Treating mild sleep apnea: Should you consider a CPAP device?

Obstructive sleep apnea (OSA) is a disorder in which the upper airway is blocked, either partially or completely, many times during sleep. This causes waking up and changes in the amount of oxygen in the blood while sleeping. As a specialist in sleep medicine, OSA is one of the most common problems I see. This isn’t surprising, since OSA affects about 20% of the general population and is even more common in people who are overweight or have heart or metabolic diseases like diabetes.

If OSA isn’t treated, it can hurt your heart and metabolism, lower your quality of life, and cause you to sleep too much during the day, have trouble sleeping, have trouble thinking, and feel depressed or anxious. OSA affects people of all ages, backgrounds, shapes, and sizes. Over the past few years, both patients and doctors have learned more about OSA and how it affects people, but about 80% of people with OSA are still not diagnosed.

How is OSA found out?

The apnea-hypopnea index (also called the apnea-hypopnea index) is a measure of how bad OSA is. It is based on how many times breathing stops and starts during an hour of sleep (AHI). In general, the sleep apnea is worse the higher the AHI. Most population studies show that about 60% of people with OSA are in the mild category. In general, many studies show that there is a linear relationship between the AHI and bad health outcomes. This gives strong support for treating moderate and severe OSA, but there is less clear evidence that treating mild OSA has clinical and/or cost-effective benefits.

Not always do scores for OSA match up with symptoms.

No matter what criteria are used to classify OSA as mild, moderate, or severe, the severity of the disease does not always match the severity of the symptoms. In other words, some people with very mild disease (based on their AHI) can have a lot of symptoms, like being overly sleepy or having severe insomnia, while others with severe disease feel like they sleep well and don’t have a lot of problems during the day.

Sleep disorders often happen at the same time, and people with OSA may also have insomnia, circadian (body clock) disorders, sleep movement disorders (like restless legs syndrome), and/or hypersomnia (such as narcolepsy). To really help a patient sleep better and do better during the day, you need to know a lot about their sleep history and take a comprehensive, multidimensional, and individualized approach to their sleep problems.

How you are treated depends on how bad your OSA is.

When sleep apnea is moderate or severe, the first-line treatment is continuous positive airway pressure (CPAP). This is the treatment that the American Academy of Sleep Medicine recommends (AASM). By stopping snoring, breathing problems, and drops in oxygen saturation, CPAP can make breathing during sleep more normal. But for CPAP to work best, it should be worn the whole time you sleep. Unfortunately, many studies of OSA set a low bar for treatment adherence (many use a four-hour-per-night threshold) and don’t always take treatment effectiveness into account (whether sleep apnea and related daytime symptoms persist despite treatment).

What about sleep apnea that is mild?

People with mild sleep apnea haven’t always had the same outcome data or been on the same page about how to treat them. Still, several studies have shown that treating mild OSA improves quality of life. For example, in a recent study published in The Lancet, researchers from 11 centers in the UK recruited and randomly assigned 301 patients with mild OSA to receive CPAP plus standard of care (sleep hygiene counseling) or standard of care alone, and then followed them for three months. Based on a validated questionnaire, the results showed that people with mild OSA who were treated with CPAP had a better quality of life.

This study shows that a whole-person approach is the best way to diagnose and treat mild OSA. Even though CPAP may not be necessary for everyone with mild OSA, it can be very helpful for some people.

It may take you and your doctor a few tries to find the right treatment.

When sleep apnea is mild, the best way to treat it isn’t always clear. It depends on how bad your symptoms are, what you want, and if you have any other health problems. You and your doctor can take a step-by-step approach. If one treatment doesn’t work, you can stop doing it and try something else. Managing mild sleep apnea involves making decisions with your doctor. You should think about how much your sleep apnea symptoms bother you and what other parts of your health could get worse if you don’t treat your sleep apnea.

Take-home suggestions

Approaches that are safe for mild OSA:

Try to sleep on your side as much as possible and not on your back.

Optimize weight if you are overweight or obese. Even losing 5 to 10 pounds can help with mild OSA.

Take care of allergies and stuffy noses.

Don’t drink alcohol or take medicines that slow your breathing right before bed.

Make sure you get enough sleep and that you sleep and wake up at about the same time every day of the week.

If you have bothersome OSA symptoms, such as loud, disruptive snoring, long pauses in breathing, repeated nighttime awakenings, restless sleep, insomnia, trouble thinking, or too much daytime sleepiness, or if you have serious health problems that could be made worse by OSA (even if it’s mild), such as arrhythmia, high blood pressure that needs multiple medications to control, stroke, or a severe mood disorder, you should think about getting medical treatment(s) for OS

The medicines used to treat mild OSA are:

continuous positive airway pressure device (CPAP)

a dental appliance to treat sleep apnea

a checkup with an ENT to see if there is a physical problem (like a severely deviated nasal septum) that could be causing OSA or making it worse.

Talk to your doctor if you think you might have OSA.

Your doctor may tell you to get a sleep study or send you to a sleep medicine specialist based on your symptoms, exam, and risk factors. Since sleep disorders tend to overlap, a full sleep assessment is needed to figure out what’s going on with sleep complaints. If you have mild OSA, treatment may help you feel better and improve your quality of life. But when it comes to sleep disorders, there is no one-size-fits-all solution. Instead, you need to try different things until you find what works for you.