Dr Thomas Crowhurst

Treatment for sleep apnoea

Sleep apnoea and many other sleep disorders are diagnosed through a sleep study. Please see here for more information about this process.

Dr Crowhurst will explain, based on the diagnostic sleep study results, the nature of the diagnosis and its severity. He will then outline the different treatment options that are available and provide recommendations regarding which are most appropriate in your individual circumstances. Treatment of ‘sleep apnoea’ is a complex and growing area, so getting specialist advice is an important step.

Sleep apnoea is really a non-professional umbrella term that refers to a range of different problems with breathing in sleep, including the specific disorders of obstructive sleep apnoea (OSA), central sleep apnoea (CSA), mixed obstructive and central sleep apnoea, respiratory failure in sleep, and obesity hypoventilation syndrome (OHS) among others.

OSA is by far the most common of these conditions, and involves repetitive partial or complete collapse of the upper airway in sleep associated with disruption of sleep (cortical arousals measured on electroencephalography) and reduced oxygen levels (desaturations). More information about OSA can be found here. Some patients do not have ‘sleep apnoea’ but do have problematic snoring that may impact the quality of life of their partner.

Treatment options for OSA and snoring include:

Increased weight and obesity are major risk factors for OSA and, in many patients, weight loss can be sufficient to improve the disorder to a level that no longer requires any other treatment (or indeed eliminate the condition altogether). Weight loss is challenging for many patients but options to achieve it include diet and exercise (with or without input from a dietitian and / or exercise physiologist), supervised medical therapy and bariatric surgery. Dr Crowhurst can provide general guidance. Your general practitioner is the best initial medical professional to see regarding weight loss.

Positive airway pressure (PAP) is one of the most commonly used treatments for OSA and, as the name implies, involves applying air pressure to the upper airway in order to maintain patency despite the loss of muscle tone that occurs in sleep. PAP can be ‘continuous’ (C-PAP) or ‘automated’ (A-PAP). PAP is conceptually simple but complex in its application to the individual patient, and specialist input at the commencement of treatment is often very helpful.

Dr Crowhurst will explain whether PAP is recommended in your specific case and outline the advantages and disadvantages of different masks and device settings / strategies. If it is medically appropriate, he will provide a prescription for PAP therapy, along with recommendations for a number of different PAP suppliers that you can then compare before deciding on which to partner with.

More information on PAP is found on the Sleep Health Foundation website.

A mandibular advancement splint (MAS) is an oral device worn during sleep which has the effect of pulling the lower jaw (mandible) forward relative to the upper jaw, helping to improve upper airway patency in sleep. The best results are achieved from a MAS when it is used in well-selected cases (based on severity of the underlying obstructive sleep apnoea and after ensuring the particular patient has appropriate anatomy) and when it is constructed and supervised by an appropriately trained dentist. Dr Crowhurst can advise whether an MAS is worthy of consideration in your individual circumstances and provide appropriate referrals if this is an option you wish to pursue.

Otolaryngologists (ENT surgeons) can perform one or a number of different procedures in an attempt to improve obstructive sleep apnoea / snoring. Collectively these procedures are termed ‘sleep surgery’ and can involve surgery on the nose, palate and/or tongue. As with MAS, sleep surgery needs to be considered carefully based on the severity of the underlying obstructive sleep apnoea and the anatomy of the particular patient as well as the tolerance of other less invasive treatment options. Dr Crowhurst can advise whether sleep surgery is worthy of consideration in your individual circumstances and provide appropriate referrals if this is an option you wish to pursue.

A quick search on the internet will reveal a wide range of other treatment options that are offered for obstructive sleep apnoea / snoring. Examples include devices to prevent supine sleep, nasal dilators and special pillows. It can be difficult for patients to know which of these treatments, if any, is likely to be appropriate and helpful. After reviewing your sleep study and conducting a thorough clinical assessment, Dr Crowhurst will be able to advise if any of these options should be considered in your case.

If you have a more complex ‘sleep apnoea’ disorder (such as mixed obstructive and central sleep apnoea or respiratory failure in sleep), the treatments are more sophisticated and seeking specialist input from a sleep physician is strongly recommended. Dr Crowhurst can organise all of the appropriate diagnostic assessments and can facilitate access to all available therapies for these complex disorders.

More patient information regarding other treatments for sleep apnoea can be found at the Sleep Health Foundation.