Myofascial (Muscle) pain, also known as chronic myofascial pain (CMP) is a syndrome categorized by chronic pain caused by multiple trigger points and fascial constrictions. The most notable feature of CMP is the presence of trigger points. In some cases the origin of pain is different from the location where a person experiences pain. Nearly everyone at some point suffers from muscle pain, commonly known as myalgia fascitis or myofascitis. CMP most often occurs in people between the ages of 30 and 60 years & affects men and women equally.
Myofascial pain is steady, aching, and deep. Depending on the condition and location the intensity can range from mild discomfort to painful and "lightning-like", in some cases knots may be visible or felt underneath the skin.
Symptoms of Myofascial Pain
- Jaw or facial pain
- Pain while talking, yawning, eating
- Deep, aching pain in a muscle
- Pain that persists or worsens
- A tender knot in a muscle
Causes for Myofascial Pain
Although the causes are unknown, few possible factors which relates to CMP are:
- Strain or injury to the muscles
- Using a muscle after you haven't used it for a while -stroke or facture
- Poor posture, poor exercise techniques
- Mechanical problems - one leg longer than the other, poor posture
- Overwork or fatigue of muscles
- Direct trauma & cold
- Anxiety or depression
The pain related with CMP might lead to problems in sleeping & pain may worsen progressively. In some cases, the pain of CMP can affect additional muscles for example, a muscle can be stressed when another muscle is affected by CMP and is not functioning properly.
Myofascial pain does not resolve on its own, even after typical first-aid self-care such as ice, heat, and rest.The muscle may be swollen or hard—a "taut band" of muscle or "knot" in the muscle, sensation of muscle weakness, tingling, and stiffness are alarming signs to seek medical attention.
It is recommended to seekmedical attention if your muscle pain which feel like aching, burning, stinging, or stabbing and is associated with specific trigger points and get worse when pressed on a trigger point persists despite rest, massage and similar self-care measures. One may experience referred pain, a feeling of weakness in the affected muscle and limited range of motion.
Treatment for Chronic Myofascial Pain
- Physical therapy includes stretching, postural and strengthening exercises.
- Medicines used ranges from non-steroidal anti-inflammatory drugs, anti-depressants, anti-convulsants to muscle relaxants.
- Massage therapy includes therapeutic massage that helps loosen tight muscles and relieve cramping or spasms.
- Injectioning a pain medicine directly into the trigger points. Trigger point injectionshas been found effective in regard to patients finding longer term relief after a few sessions. Regular TPIs provides substantial relief from pain as much as to reduce the use of severe pain medication.
- Posture evaluation and ergonomic for poor posture, workplace ergonomics or mechanical problems that might be contributing to CMP pains may provide significant relief in the early stages of treatment. Movement therapies such as Alexander Technique and Feldenkrais Method may also be helpful.
When properly diagnosed and treated, the pain associated with CMP often can be controlled.
Temporomandibular disorders (TMD) are a common subgroup of orofacial pain disorders often referred to as “TMJ” (Tempromandibular Joint), which is nothing but the name of the joint. TMJ connects the temporal bone (the bone that forms the side of the skull) and the mandible (the lower jaw). TMD can be explained as pain in the jaw joint and surrounding tissues and limitation in jaw movements.
This complex pain can originate in the joint, bone, muscles, nerve, tendons, ligaments, connective tissue or teeth and is usually a dull ache, but may be sharp and occur suddenly. Jaw sounds like clicking sound or grating sensation when opening mouth or eating is one of the most prominent features for TMD.
Symptoms of TMD
Though variety of symptoms may be linked to TMD, some of the more common symptoms include:
- Clicking or grinding noises coming from one or both of jaw joints
- Pain, discomfort or tenderness of the jaw joints and surrounding muscles
- Locking of the jaw when opening the mouth
- Reduced opening of the mouth
- Difficulty to open or close mouth
- Pain on eating and yawning
- Headache or dizziness
- Neck Pain
- Swelling on the face or tired feeling on face
TMD might affect one or both sides of face and patient may also experience toothaches, hearing problems, upper shoulder pain, and ringing in the ears (tinnitus). TMD most commonly affects young adults, but can occur in children and older people. Women may be slightly more likely to suffer from it than men.
Causes of TMD
TMD may be caused by trauma or sometimes the exact cause is not known, while other causes of TMD may include:
- Degenerative processes of the joint
- Altered movement of the disc in the joint complex
- Occlusion, Psychological factors, prescription medication may increase levels of pain
TMD is likely to occur when people are stressed or anxious for example, when studying for exams, moving house, or starting a new job. It may also affect those in jobs, where it is necessary to talk frequently or hold the jaw in an awkward position – for example musicians.
TMD can affect eating and chewing, mood and sleep, it causes significant discomfort and can affect ones quality of life.
One should seek medical intervention, in case of having persistent pain or tenderness in the jaw during rest or movement or difficulty in opening or closing the jaw completely, deviated or restricted jaw movement. A TMD specialist can discuss probable causes and treatments of your problem.
Treatment of TMD
The goals of treatment for Tempomandibular joint Disorder (TMD) are to decrease pain, to improve jaw function, and to limit the impact of TMD on daily life therefore bringing improvement to quality of life of patients. TMD is managed like other joint and muscle problems in the body, possible treatment options for TMD include:
- Trigger Point Injections (TPI) is seen as effective means to provide immediate relief.
- Radio Wave Therapy is used stimulate the joint, which increases blood flow and eases pain.
- Low-level Laser Therapy to lowers pain and inflammation and for better joint movement.
- Splint or Night Guard (complete full arch coverage worn only at night) to manage occlusal forces on the joint.
- Transcutaneous Electrical Nerve Stimulation (TENS) - To provide pain relief by relaxing the jaw joint and facial muscles.
- Medications generally prescribed are traditional pain relievers.
- Psychotherapy is highly effective in people suffering from TMD may benefit from pain management psychology by developing required coping skills to help with the effects of living with chronic pain.
- Avoidance Protocol (Soft diet, not clenching, stretching exercises etc.)
- Surgery is needed in cases of severe, constant pain or loss of function.
- Combination treatment TMD is an interdisciplinary problem which may involve synergistic working between various medical specialists.
Headaches are one of the most commonly experienced pain. Headache can be occasional, periodic or chronic in nature.
Headache is experienced through pain-sensitive structures around the head and neck including blood vessels, nerves, muscles and tissues, including the eyes, ears and sinuses. It can range in intensity from mild to tolerable to severe pain that does not allow daily activities. When headaches are recurrent and interfere with function, they become a disorder.
Headache is experienced through pain-sensitive structures around the head and neck. It includes blood vessels, nerves, muscles, tissues as well as the eyes, ears and sinuses. It can range in pain intensity from mild to tolerable to severe that hinders daily activities. When headaches are recurrent and interfere with function, they become a disorder.
Types of Headaches
Primary headache where no disease is present that is causing the headache, this includes
- Tension Type Headache
- Cluster Headaches
Secondary headache have their origin in other illnesses like an infection or tumour. Also overuse of pain medication can cause headache.
Many patients associate severe headache with migraine, but the amount of pain does not determine the diagnosis of migraine. Migraine is a headache that tends to come repeatedly in a person and is moderate to severe if left untreated.
Clinically, migraine is described as a recurrent headache lasting from couple of hours to three days. Usually it has one-sided pulsating pain, which varies from moderate to severe intensity.
Symptoms of Migraine
- Sensitivity to light, noise and odours
- Nausea and vomiting
- Stomach upset, abdominal pain, loss of appetite
- Sensations of being very warm or cold
- Paleness (pallor), fatigue, dizziness
- Blurred vision, diarrhoea (rare), fever (rare)
Causes of Migraine
Exact causes for migraine are unknown, although they are related to changes in the brain as well as to genetic causes. Pain of migraine can be aggravated by routine physical activities. It can be associated with light, sound, and even smell sensitivity which may lead to nausea and dizziness. In few cases there can be visual or sensory changes before, during or after the headache, known as auras. Migraines occur about three times more frequently in women than in men. Many migraines seem to be influenced by external factors. Possible factors include:
- Emotional stress
- Sensitivity to specific chemicals and preservatives in foods
- Caffeine, menstrual periods
- Tension, excessive fatigue
- Missing meals
- Changes in normal sleep pattern
Treatment of Migraine
Treatment often falls into three categories:
can be classified as preventive or abortive.
Preventive medications help prevent headaches which are frequent, long lasting and/or severe enough to change activities of daily living, family / social interactions and ability to work.
Abortive medications help in controlling headaches. These medications include various forms of over-the-counter and prescription medications.
include dietary avoidance, stress reduction techniques and avoidance of headache triggers.
Physical therapy and exercise
includes combination of stretching and other exercises aimed at alleviating muscle soreness in the head and neck.
usually works wonders and incorporates a combination of above treatment modes and is effective in headache treatment.
TENSION TYPE HEADACHE (TTH)
Tension type headaches are the most common type of headache and as many as 30% to 78% of the general population experience it at some time during their lifetime.Tension Type headache is a mild intensity headache that often feels like a pressure or a tight band around the head. Generally, tension headaches involve both sides of the head and can last hours to days.
Cause of TTH
Tension type headaches may be as common as a stressful work environment or a difficult personal relationship. They are not as severe as migraines and do not usually cause nausea or vomiting.
Treatment for TTH
Treatment for tension type headaches can vary but often includes anti-inflammatory medications, muscle relaxants, anti-depressants and pain medication to control the headache. Great deal of attention has to be paid to stress management and physical conditions that may bring on and/or maintain the headache.
Cluster headachesare a rare type of primary headache which appear suddenly and are experienced as severe debilitating pain on one side of the head, usually behind the eye or around the temple and are often accompanied by a watery eye and nasal congestion or a runny nose on the same side of the face.
Each headache lasts typically 30-45 minutes and often recurs at least once during the day, often at similar times. The headaches cluster in period of weeks and then goes away. A person can be pain free for months to years.
Causes of Cluster Headaches
Cause for cluster headaches are unknown, but there may be a genetic component. It more commonly affects men in their late 20s though women and children can also suffer from this type of headache.
Treatment of Cluster Headaches
Cluster headaches are treated by medications and at times an acute attack may require hospital admission for management.
Organic headache is experienced as sudden, sharp, intense or severe pain. Sudden lack of balance or falling, inappropriate behaviour, seizures, difficulty in speaking can also be associated with this type of headache.
This type of headache ismainly caused due to underlying medical disorders such as infection, tumouror stroke. Immediate medical attention is suggested in these cases.
REBOUND HEADACHE/ MEDICATION OVERUSEHEADACHE
Overuse of painkillers for headaches can ironically lead to rebound headaches. Also, over-use of medications (exceeding labelling instructions or physician's advice) can precipitate a "rebound" into another episode of headache.
Over-use of medicines can result in addiction with more severe pain when they wear off and possible serious side-effects.
Sinus headaches are related with a deep and constant pain in the cheekbones, forehead, or bridge of the nose. The pain usually intensifies with sudden head movement or straining. When a sinus becomes inflamed often due to an infection or allergic reaction it can cause pain.
Treatment for sinus is aimed at treating the infection and alleviation of other symptoms.If patient does have a true sinus headache and takes wrong medicines, it will worsen the headache.
Acute headaches are observed in children. These headaches occur suddenly and have symptoms that recede after a fairly short period of time.
If there are no neurological signs or symptoms the most common cause for acute headaches in children and adolescents is a respiratory or sinus infection. Children often experience acute pain as a manifestation of study related stress.
Neuropathic pain is a group of conditions in which there has been damage to the nerves that transmit sensation. Traditionally, neuropathic facial pain begins following an injury to the face, teeth or gums which can be through tooth extraction, trauma, surgery or sometimes routine dental procedures.
Symptoms of Neuropathic Orofacial Pain
- Sharp, shooting and burning pain in orofacial region
- Tingling and numbness / loss of sensation (commonly seen around chin area)
- Sometimes pain feels like an electrical shock and is often worse at night than during the day, pain may be constant or it may come and go.
The patient afflicted with neuropathic oral/orofacial pain may present to the dentist with a persistent, severe pain, yet there are no clearly identifiable clinical or radiographic abnormalities. Nerve or Neuropathic orofacial pain occurs in specific or generalized areas of the face, head, mouth or neck.
Causes of Neuropathic Orofacial Pain
Neuropathic pain often seems to have no obvious cause but some common causes of neuropathic pain may include:
- Vitamin B12 or thiamine (vitamin B1) deficiency
- Alcohol abuse
- Multiple Sclerosis
- Nerve compression or Nerve entrapment
- Infections such as shingles and HIV/AIDS
Types of Neuropathic Orofacial Pain
The most common orofacial neuropathic pain condition is trigeminal neuralgia. It often appears suddenly as a sharp, shooting, lightning-like pain lasting a few seconds. There may be a specific trigger area that when touched causes the pain to occur. Attacks are triggered by contact with the affected area such as the cheek, teeth or scalp.
The trigeminal nerve is the major sensory nerve to the face.Trigeminal nerve is divided into three branches on either side of the face and the pain may be in one or more branches of the nerve. Patient may suffer from trigeminal neuralgia episodes for a period of days, weeks or months and then experience a pain-free period lasting months or years. The pain is almost always unilateral and occurs nearly equally in the maxillary and mandibular trigeminal divisions while less commonly in the ophthalmic division.
Trigeminal neuralgia occurs nearly equally among males and females, though some reports have found slightly higher rates among females.
Causes of Trigeminal Neuralgia
Trigeminal neuralgia may be primary or secondary.
- Primary trigeminal neuralgia occurs in the absence of an identified cause; most cases of trigeminal neuralgia are primary.
- Secondary trigeminal neuralgia occurs because of some identified abnormality such as an intra- or extra cranial tumour or other space-occupying lesion, multiple sclerosis (MS), or trauma.
Diagnosis of Trigeminal Neuralgia
Diagnosis is based almost exclusively on the history and physical examination, imaging studies may further identify underlying disorders. A complete cranial nerve examination is essential for detecting other abnormalities that might support an underlying illness.
Treatment of Trigeminal Neuralgia
Several medical and surgical modalities of treatment exist for trigeminal neuralgia. All therapies are directed toward reducing nerve excitability/volatility. Treatment can be subdivided into pharmacologic therapy, percutaneous procedures, surgery and radiation therapy though adequate pharmacologic trials should always precede the thought of a more invasive approach.
Patients with trigeminal neuralgia believe the pain may be tooth related and seek initial care from the dentist and lead to major surgery with no relief in pain.
BURNING MOUTH SYNDROME
Burning mouth syndrome is experienced as burning in the mouth without an obvious cause which affects tongue, gums, lips, inside of cheeks, roof of mouth or widespread areas of whole mouth with a sensation of dry mouth, increased thirst, taste changes or loss of taste.
Causes of Burning Mouth Syndrome
Unfortunately, the cause of burning mouth syndrome often cannot be determined. It can be caused due to problems with taste and sensory nerves of the peripheral or central nervous system or by an underlying medical condition.
Diagnosis of Burning Mouth Syndrome
Burning mouth syndrome appears suddenly and can be severe. Certain tests are usually performed to rule out other diseases and help diagnosis of Burning Mouth Syndrome.These include:
- Blood tests to check for certain medical problems
- Oral swab tests
- Allergy tests
- Salivary flow test
- Biopsy of tissue
- Imaging tests
Treatment of Burning Mouth Syndrome
As burning mouth syndrome is a complex pain disorder.The treatment that works for one person may not work for another although medicine can help control pain and relieve dry mouth.
FACIAL PALSY (BELL’S PALSY)
The term facial palsy generally refers to weakness of the facial muscles mainly resulting from temporary or permanent damage to the facial nerve.
Symptoms of Facial Palsy
Facial paralysis has a major impact on a person’s quality of life. One may lose confidence and feel embarrassed. In addition facial paralysis can cause:
- Facial pain
- Headaches or dizziness
- Earaches, ringing in one or both ears and sensitivity to sound
- Difficulty talking, inability to express emotion
- Difficulty eating or drinking
- Drooling, muscle twitching
- Tearing of the eye
- Dryness of the eye and mouth
The greatest danger of facial paralysis is possible eye damage. Seek medical attention if you have weakness or numbness in your face, an emergency medical help right away if you have above symptoms along with a severe headache, seizure, or blindness.
Causes of Facial Palsy
Facial muscles droop or becomes weak which usually happens on just one side of the face and is almost always caused by:
- Damage or swelling of the facial nerve which carries signals from the brain to the muscles of the face.
- Damage to the area of the brain that sends signals to the muscles of the face.
- In people who are otherwise healthy, facial paralysis is often due to Bell's palsy, a condition in which the facial nerve becomes inflamed.
- Other causes include:
- Head trauma
- Head or neck tumour
- Chronic middle ear infection or other ear damage
- High blood pressure
- Lyme disease, a bacterial disease transmitted to humans by a tick bite
- Ramsay-Hunt Syndrome, a viral infection of the facial nerve
- Autoimmune diseases
Diagnosis of Facial Palsy
Physical examination and detail assessment of medical history following to which few tests will be recommended.
Treatment of Facial Palsy
Mostly those with Bell’s palsy will recover on their own with or without treatment though oral steroids and antiviral medications
can help boost chances of complete recovery.
Can also help strengthen muscles and prevent permanent damage.For patients who don’t recover fully, cosmetic surgery can help.
Facial paralysis due to other causes may benefit from surgery
. Surgery helps repair / replace damaged nerves, muscles and to remove tumours.
Some patients may experience uncontrolled muscle movements in addition to paralysis. Botox injections
that freeze the muscles as well as physical therapy can help.
PERSISTENT DENTO-ALVEOLAR PAIN DISORDER (PDAP)
Among the more common forms of neuropathic orofacial pain is PDAP called atypical odontalgia or phantom tooth pain in the past.Patient with PDAP experience a constant dull, deep, aching pain with occasional spontaneous sharp pain with no refractory period. PDAP is a persistent pain in the teeth, face or alveolar process that follows pulp extirpation, apicoectomy or tooth extraction.
Causes of PDAP
Pain is experienced in a tooth that is denervated by root canal therapy or has been extracted. The patient may also experience perverted sensations of tooth size, shape, or location which may start days, weeks, months and even years after the initial injury.
Treatment of PDAP
Treatment of PDAP is challenging and generally includes injection (local) and oral medications. Local drug application has shown some positive results, it is often combined with cognitive therapy and psychological counselling.
POST HERPETIC NEURALGIA
Post herpetic neuralgia is a complication of shingles, which is caused by the chickenpox (herpes zoster) virus. Most cases of shingles clear up within a few weeks. But if the pain lasts long after the shingles rash and blisters have disappeared, it's called post herpetic neuralgia
Symptoms of Post Herpetic Neuralgia
Patients experience this chronic pain as moderate to severe and burning. There may be dysesthesia, such as facial itching, or other unusual sensations involving the intraoral mucosa (eg, the sensation that something is stuck between the teeth). Pain is often exacerbated by mechanical contact.Intraoral pain, when present, is also constant and is perceived as arising in the mucosa or teeth; it may be aggravated by chewing. The pain of PHN is unilateral and restricted to the appropriate dermatome.
Causes of Post Herpetic Neuralgia
Once one had chickenpox, the virus that caused it remains in the body for the rest of life. As one grows older, the virus can reactivate. In few cases post herpeticneuralgia may occur when one is stressed or because of another infection or due to medications that suppress your immune system.
This condition occurs mainly in people over 40 and may affect 75% of the population by age 90 with a previous exposure to the chicken pox.
Management of this disorder can be difficult especially if pain persists for over 1 year.Post herpetic neuralgia is more common among females.One should consult doctor at the first sign of shingles, often the pain starts before you notice a rash.
Treatment of Post Herpetic Neuralgia
Currently, there's no cure for post herpetic neuralgia, but there are treatment options to ease symptoms. Therapeutic options for PHN include systemic antiviral medication.
NERVE INJURY AND NEUROMA PAIN
Neuroma occurs after a nerve is partially or completely disrupted by an injury — either due to a cut, a crush, or an excessive stretch, which can be painful or cause a tingling sensation if tapped or if pressure is applied.
In some cases, the pain associated with neuromas can cause a more generalized pain in the region of the injury. While the injury may have been localized just to the nerve, over time the pain can migrate to the non-injured adjacent skin, which becomes painful to the touch.
Diagnosis of Neuromas
Neuromas can be diagnosed by history and physical exam of patients. The areas of sensitivity are identified by tapping directly on known pathways for peripheral nerves, which should elicit the painful symptoms and often a tingling sensation.
Treatment of Neuromas
Neuroma can be reasonably well diagnosed and thus microsurgical repair is an option, use of medications (tricyclic antidepressant medications as neuropathic analgesics) often provides additional relief.
The pain location is in the distribution of the glossopharyngeal nerve, specifically the posterior tongue and lateral oropharynx and is provoked by swallowing or contact with the mucosa overlying the region innervated by the glossopharyngeal nerve.
Causes of Glossopharyngeal Neuralgia
Some possible causes for this type of nerve pain (neuralgia) are:
- Blood vessels pressing on the glossopharyngeal nerve
- Growths at the base of the skull pressing on the glossopharyngeal nerve
- Tumours or infections of the throat and mouth pressing on the glossopharyngeal nerve
Diagnosis of Glossopharyngeal Neuralgia
Diagnosis of glossopharyngeal neuralgia, much the same as for trigeminal neuralgia, is a clinical diagnosis based on the history and examination
Treatment of Glossopharyngeal Neuralgia
Treatment- It is most commonly treated with medications but when pain is difficult to treat surgery to take pressure off the glossopharyngeal nerve may be needed.
SLEEP APNEA & SNORING
Everyone knows a good night’s sleep can make or break his or her day. What most people don’t know is that sleep apnea ignored for long period of time can lead to complications of severe nature like high blood pressure, stroke, heart failure, irregular heartbeats, heart attacks, diabetes, depression and headaches.
People who suffer from sleep disorders frequently don’t even know it is happening to them. They wake up in the morning without feeling rested or have head and ear-aches and don’t even know why. Sleep apnea is a total blockage of the airway during sleep, causing the patient to stop breathing for 10 seconds or longer which causes tissues in the throat to vibrate when the patient breathes.
Types of Sleep Apnea:
- Obstructive Sleep Apnea (OSA)
- Central Sleep Apnea (CSA)
- Mixed Sleep Apnea
OBSTRUCTIVE SLEEP APNEA (OSA)
Symptoms of Obstructive Sleep Apnea
It can affect anyone at any age, even children. Obstructive sleep apnea is as common as adult asthma. Warning signs to look out for sleep apnea can be:
- Loud snoring
- Breath holding at night (apnoea)
- Daytime fatigue
- Short term memory loss
- Multiple trips to urinate through the night
- Early morning headaches
- Trouble concentrating
- Memory or learning problems
- Moodiness, irritability or depression
Causes of Obstructive Sleep Apnea
- Blockage of the airway, usually when the soft tissue in the rear of the throat collapses and closes during sleep.
- People who have smaller airways in their nose, throat or mouth. People with deviated septum in the nose might also experience OSA. Also common among people with thick or large necks.
- People who have larger than average tongue have higher chances of sleep apnea. Here the tongue blocks the airway causing OSA.
Treatment of Obstructive Sleep Apnea
Although continuous positive airway pressure (CPAP) therapy is the first line of treatment for sleep apnea, there are two main methods of treatment of OSA (obstructive sleep apnea) in patients who have been diagnosed using an overnight sleep study. These are:
Oral Appliance Therapy
An oral appliance is a small plastic device that fits in the mouth like a sports mouth guard or orthodontic retainer. Oral appliances help prevent the collapse of the tongue and soft tissues in the back of the throat, keeping the airway open during sleep and promoting adequate air intake.
Oral appliance therapy involves the selection, fitting and use of a specially designed oral appliance that maintains an open, unobstructed airway in the throat when worn during sleep. Nearly all appliances fall into one of two categories & can be classified by mode of action or design variation.
Mandibular Repositioning Appliances
Tongue Retaining Appliances - Tongue retaining appliances hold the tongue in a forward position using a suction bulb. When the tongue is in a forward position, it serves to keep the back of the tongue from collapsing during sleep and obstructing the airway in the throat.
- Mandibular repositioning appliances reposition and maintain the lower jaw in a protruded position during sleep. The device serves to open the airway by indirectly pulling the tongue forward, stimulating activity of the muscles in the tongue and making it more rigid, it also holds the lower jaw and other structures in a stable position to prevent the mouth from .
Treatment of snoring and obstructive sleep apnea with oral appliance therapy requires ongoing care which includes short- and long-term follow-up. Many patients prefer an oral appliance to CPAP which may be used alone or in combination with other treatments for sleep-related breathing disorders such as weight management, surgery or CPAP
Upper Airway Surgery. Surgery is site-specific meaning it requires the identification of specific anatomic areas contributing to airway obstruction. Depending on the location and nature of the airway obstruction the procedure may be minimally invasive or more complex.
Other options for managing OSA are weight loss, smoking cessation, decreased alcohol use, more exercise, and an attempt to better regulate the sleep/wake time.
CENTRAL SLEEP APNEA (CSA)
In CSA, airway is not blocked but the brain fails to signal the muscles to breathe. CSA occurs when the brain does not send the signal to the muscles to take a breath and there is no muscular effort to take a breath.
CSA usually occurs in adults with other medical problems. In infants, it usually occurs with prematurity or other congenital disorders. In both patient groups it is usually suspected by the primary care doctor.
CSA can be diagnosed with a sleep study or overnight monitoring while the patient is in the hospital. In infants, central sleep apnea is treated with an apnea alarm, in adults with central sleep apnea the treatment involves treating the underlying heart disease, medication interaction or other primary problem.
MIXED SLEEP APNEA
Mixed sleep apnea occurs when there is both central sleep apnea and obstructive sleep apnea, the brain rouses the person usually only partially to signal breathing to resume. As a result, the sleep is extremely fragmented and of poor quality.
Cures and preventive measures for sleep apnea range from the psychological (antidepressants) to the extreme (laser surgery to remove soft tissue). If you have severe sleep apnea, it usually won't get better on its own, so it's important to get treatment.