If you are having difficulty adjusting to CPAP (continuous positive airway pressure) treatment, there are several other alternatives to CPAP for sleep apnea. Although CPAP is the most popular treatment for this sleep disorder, there are other therapies available that may be more effective or comfortable for you.
In this section we will discuss some of the most popular CPAP alternatives, although you should always consult with your doctor before deciding which treatment plan is right for you.
BiPAP for Sleep Apnea
BiPAP, or BiLevel PAP therapy, works in a similar manner as CPAP. Instead of one single pressure, BiPAP uses two pressures – an inhale pressure and a lower exhale pressure. BiPAP is often used as an alternative to CPAP for sleep apnea when patients also present with lung issues, like COPD. Historically, it was also used for sleep apnea patients that had difficulty tolerating CPAP. Your sleep specialist will be able to help you decide if BiPAP would be suitable for you.
Weight loss can be a very effective CPAP alternative for overweight and obese patients. There is a strong correlation between weight and sleep apnea. Diet and exercise work for many patients. 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. However, bariatric surgery, like all surgeries, has a risk for complications, is associated with post-operative pain, and is not guaranteed to yield weight loss.
Mouthguards and Oral Devices
Mandibular advancing devices (MADs) are oral devices that resemble sports mouth guards and work in the same way as snoring mouthpieces. They are specially adjusted by sleep apnea dentists to move the lower jaw forward and open the airway wider during sleep. Many of these devices are adjustable as they are often made of plastic or silicone. Some are hinged, meaning that you can open your mouth with the device still in place.
Although sleep apnea oral appliances (OAs) can be a simple and cost-effective CPAP alternative, they may cause tooth shifting and temporal mandibular joint (TMJ) pain.
Sleep Apnea Surgery
There are multiple surgical procedures that can be performed to reduce or eliminate sleep apnea. Procedures can be grouped into those directed at the soft palate or other parts of the breathing passages, such as the tongue.
The type of sleep apnea surgery that will be most effective for you depends on the structures that are causing your sleep apnea and blocking your breathing during sleep. In children, surgery (usually tonsillectomy and/or adenoidectomy) is a first-line option for obstructive sleep apnea (OSA), whereas sleep apnea surgery is typically a second-line therapy in adults.
Soft Palate Procedures
Soft palate procedures are the most common sleep apnea surgeries. They include uvulopalatopharyngoplasty (UPPP) and newer procedures such as expansion sphincter pharyngoplasty or lateral pharyngoplasty, which some studies have shown to be better than traditional UPPP in some studies.
Hypopharyngeal sleep apnea surgeries include tongue radiofrequency, genioglossus advancement, hyoid suspension, and partial glossectomy. They can be performed alone or in combination with soft palate procedures.
Jaw Advancement Surgery
Also known as maxillomandibular advancement or bimaxillary advancement, this sleep apnea surgery is another CPAP alternative which moves the jaw forward to facilitate breathing.
Hypoglossal Nerve Stimulation
Hypoglossal nerve stimulation is a newer therapy that involves stimulation of the nerve that controls tongue movement. 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.
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.
Other CPAP Alternatives
Adaptive Servo Ventilation
Adaptive servo ventilation is a relatively new alternative to CPAP for sleep apnea. It continuously monitors the breathing status of patients with central sleep apnea (CSA). Considered to be a form of positive airway pressure therapy (PAP), adaptive servo ventilation adjusts pressure delivery based on the detection of pauses, or apneas, in breathing during sleep.
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. This CPAP alternative explores these different devices with the patient to find the best option for their needs.
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)
This is a treatment for OSA that uses vacuum pressure to suction the soft palate towards the middle of the mouth, widening the nasal airway reducing or eliminating airway obstruction.
Continuous Negative External Pressure (cNEP)
This is a new technology that utilizes a sucking pressure outside of the neck area in order to keep the airway open during sleep.
Finding a CPAP Alternative
Sleep apnea can be a potentially deadly sleep disorder. It is imperative that the treatment that you and your physician choose is effective for you. Every person has unique issues and not every CPAP alternative listed above will be suitable for every patient.
Talk to your doctor about these alternatives to CPAP for sleep apnea. They will be able to accurately assess the severity of your sleep apnea and provide suggestions to accommodate your comfort desires and personal needs.
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