinates may provide some relief to nasal congestion and obstruction. Debulking of the base of the tongue and movement of the tongues anchors (called hyoid advancement) are also sometimes performed.

In addition, there are some risk factors that are modifiable with other changes that do not require surgery.

Changing Risk Factors for Sleep Apnea

Apart from surgery, there are some things that can be changed that will actually reduce the severity or even the presence of sleep apnea. If you are overweight or obese, weight loss can be a key part of fixing sleep apnea. Fat or adipose tissue can line the airway, contributing to the narrowing and risk for airway collapse. Weight loss can have a positive effect on this risk.

The muscle tone lining the airway can be improved through targeted exercise. Studies have demonstrated the positive effects of circular breathing techniques used to play the didgeridoo as well as tongue strengthening exercises called myofunctional therapy.

Unfortunately, muscle bulk and tone is lost with aging, and without counteracting these effects, this inevitably leads to a worsening of sleep apnea. In addition, women who pass the age of menopause during which the protective effect of progesterone and estrogen are lost, may also experience a gradually worsening of sleep apnea with aging.

Keeping the nasal passage open by treating allergies with nasal steroids can also be helpful. Medications such as Nasonex, Flonase, and Rhinocort may prove beneficial in this regard. To counteract the effects of gravity in collapsing the airway, especially in shifting the tongue backwards, it can be helpful to sleep on your sides. In addition, raising the head of bed to 30 to 45 degrees by propping it up on books or even cinder blocks may also be useful.

Finally, though sleep apnea may not be avoidable in most circumstances, the good news is that there remains an effective treatment: continuous positive airway pressure (CPAP). This constant flow of air keeps the airway open and prevents its collapse. Much like a pair of glasses, it only works when it is used, but it can be highly effective for those who can tolerate it.

If you have further questions about the treatment of obstructive sleep apnea, you can speak with your sleep specialist about the treatment options available to you. Fortunately, there are many treatment options available, even if it is a condition that does not necessarily go away on its own.

Source:

Kryger, MH et al. "Principles and Practice of Sleep Medicine." Elsevier, 5th edition. 2011.

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