CPAP alternatives

CPAP Alternatives

CPAP Alternatives – Research & Treatments

There are several treatment options and CPAP alternatives for obstructive sleep apnea (OSA). Although CPAP (continuous positive airway pressure) is the most popular treatment for sleep apnea, there are other therapies available. In this section we will discuss some of the most popular CPAP alternatives.

Before we begin, let’s review CPAP.

CPAP –  the most popular treatment for OSA. It simply works by pushing air into the back of the throat acting as a splint to keep the airway open. CPAP is very safe. It generally works from the first night of treatment. One of the most common problems with CPAP is discomfort or difficulty tolerating the mask and the air pressure. Although many of the new PAP machines incorporate technologies with the goal of improving therapy compliance,  many OSA patients continue to have difficulty with this treatment option

CPAP Alternatives F&P CPAP Mask
F&P CPAP Mask

BiPAP – BiPAP, or BiLevel PAP therapy works in a similar manner as CPAP. However, instead of one single pressure, BiLevel uses two pressures – an inhale pressure and a lower exhale pressure. BiPAP/BiLevel PAP is often used for those that have sleep apnea and lung issues, like COPD. Historically, it was also used for sleep apnea patients that had difficulty tolerating CPAP.

Weight Loss – Weight loss can be a very effective treatment option for overweight and obese patients. There is a strong correlation between weight and sleep apnea. Diet and exercise work for many. However, weight loss with traditional methods takes a long time and has a high failure rate. Bariatric surgery is an option for obese patients who are unable to lose weight through traditional approaches. Bariatric surgery, like all surgeries, has a risk for complications, is associated with post-operative pain, and is not guaranteed to yield weight loss.

Sleep apnea oral appliance also called mandibular advancing devices, these

CPAP Alternatives - Variety or sleep apnea oral mouth guards devices
Variety or sleep apnea oral mouth guards devices

resemble sports mouth guards. They are specially adjusted by sleep apnea dentists. These dental devices work by moving the lower jaw forward which opens the airway wider during sleep. Many of these devices are adjustable. They are often made of plastic or silicone. Many are hinged, meaning that you can open your mouth with the device still in place. Sleep apnea oral appliances (OA’s) can cause tooth shifting and temporal manidibular joint (TMJ) pain.

Oral surgery

For adults, there are multiple surgical procedures that can be performed, and the choice among them can be based on the structures that are causing sleep apnea by blocking breathing during sleep.  Procedures can be grouped into those directed at the soft palate or other parts of the breathing passages, such as the tongue. Soft Palate procedures for sleep apnea are more common and include uvulopalatopharyngoplasty (UPPP) as well as newer procedures such as expansion sphincter pharyngoplasty or lateral pharyngoplasty that have proven better than traditional UPPP in some studies.

Hypopharyngeal procedures, including tongue radiofrequency, genioglossus advancement, hyoid suspension and partial glossectomy, can be performed alone or in combination with soft palate procedures. Jaw advancement surgery (called maxillomandibular advancement or bimaxillary advancement) is another option. In children, surgery (usually tonsillectomy and/or adenoidectomy) is a first-line option for obstructive sleep apnea, whereas surgery is typically a second-line therapy in adults.

Hypoglossal Nerve Stimulation – This is a newer therapy that involves stimulation of the nerve that controls tongue movement (hypoglossal nerve).  A system is placed inside the body during a surgical procedure.  When the system is turned on during sleep, stimulation of the hypoglossal nerve moves the tongue forward to open the space for breathing in the throat.

  • CPAP Alternatives - Snoring Mouth Picture
    Snoring Mouth Picture

Pillar Procedure – This outpatient surgical procedure uses inserted coffee-straw-like pieces inserted into the roof of the mouth. The result is a stiffening of this area which reduces collapse of the airway.

Positional therapy – sleep apnea is often worse when sleeping in the supine, or back, position. There are a few simple, as well as complex, devices that aim to prevent these people from sleeping on their back.

EPAP Valve – Expiratory Positive Airway Pressure devices work by creating resistance on exhale of breath. Current devices are adhesive and stick to the nostrils like a bandage.

Oral Pressure Therapy (OPT) is a treatment for obstructive sleep apnea that uses vacuum pressure to suction the soft palate towards the middle of the mouth with the objective of widening the nasal airway reducing or eliminating airway obstruction.

Choosing an alternative to CPAP should be done in conjunction with your physician. Sleep apnea can be a potentially deadly sleep disorder. It is imperative that the treatment that you and your physician choose is ideal for you.  Every person has unique issues. The severity of sleep apnea must be evaluated in the context of the individual’s comfort desires and personal needs.

Above are several alternatives to CPAP for the treatment of obstructive sleep apnea. Not every option is suitable for every patient. Talk to your doctor about these CPAP alternatives for the treatment of sleep apnea.

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27 Replies to “CPAP Alternatives”

  1. Randall

    I am exhausted at night. I have an extremely tough job. I am fully self employed. I own a gutter cleaning service. I am so tired of waking up on the couch. My wife gets upset with me because of how loud I snore. I am tired of the sore throat and headaches. Please tell me which mouth piece you recommend.

  2. jaredh4

    Some of those options mentioned at the end of the article are still in ‘experimental’ phase. They are not common and most clinicians are not familiar with some of them.

  3. Mark

    Hello. I’m a sleep tech in Ohio. The mouth pieces pull your jaw forward, much like they teach in CPR classes, to pull the tissue away from the back of your throat. They only cure low levels of sleep apnea.

    Some dentists do fit them, but most do not. Also, the problem with going to a dentist is that most bill though your dental insurance, and treatment for sleep apnea may not be covered under that. You would have to pay for it yourself and submit the information to your insurance for reimbursement.

    Probably the best thing for you to do is to have your family doctor order a home sleep test. There are certain criteria (CHF, neurological disorders, and the use of certain medications, among others) that would mean a home sleep test would not work, and you might have to have an in-lab study. Then, if the home sleep test does show you have sleep apnea, assuming you are otherwise healthy, your family doctor might be able to order an “autopap” device that automatically adjusts to whatever pressures are needed to clear your airway. Again, there are certain conditions that would not allow that to work for you. If those things are possible, that could be the least expensive way to get treated.

    By far, the best way to get treatment is to go to see an actual sleep specialist and see what they recommend. That may involve in-lab sleep studies. If it does, SHOP AROUND FOR THE PRICE!!! I used to work for three labs. The independent lab charged $1900. One hospital charged $3000. The other charged $6,200- all for the same test.

    The consequences of sleep apnea are severe and possibly fatal, and what you described makes it sound very much like you have it. Start with your doctor- they can get you started in the right place.

  4. Robin

    I just finished a sleep study night and the tech told me I stopped breathing so many times in one hour I was not breathing for more minutes than I was breathing. I cannot tolerate a mask strapped to my face due to my trauma history. What other options are going to help me?

  5. Barry

    It seems there are no answers offered here but I’ll put in my bit anyway. I went through the tests in hospitals twice. The first was with faulty equipment. They kept waking me to fix it. So much for the results. The next was good and showed I needed help. I bought a good CPAP device then found I needed a full face mask as my mouth opens and air rushes out making lots of noise. The full face kept my mouth closed but a sinus inflammation problem blocks my nose deep inside so I can’t breath anyway. I had a sinus operation but it came back. I only need the minimum pressure anyway. I’m a “lazy” breather and often relax so much I stop breathing for a short time, even when I’m awake. I don’t snore all night or even every night. I have a gag problem so I can’t use the mouth guard style device. Any suggestions?

    • Sylvia Robinson

      I have used cpap since 1987 and believe me i have tried most of them. I cannot do full face or nose mask does not seal or causes claustrophobia.the Pillows are better does not cover your face at all. And if your mouth tends to fall open get a chin strap. There is one I liked a lot the ‘tap pap’ my insurance didn’t cover it. One other things shop for headgear,some are very restrictive and you feel like that silence of the lamb guy. Look online at different cpap vendors see whats out there. your DME is probably only going to carry a fraction of whats out there.

  6. Lori

    There was a lot of talk a couple of years ago on a cpap message board about 2 ways to keep your lips from opening. One was using white medical paper tape. You can find at any discount store or drug store. I use the 2″high tape, I tear it off at about 2.5 – 3 inches, and tape my mouth closed. My doctors nurse was aghast, and asked me what if I had to throw up? Well, I’ve yet to wake up with an urgent need to be sick, so not too worried about that. The other way was to use a small amount of denture cream on your lips, when its on lightly lick your lips, then press them together and hold a minute for it to set up. This works as well; if you wake up with a leak, lick the spot where air is leaking through and press your lips together again. Should hold up well for at least 8-9 hours.

  7. Lori

    I wanted to finish off, this allows me to use a nasal pillow mask, where virtually nothing but the 2 nasal pillows touches my face, so all the inability to sleep with a mask should be alleviated.

  8. Deb

    I too have been evaluated a sleep lab and told I have severe obstructive sleep apnea. The Dr. told me my only option is CPAP. I am claustrophobic and cannot tolerate the machine, even with the simple nasal pillows. I would like to look into surgery but have not found anyone with experience. For now I wear a snoring mouthpiece which stops my snoring considerably and my husband is happy.

  9. Veronica Gore

    I have had my CPAP machine for over 10 years, is there any other cures for sleep apnea instead of a machine? The straps have left wrinkles on my forehead and strap intentions. Tricare no longer covers CPAP accessories I have been ordering online and that cleaning machine is 300 dollars. I seriously think we all need proper cleaning for the mask and hoses.

    • Sylvia Robinson

      Alternative cpap therapies include mouth appliance need to go to sleep dentist or sleep doctors for custom fit.

  10. Oventus

    Australia’s Oventus Medical has been working on a streamlined, compact solution in the form of their customizable titanium mouth device called the O2Vent. We’ve reported previously on Oventus and their collaboration with Australia’s Commonwealth Scientific and Industrial Research Organisation in bringing this innovative, customized breathing device to market in Australia this year.

  11. David

    I have given my full mask CPAP a chance and used it for the obligatory three months. I hate using it! I have not had a full nights sleep in three months. I hate using it ! All I hear is Darth Vader breathing all night. I hate using it! All I feel is Capt. Hook’s crocodile biting my head and face! I hate using it! In the morning my mouth is dry as Lawrence of Arabia! I hate using it!

    I really want to find an alternative. Other than a dentist making one for me, is there a mouthpiece out there that works?

    Oh……did I tell you that I hate using it?

    • Tamara Lichtenstein

      Yes! (Hearing that you hate using it). Mine was prescribed a few years ago. Tried many masks, none fit well, all leaked. I really gave it a good effort, but eventually couldn’t take it anymore–which was worse: disrupted sleep from apnea, most of which I wasn’t aware of (very high apnea score though) or disrupted sleep from the medieval contraption? Yeah… Got surgery for deviated septum (the doc said this would not replace need for CPAP but would help it work better). Not better. Pulled the machine out of the closet a couple nights ago after a terrible apnea night, the kind that reminds you this can kill you. Did okay the first night but second night, last night, woke with a horribly bloody-looking eye. So I’m online discovering that eye problems go with CPAP, not just dry eye but potentially from mask pressure. What the hell…Now I have to make up fun story (instead of boring CPAP crap) to explain at work for however long I look this way. Tired and scared to sleep, not a good combination.

      • BJ

        CANNOT TOLERATE MY MASK, I am allergic to the plastic and nose and lip gets blisters, then cannot wear it until the sores heal up.

      • Laura

        the cpap machine has to be adjusted when you have nasal or face surgery..or lose or gain some wieght..tamara get your machine adjusted..my mother had blood filled eyes that really could cause you to go blind to much pressure?just a guess..but your surgeon should have told you go back do a study get it adjusted do not even bother wearing it until then …more harm than good.

  12. Pamela Gay Conley

    I am allergic to the silicone in my full face mask. Do you or anyone else know of a full face mask made without silicone? I cannot use the Remzzz’s as they slip off at night and the fibers get into my eyes. Please email me if you have any information about an alternative mask. The Sleepweaver cloth mask is useless. I cannot seal it. Thanks

  13. Andrew

    Have a look at a product called air ring, just google air ring. It’s not available yet as it hasn’t been approved by the regulators but it looks like it will be easier to use this compared to a CPAP Machine

  14. Jim

    I have to confess that I’m mildly astonished at all the negativity surrounding the CPAP machines. For people who are reading these notes before having tried any of the alternatives, let me add a more positive experience. I have been using one for about three years, and my only real complaint is the annoyance of having to carry it around when I travel.
    The machines themselves are quiet, and a little tinkering with the strap tension and mask positioning eliminates any escaping air noise. I have used both the full face mask and the pillow; the pillow is clearly preferable.

  15. Coan C

    Like all of the people above, I too had problems for the entire time I used my CPAP. I was diagnosed by a doctor who prescribes CPAPs as if he’s using a rubber stamp. Everyone who sees this guy gets a CPAP. I used a CPAP for 9 years, reluctantly. I hated the machine and I hated the noise and the wind and the hose disconnecting during the night, and the weight of carrying the machine while traveling. Not to mention, I hated HAVING to sleep on my back. I used it, because without it, I was worse off.
    When I heard about a study being conducted by Johns Hopkins, I immediately contacted them to find out about details.
    I was lucky enough to be selected to participate in ImThera’s trial of their Aura 6000 device. What a Godsend!
    Now, without a CPAP, I am getting the best sleep of my life.
    I’m still in the trial and I’m still being followed, but the results so far are extraordinary. I’ve gone from 38 Apneas per hour to 2 per night. I get better, more restful sleep. I don’t wake up my wife, and I don’t need to carry 10 Lbs of CPAP with me wherever I go, and now, I no longer have to sleep on my back.
    In my opinion, if you are examined and have the right physiology and are willing to try, Hypoglossal Nerve Stimulation is the single best solution for Sleep Apnea.
    It works for me and I would do it again.

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