Sleep Disorder TreatmentsSleep Hygiene Education — Sleep Hygiene Education is usually recommended for all patients with sleep disorders and may be especially helpful for insomnia. This involves a discussion specific to the patient’s own habits and difficulties, as well as reading materials to inform patients about healthy sleeping habits.
Continuous Positive Airway Pressure (CPAP) — A Continuous Positive Airway Pressure (CPAP) device is considered the gold standard and mainstay for treating sleep apnea. It involves wearing a mask to bed and may take awhile before a patient is comfortably able to sleep throughout the night with it. Masks now come in a wide variety of shapes and sizes from full face covering to just the nostrils (nasal pillows), and recent machines have become much quieter.
Oral Appliances — Oral Appliances may be an option for those patients unable to tolerate a CPAP and who do not have severe disease. These are customized and fitted by a dentist who has completed further training and certification in dental sleep medicine or orofacial pain.
Positional Therapy — Utilizing products designed to keep patients sleeping on their sides, rather than on their backs. Useful when snoring or apnea worsens when sleeping on one’s back as compared to sleeping on one’s side. Examples include wedges, shirts with tennis balls sew into the upper back, and recently Night Shift. Night Shift applies vibration to the back of the neck when positioned on your back until you change to sleeping on your side. Many such products can be purchased on the internet; however, Night Shift first requires a doctor’s prescription after meeting certain criteria on a sleep study. These devices may be used alone for snoring, or in addition to a CPAP or oral appliance therapy.
Medically Supervised Weight Loss — Medically supervised weight loss is recommended for sleep apnea patients with an abnormally high body mass index (BMI). A reduction of 10% of the bodyweight is associated with a 26% improvement in the apnea hypopnea index (AHI) value. This is an index obtained from a sleep study to denote the severity of the disease. This means that for most patients a lower CPAP pressure would be needed, and for some patients with mild disease the device might no longer be necessary.
Provent — Provent is a disposable flap of material worn over each nostril which has recently become available by prescription, but only recommended for mild apnea.
Surgery — Surgery is an option for some patients with certain anatomical abnormalities and severe apnea, but is not considered a standard of care.
Behavioral Therapy & Medication — Therapy for insomnia may involve either behavioral therapy, medication, or both. Behavioral therapy refers to many different techniques including relaxation, stimulus control, temporal control, sleep restriction, cognitive therapy, and cognitive-behavioral therapy which may include all of the former. Initial improvement may be faster with medication, however, benefits are more long term after behavioral therapy. We now offer on line cognitive therapy training for our patients’ convenience. Medication is generally for short term use and may have untoward side effects, such as daytime sleepiness.
Bright Light Therapy — Bright light therapy (2,500 to 10,000 lux) and melatonin are used to treat circadian rhythm disorders such as jet lag disorder, or shift work sleep disorder. Timing of light therapy or melatonin administration is crucial for success. The 24 hour peak in a patient’s melatonin level must first be determined before the timing can be established with the goal of gradually resetting the patient’s intrinsic sleep wake cycle to match the desired external cycle. The effect of oral melatonin usually wears off after 30 minutes.
Pregnancy and Sleep — Sleeping on your side, rather than on your back is usually best for the health of both the mother and fetus. This position optimizes circulation by relieving pressure on the maternal inferior vena cava, the large vessel that returns blood to the heart. Positional therapy devices traditionally used for patients with positional obstructive sleep apnea are also useful during pregnancy.
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