What treatment options are available?

Depending on the risk profile of the affected person, various therapeutic measures can either lead to a cure or at least to a more significant improvement of the symptoms and thus to a reduction in the incidence of secondary diseases.

Basic therapy (conservative therapy) for mild forms and corresponding patient profile:

Weight reduction; avoidance of alcohol (at least in the 2 hours before going to bed), nicotine, and sleeping and sedative medications; adherence to a regular sleep cycle; possibly avoidance of a supine position during sleep, in which the tongue falls backwards due to gravity and is a relevant respiratory barrier when muscle tone is low. A positive effect of theophylline, a drug that increases the central respiratory drive, is also described.

Mechanical therapy (apparatus therapy) for mild to severe forms and corresponding patient profile:

In (nasal) ventilation therapy using CPAP (continuous positive airway pressure), a breathing mask (usually a nasal mask) is used to create a slight positive pressure in the upper airways, from the nasal entrance to the trachea, so that these are kept open permanently. In this context one also speaks of a “pneumatic splinting”. Ventilation is performed using room air, and additional oxygen treatment is possible.

A variety of systems from different suppliers are available. The individual adjustment is carried out in the sleep laboratory or also on an outpatient basis. If necessary, adjustments are necessary, e.g. in case of weight changes.

As a rule, the ventilation system must be used every night and for the rest of the patient’s life. This can be perceived as annoying. One of the side effects that can occur is drying out of the mucous membranes in the nasopharynx, which in turn can be counteracted with an additional humidifier.

Since the counterpressure generated by the CPAP device can be strenuous when breathing out, switching to a BiPAP device is an alternative. This is a self-regulating system in which the pressures are reduced when the device is switched on.

(Nasal) continuous positive pressure ventilation (nCPAP)