How to Manage Sleep Apnea

Some 18 million Americans suffer from obstructive sleep apnea. Here are four expert solutions:

The sleep specialist. For those who can use it, PAP (positive airway pressure) therapy is the best fix. Continuous, or CPAP, is a common type. Apnea is a form of sleep disordered breathing (SDB), which causes the airway to collapse partially or fully; pressure (applied through a mask) keeps the airway open. Sleeping pills won't work and could worsen the problem. PAP therapy can also help relieve depression and insomnia. Both may be linked to SDB.

-- Barry Krakow, MD Medical Director, Sleep and Human Health Institute, Albuquerque, New Mexico 

The acupuncturist. Depending on the cause of the problem, exercise, losing weight and quitting smoking may be beneficial. Try sleeping on your side, not your back. An acupuncturist might place needles on the nose, chest, arms and other points to open the airway and help control the problem. 

-- Anjali Hasija, LAC Satori Holistic Center and Spa, New York, New York 

The respiratory expert. If you're overweight, as most sleep apnea sufferers are, losing weight will inevitably help. PAP therapy is the gold standard, so only if that fails should you try other things, such as dental devices that push your jaw forward while you sleep. They can open the upper airway. And don't drink at night: Alcohol relaxes the upper airway, making it more likely to narrow and collapse. 

-- John Stradling, MD Professor of Respiratory Medicine, Oxford University, Churchill Hospital, Oxford, United Kingdom 

The surgeon. Surgery should be the last approach. It's the most invasive and it's only successful half the time, even in the best surgeon's hands. If PAP therapy and other treatments fail, only then should you talk to a surgeon about corrective procedures that can improve airflow through both the nose and throat. 

-- Jeffrey Schonberg, MD Otolaryngologist, Head and Neck Surgeon, Chicago, Illinois 

If your neck size is over 17 inches (16 for women), you're at risk for OSA. You may have heart problems too. And you can't exercise to drop weight if you're tired. Most folks lose weight from the neck quickly, so a 5% loss will reduce OSA symptoms. Cutting out alcohol may help.