Continuous Positive Airway Pressure (CPAP) is a small machine worn at night. It pushes air into the nose and keeps the throat open. A mask or nasal pillow placed on the face or nose prevents leak. These machines have become quite small. They sound like a fan. There are lots of masks and nasal pillows. They may cover just the nostrils, the nose, or the nose and mouth. A comfortable one is easy to find. CPAP is the best treatment for sleep apnea. It works in almost 100% of patients. However, it has to be used regularly.

The best way to find the right pressure for your CPAP is an overnight test at the Sleep & Attention Disorders Institute. Dr. Sangal will find the best mask and pressure setting that works best for you. When the pressure is too high, it’s hard to keep the CPAP on. Sleep gets interrupted. It may also cause central sleep apnea. When the pressure is too low, the sleep apnea isn’t managed properly. We will find the right pressure for you. We will find a mask that is comfortable and control any leaks.

If you’ve heard negative things about CPAP from friends or family members, rest assured your experience will be different when you are working with Dr. Sangal. First, CPAP equipment has changed over the years. Face masks are smaller and less intrusive. CPAP machines are much quieter now than older models even a few years ago were.

Most importantly, few other physicians work with patients as closely as Dr. Sangal to help them use CPAP. He will find and trouble-shoot any problems preventing you from using CPAP. If you are congested, he will treat that. If you are having trouble with the mask, the suppliers he uses will work with you to find one you are comfortable with. If you are finding the pressure a problem, he will re-adjust it. If you are having difficulty sleeping with the CPAP, he will use non-addicting medicines to help you sleep with it. In general, it is reported only 59% of patients use CPAP regularly. 90 percent of Dr. Sangal’s patients use their CPAP machines regularly with his help.

Auto-adjusting Positive Airway Pressure (APAP) is like CPAP. However, instead of Dr. Sangal determining the best pressure you should use, a computer adjusts the pressure throughout the night. It does this based on incomplete information. Airflow is normally quite irregular. To decide when you are breathing abnormally in sleep (having sleep apnea) we have to monitor not just airflow, but also breathing effort and oxygen saturation. APAP monitors only airflow, not effort or oxygen saturation. Based on incomplete information, it raises and lowers the pressure again and again all through the night. So, part of the night the pressure may be too low and you still have sleep apnea, low oxygen, and related symptoms. In other parts of the night, the pressure gets too high, and there is more discomfort, higher leaks, and arousals. The higher pressure may wake you up and you may take it off and fall back to sleep. Thus, too much pressure makes it hard for patients to use it regularly. Too much pressure can also cause central sleep apnea. The human body also adjusts to things that are constant (like CPAP), and gets used to such things. We have more difficulty adjusting to anything that is constantly changing, such as APAP. Many insurance companies require that APAP be tried unsuccessfully before switching to CPAP. If APAP seems to work, the patient stays on it. But, it is not unusual for patients to have difficulty tolerating APAP or continue to have symptoms on APAP. In that case, these insurance companies will allow us to bring you in at night and find the right pressure (CPAP) for you. Your APAP machine can then be set to CPAP mode.

Bi-level Positive Airway Pressure (BPAP) is like CPAP. When you breathe in, the pressure increases (IPAP). When you breathe out, the pressure decreases (EPAP). It is good for breathing failure. It has a limited role in sleep apnea. People who are unable to breathe out against the pressure of CPAP sometimes can use BPAP. However, BPAP is more likely to cause central apnea.

Adaptive Servo-Ventilator (ASV): It is like CPAP. It adjusts three pressures through the night. It is used if you develop central apneas with CPAP or BPAP. This is called complex sleep apnea.

There are many treatments available on the market to treat dangerous sleep apnea. Dr. R Bart Sangal has been a successful sleep medicine physician in the Greater Detroit area for over 30 years. He believes, without question, that CPAP is the best treatment for sleep apnea.

However, some patients are able to be treated successfully using other treatment methods. These include:

• Mouth devices: These go in the mouth at night. They pull the lower jaw out. Most inexpensive devices on the market do not pull the lower jaw out enough. In these cases, a mouth device won’t work for sleep apnea. Effective mouth devices are expensive. Insurance coverage is usually limited. They may work half the time for snoring and mild to moderate obstructive sleep apnea. They do not work for severe sleep apnea. They are a useful option for patients who just cannot tolerate or will not use CPAP.
• Oral pressure device: This is something in your mouth, with suction to pull your tongue out while you sleep. It is not very effective. It may help with mild sleep apnea.
• Nasal pressure device: Devices on the nose which provide resistance against breathing are not very effective. They may help with mild sleep apnea.
• Weight loss: Losing 20 percent of body weight may help sleep apnea. Losing weight is hard to do. Keeping it off is even harder. For obese patients, bariatric surgery may help.

Tonsillectomy: Removing large tonsils helps adult snoring. It does not usually control adult sleep apnea. Tonsillectomy may help child sleep apnea in children.

UPPP: Removing the uvula and the back of the palate helps adult snoring. It does not usually control adult sleep apnea.

Robotic surgery: Using a robot during throat surgery for sleep apnea does not really work any better. It helps adult snoring. It does not usually control adult sleep apnea.

Palate implants in the roof of the mouth can help adult snoring. They do not usually control sleep apnea.

Laser surgery: Surgery removes part of the uvula or stiffens part of the palate. This may help snoring. It does not usually control sleep apnea.

Radio-frequency surgery: Radio-frequency burns part of the uvula or palate. This may help snoring. It does not usually control sleep apnea.

Tongue surgery: Shaving part of the tongue with a laser or knife may help snoring. It does not usually control sleep apnea.

Nose surgery: This may make it easier to breathe and to tolerate CPAP. It does not help sleep apnea.

Jaw surgery: Both jaws are cut. They are moved out about half an inch or more. Orthodontics (braces) before surgery re-aligns the jaws. This surgery is done after a UPPP. It usually helps moderate to severe obstructive sleep apnea. It does not work quite as well as CPAP.

Tongue pacemaker implant: A pacemaker is implanted on the right side of the tongue. It pulls your tongue away from your throat while sleeping. It may work in people who have a partial collapse of the throat and are not overweight.

It is crucial that you be tested after any treatment other than CPAP to confirm if it really helped your sleep apnea.