Sleep apnea treatment is vital in mitigating the effects of long-term exposure to its symptoms. There are numerous treatment modalities available to clinicians and each has its own clinical indications. The treatment modalities as well as their efficacy and indications are discussed below.

Surgical Treatment. Surgical treatment for sleep apnea targets four different areas of the upper airway. These include the nasal region, the soft palate, the tongue, and the mandible. Surgery in the nasal region is usually ineffective at reducing the severity of sleep apnea, but is frequently used to improve Positive Airway Pressure (PAP) therapy adherence, as it unblocks the nasal passage and reduces mouth breathing.

Surgery is indicated in cases where abnormal anatomy is the cause of sleep apnea. For example, patients with retrognathia (unusual positioning of the mandible) would benefit significantly from surgery. The efficacy of surgical treatment varies depending on the suitability of the procedure for the patient, and the type of surgery conducted. In many cases, surgery is not a long-term solution and alternative treatment must be sought after 5 years, or additional surgical procedures must be undertaken .

Behavioural Therapy. This treatment method is aimed at addressing the habits and elements of a patient’s lifestyle that may be contributing to their condition. These therapies include weight loss, positional therapy (changing their sleeping position), exercise, and avoidance of sedatives or alcohol before sleeping.

This treatment is often considered before other treatment methods or is considered in parallel to receiving other treatment. It is also advised for patients with mild sleep apnoea who do not tolerate PAP therapy. This is because it is minimally invasive and produces good long-term results as it reduces the effects of underlying habits that cause or exacerbate sleep apnoea. The efficacy of the treatment is patient-specific as it depends on the cause of sleep apnoea. Behavioural therapy is not a short-term treatment option, especially for patients with moderate to severe sleep apnoea. PAP therapy is still usually advised initially for such patients.

Oral devices. Oral devices are used while the patient is asleep. They can have long-term effects on dental health, including bite changes, and so benefits need to be weighed against the long-term effects. There are two main types of oral devices. Mandibular repositioning appliances (MRA) and tongue retaining devices (TRD).

A TRDs is suitable for patients with macroglossia (enlarged tongue) or for patients whose condition worsens when in the supine position. MRAs are suitable for patients who do not exceed their ideal body weight by more than 30% or for patients with retrognathia. Both devices are only suitable for patients with mild sleep apnoea and are only considered if they do not tolerate PAP therapy.

Lastly, Positive Airway Pressure (PAP) Therapy. PAP therapy is regarded as the gold standard for treating sleep apnoea and the AASM suggest that PAP therapy is the treatment of choice for all patients with sleep apnoea.

PAP therapy is the application of positive air pressure to the patient’s upper airway so that the airway is supported and does not collapse. The pressure is applied via a mask that either covers the nose and mouth or just the nose. There are different modes of PAP therapy, with each of them being used for different situations. The most common form is Continuous Positive Airway Pressure (CPAP) and is used for patients with mild, moderate, and severe sleep apnoea. It is used for the vast majority of patients with sleep apnoea.