Snoring and sleep apnoea treatments?

Traitement

There are a large number of snoring and sleep apnoea treatments which vary in effectiveness and in price.

Treatment by CPAP

Sleep apnoea is treated in the majority of cases by fitting a continuous positive pressure device (CPAP).
This machine is registered on the French list of reimbursable products and benefits (LPPR), and is available as a rental package.
In France, cover is provided following a health insurance agreement filled in by the GP at the time of the first prescription for a probationary period of 5 months, then once every year when the agreement is renewed.

The treatment costs from €1,600/year.

Mandibular advancement orthesis

This is a double mouthguard that advances the lower jaw forward during sleep. The tongue is therefore lifted from the back wall, freeing airflow.
This model is custom-made by dentists and oral surgeons. They therefore fit perfectly, but are very costly.
The orthesis can be prescribed as “first-line treatment” for light and moderate sleep apneics who are not considered to be at high cardiovascular risk, nor suffer from excessive daytime sleepiness.
Producing a custom-made mouthguard is a complicated and costly procedure and dentists do not always have the time or the necessary skills.

The cost can range from €800 to €1,800.

Surgery

Surgery known as uvulopalatopharyngoplasty (or UPPP) is the most common form of treatment and consists in widening the pharynx by removing the back of the soft palate and the uvula.
The tonsils can also be removed if they are obstructive.
The procedure is recommended for snoring when apnoea is not so frequent (A.I. less than 20/25) and does not have a significant impact or cause functional problems.

Laser surgery

Other techniques for treating snoring have become popular in recent years such as laser treatment, which involves vaporising the uvula and the soft palate, or bending the palate by radial waves, leaving the tonsils in place.
This procedure is carried out over several sessions under local anaesthetic and is sometimes painful. It is less effective than conventional surgery.

Radio frequency

A more recent treatment is radio frequency, which consists of heating and tightening the palate using a probe which emits a localised beam of microwaves.
This treatment is less aggressive but nonetheless painful, and has not yet been shown to be greatly effective, at least in the medium to long-term.

Oropharyngeal Airway

This is a simple system, derived from the Guedel airway, that is used on patients to prevent them “swallowing their tongue” when coming round from anaesthesia. This device prevents the tongue base from blocking airflow to the larynx.
It consists of a flexible silicone tube which is placed in the mouth. An external filter removes dust from the air and humidifies it.
An elastic band holds the filter in place and keeps the flexible tube in the mouth during sleep.
Air is therefore able to flow freely to the larynx, noiselessly and unobstructed.
This simple device is effective in treating snoring and sleep apnoea.
Only tolerance, linked to possible gag reflexes, can pose problems.
This system, which can be used to treat snoring, is currently being assessed for treating sleep apnoea.

Other treatments

Oral or nasal sprays contain oils or other “natural” products. They largely have a psychological and placebo effect. Their widespread distribution is based mainly on marketing considerations.
Nasal strips or dilators improve only the flow of air into the nostrils but do not actually treat snoring.
Anti-snoring pillows or any other hyperextension system can be effective to a certain degree by improving airflow.
Electric wristbands or other electronic devices that detect snoring can cause the sufferer to change position so that they sleep on their side or stomach.
Moderate snoring can be eliminated using this device provided that the intensity of the pulses is adjusted in advance so as not to awaken the snorer.
Losing weight is always recommended in patients who are overweight. Reducing the volume of the tongue base and the pharyngeal tissues will improve airflow.

Sleeping on one’s side or, even better, on the stomach: sleeping on one’s back brings the tongue toward the back of the palate, reducing the space for airflow.

This can be avoided by placing a small ball in the back of one’s pyjamas or using an anti-snoring T-shirt. Changing position cannot eliminate severe snoring, but can eliminate moderate snoring.

 

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