General measures

For all adults with obstructive sleep apnoea, consider the general treatment measures outlined in General measures for adults with obstructive sleep apnoea. In some patients—especially those with mild disease with no daytime sleepiness, no impairment to daytime functioning, and no hypertension—these interventions may be sufficient. They can also be trialled before testing for sleep apnoea.

Figure 1. General measures for adults with obstructive sleep apnoea

Consider the following general measures for all adults with obstructive sleep apnoea:

  • Weight reduction—many patients with obstructive sleep apnoea are overweight, and weight reduction is beneficial.
  • Smoking cessation (recommended for all patients)—in addition to other health benefits, smoking cessation can also reduce nasal resistance.
  • Improved sleep practices (see Good sleep practices for adults)—sleep deprivation increases the likelihood of daytime dysfunction.
  • Avoidance of alcohol and drugs that can affect sleep.
  • Intranasal corticosteroid to reduce nasal resistance.
  • Positional therapy—for patients with predominantly supine obstructive sleep apnoea (identified by sleep study), suggest:
    • sleeping on the side; consider simple measures to keep the patient on their side (eg pillows behind the back, a tennis ball attached to the back of a pyjama top)
    • vibratory alarms that sound if the patient adopts the supine position
    • raising the head of the bed by 5 to 8 cm to help reduce rostral fluid shift [NB1]
    • sleeping with the neck extended and mouth closed can also help.
Note: NB1: Rostral fluid shift is a phenomenon in which extravascular fluid shifts from the lower limbs and abdomen to the thorax, head and neck while the patient is supine overnight.

Many complementary treatments (eg nasal strips, nasal dilators, snore-stop drops, ‘snore-easy’ pillows) are marketed for snoring and mild sleep apnoea, but they have little supporting data. Nasal expiratory valves have proven benefit, but are usually poorly tolerated.

Increased sleepiness increases the likelihood of motor vehicle accidents. Advise patients with obstructive sleep apnoea causing severe daytime sleepiness to stop driving vehicles and operating machinery until their condition is stabilised on treatment.

The individual driving risk should not be based solely on the severity of symptoms; consider factors such as acute sleep deprivation, circadian misalignment (eg shift work, jet lag), narcolepsy, alcohol consumption, comorbidities and other drugs. See the Austroads website for general information about fitness to drive. If there is concern about the patient’s fitness to drive, seek expert advice.