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 and BiPAP
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.
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 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.
Oral and Dental Options for Treating Sleep Apnea
Sleep apnea oral appliance – also called mandibular advancing devices, these 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.
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.
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.
Continuous Negative External Pressure (cNEP) is a new technology utilizes a sucking pressure outside of the neck area in order to keep the airway open during sleep.
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.