Other Somatic Treatments

Continuous positive airway pressure and bilevel positive airway pressure Continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP) are used to treat breathing-related sleep disorder (Grunstein and Sullivan 2000; Strollo and Rogers 1996). Both modalities produce a pneumatic splint to maintain airway patency during sleep. The devices consist of a nasal mask with a tight seal on the face. The mask is connected via hose to an air compressor, which maintains positive pressure through the airway. CPAP is used to treat obstructive sleep apnea syndrome and some forms of central sleep apnea syndrome. BiPAP can be used to treat patients who tolerate CPAP poorly and for patients with neuromuscular disorders that lead to impaired respiration during sleep. Humidifiers and pressure "ramps" to gradually increase air pressure may improve tolerability of and compliance with nasal pressure devices.

Surgical treatments Surgical treatments also have been used to treat breathing-related sleep disorders in some patients (Atwood et al. 1997). Procedures such as uvulopalatopharyngoplasty, laser-assisted uvuloplasty, genioglossal advancement and hyoid myotomy, and maxillomandibular advancement can be effective treatments for breathing-related sleep disorders or snoring. Successful treatment depends on correct identification of the site and type of obstruction or airway abnormality. Because multiple sites of airway collapse may be present, targeting only one area for surgical intervention may be inadequate. Postoperative morbidity resulting from pain and swelling of the airway can be significant.

Phototherapy Phototherapy uses bright, full-spectrum light and, in some instances, timed exposure to darkness to change the timing of sleep and wakefulness. Phototherapy affects the circadian timing system, as demonstrated by clear phase changes in core body temperature rhythms (Czeisler et al. 1986) and melatonin rhythms (Lewy et al. 1987). However, circadian effects may not be responsible for therapeutic effects in patients with seasonal mood disorders (Kripke 1998). Phototherapy has been used to treat not only circadian rhythm sleep disorder but also more common forms of insomnia. Side effects are few but can include headaches, agitation, and insomnia. The long-term effects of bright light on the human visual system have not been well established.