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Lose Weight Before Trying Other Sleep Apnea Treatments

So your snoring is driving your partner crazy. Does that mean you're destined for one of those awkward-looking sleep apnea masks?

Not so fast, doctors say. Many snorers don't have sleep apnea, which causes a person to frequently stop breathing for brief periods during sleep. It's a big cause of chronic sleepiness and has been linked to a variety of health problems. Sleep apnea can also make a sufferer miserable.

"Poor concentration, daytime sleepiness, high blood pressure, certainly overweight, people who are complaining about a lot of fatigue, all of those ought to make us wonder if a patient has sleep apnea," says Dr. Molly Cooke, president of the American College of Physicians, which issued new guidelines on treatment of sleep apnea Monday. They were published online in Annals of Internal Medicine.

The big surprise here is that the doctors didn't find any evidence that sleep apnea boosts a person's risk of death. That's been commonly assumed to be true.

But the guideline committee didn't find any research that measured risk of death, heart disease or stroke in people with sleep apnea. "I had gotten it into my head that sleep apnea increased the risk of premature death," Cooke told Shots. "That turns out not to be true."

The reviewers also found out that surgery didn't help most people, even though it's been heavily promoted for sleep apnea.

"Surgery should be used as a third or fourth option if it's used at all," Cooke says. It can cause short-term problems like excessive bleeding, and long-term problems with swallowing. "It's not the get-it-over-with panacea that people sometimes think it is."

For most people, the guidelines say, the first and best treatment is simple and obvious — lose weight. "Not everyone with sleep apnea is overweight, but most patients are," Cooke says. Losing weight gets rid of fat that blocks the windpipe. It would "not only fix your sleep trouble, it would help your cholesterol, it would help your knees, your clothes would fit better and you would be a happier person," she says.

Patients who still have symptoms at that point might need to go to a sleep clinic and do an overnight test for apnea.

For people who are diagnosed by a sleep clinic, the No. 2 treatment of choice is CPAP, or continuous positive airway pressure.

It involves a pump that delivers pressurized air to a patient's nose and keeps the airway open. But it requires wearing a tight-fitting face mask during sleep, which really bothers some people. The studies reviewed here show as many as one-third of people bail on CPAP.

Don't fear the CPAP mask, says Dr. Safwan Badr, a sleep physician and president of the American Academy of Sleep Medicine. "I can tell you that CPAP is a lot more comfortable than it was 10 or 15 years ago."

The machines are a lot quieter, Badr tells Shots, and no longer sound like there's a hurricane in the bedroom. But the biggest improvement is the addition of heated, moist air. Without it, the inside of the nose gets dried out and generates secretions to compensate. "The whole airway becomes congested."

CPAP does have its challenges. "Try to sleep with your eyeglasses; it takes getting used to," Badr says. A doctor has to invest time in explaining why it's worth trying, he says, and then follow up and troubleshoot any problems.

For patients who just can't hack the mask, the guidelines suggest trying something called a mandibular advancement device that moves the lower jaw forward a bit, making more room in the back of the throat. It's a little like a bite guard. But CPAP should come first, Cooke says. "CPAP corrects more of the abnormalities that are seen in a sleep study."

Badr is also a big supporter of CPAP. "At the end of the day, what we're trying to do is pressurize that airway, one way or another, and keep it open," he says. "That's the mainstay of treatment, and it will be."

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