Here's a quick guide to CPAP and other options. Check the effectiveness of sleep masks, mouth devices & surgery in comparison to positive airway pressure machines. Make the best choice to reduce your snoring and finally get the rest you need!
PAP: Positive Airway Pressure
devices are the most reliable non-invasive treatment option for sleep apnea. All
of them deliver pressurized air through a hose into a sleep mask (nasal or full
face). This air prevents your airway from collapsing and keeps it free of obstructions
as you sleep. You can breathe freely and will experience fewer or no apnea
events. Added comfort can be achieved by adding a humidifier.
CPAP: One Set Pressure
Continuous Positive Airway Pressure. The “gold standard” of sleep apnea treatments. The CPAP machine is calibrated or “titrated” during a sleep study to blow air at one specified pressure into your airway at a constant pressure to keep your breathing passages open. This prevents apnea events by keeping your airway from relaxing too much.
Success with CPAP use depends on, well, using it. So, for greater comfort while you are falling asleep, many machines now have a “ramp” feature. The pressure starts off lower for better comfort while you are falling asleep. It builds up to the prescribed setting and stays there for the rest of the night.
With newer machines, CPAP users can collect their sleep data on an SD card or a cloud. You can read the data via software or even a mobile app. This data might include number of hours used, number of apnea events or AHI, mask leak and mask off events, and more.
There are a couple of CPAP alternatives, close cousins that give you more control over the air pressure for more comfort: APAP and BiPAP.
APAP: Best Pressure Within A Set Range
Automatic Positive Airway Pressure. It’s basically the same as a CPAP machine, but CPAP can only be set to one pressure. APAP is set up with a low range setting and a high range setting. It uses algorithms to sense changes in your breathing while you sleep and automatically adjusts itself between the ranges moment by moment.
Unlike CPAP machines, these machines are not standardized from one manufacturer to another, so finding your “sweet spot” on the settings may take some experimentation. APAP is also more expensive than CPAP.
BPAP or BiPAP: Different Pressures For Inhaling And Exhaling
Bilevel Positive Airway Pressure. One problem with CPAP machines is that some patients find it difficult to exhale against the constant incoming air pressure. It’s especially difficult for those using high pressure strengths.
BiPAP device is set up with two pressure settings. The prescribed pressure
(ipap) is set for inhaling and a lower pressure (epap) is set for exhaling. It
can also be set to time your breathing. If it senses you missed a breath it can
temporarily increase the pressure to force you to breathe.
ORAL AND DENTAL APPLIANCES
Dental sleep medicine has become a specialty because the level of non-adherence for CPAP therapy has remained high. More and more, sleep physicians are referring patients for oral appliance therapy as an alternative to CPAP rather than for throat surgery which is often less effective.
OAT (Oral Appliance Therapy)
are custom-fitted with a device that is much like an orthodontic retaining mouthpiece
or a sports mouth guard. It’s worn during sleep. It pushes your lower jaw
forward to help open your airway. If you are lucky, this alone will improve
your sleep, buff up your health, and give you back your vitality and alertness.
form of therapy is considered to have a level of effectiveness close to that of
PAP, though it is still being studied. It is much easier to comply with.
MADs (Mandibular Advancement Devices) or OAm (Oral Appliance – Mandible)
A dental sleep device or oral appliance opens your airway by holding your lower jaw (mandible) forward while you are wearing it. Your tongue is attached to your lower jaw behind your chin, so this gadget also moves your tongue forward. Presto! Better airway.
Avoid the “boil and bite” versions from the internet or department stores. A dental appliance should be fitted by your dentist in consultation with your doctor.
only 100% effective solution for sleep apnea is a tracheostomy. You probably don’t
want to do that. Here are some other surgery options, depending on the cause of
your sleep apnea.
Uvulopalatopharyngoplasty (UPPP or UP3)
UPPP, the most common
surgical treatment for sleep apnea, is the removal or altering of tissues in
your throat. These removed or altered bits could be your tonsils, your
adenoids, part of your soft palate, your uvula (the hanging down squiggly thing).
Or your uvula might get sewn to your soft palate.
It’s important to remember that CPAP always works if you use it. Surgery such as this only has a 25% to 30% success rate. The most severe cases of sleep apnea are the least likely to be cured with this surgery, according to studies.
But here is a success story: Cleveland Cavaliers forward Anthony Bennett, NBA #1 draft pick in 2013. Sleep apnea and asthma had left him with his "hands on hips, shoulders rolled, head down, mouth-breathing like a freshly hooked bass," according to sports writer Janson Concepcion. Bennett said in 2014, “Since [having] my tonsils out, my adenoids, I have a lot more room to breathe.”
uses a gastric band or removal of part of your stomach to make your stomach
The problem with CPAP treatment is low patient acceptance and adherence, and poor tolerance for being hooked up to a machine every night wearing a mask. The comparative efficacy of the more tolerable acknowledged alternative, oral appliances (OAm or MAD), is still being studied.
article published by Dr. Olivier
M. Vanderveken in the Journal of Dental Sleep Medicine discusses these
issues. Dr. Vanderveken, a professor in medicine at University of Antwerp, is a
specialist in sleep medicine and in dental appliances. He suggests that obese
patients with severe OSA who have bariatric surgery may then require lower CPAP
pressures, which may then snowball into better adherence to CPAP treatment. His
article also calls for more research into this solution.
is well-known that losing weight is one of the most effective treatments for
OSA. Losing 10% of your body weight may cause OSA to go
into complete remission. While the weight stays off.
VOAT Procedure (Ventral Only Ablation Of Tongue)
cause of OSA is that the base of a patient’s tongue is larger than normal. This
has no connection to obesity. Radiofrequency ablation (RFA) has been used for
15 years to reduce the size of the base of the tongue. Tissue is removed by
heat coming from a radio wave.
Dr. David Dillard, an ENT specialist, has finessed this at the Sleep and Sinus Centers of Georgia. His procedure “denatures” the proteins in the tongue tissues, causing scarring. Scarring is apparently the helpful part because it reduces the amount of tissue but also pulls the tongue away from the airway. Here are some comments from happy patients.
If your doctor thinks
you have sleep apnea, they will send you to a sleep specialist or sleep clinic
to determine if you should undergo sleep testing. This testing will determine
what kind of sleep apnea you have. (Here
are some tips from Alaska Sleep Education Center on choosing a sleep clinic).
Types Of Sleep Apnea Testing
Medical professionals disagree on which is the better of two types of sleep testing – PSG or HST.
Home Sleep Test (HST)
If you have central sleep apnea, the primary treatment approach will be to treat the underlying cause, such as heart failure. If you have the most common kind of sleep apnea, obstructive sleep apnea (OSA), you will be advised to lose weight if you are overweight, and to change other lifestyle factors that contribute to OSA.
For both types, you
will probably also be advised to use a positive air pressure (PAP) machine
every night. There are several types of these:
These devices need a
prescription and will be fitted and calibrated by your sleep professional (this
is called “titration”).
apnea is a serious sleep disorder. Your breathing stops suddenly and then
starts again. The stopping may wake you up. But that’s not all. You’re not
getting enough oxygen. If you suffer from daytime sleepiness after a full night
of sleep, or if you snore loudly, you may have sleep apnea and should get
Three types of sleep apnea:
your doctor sends you to the sleep clinic or specialist, they give you a sleep
test at home or in the lab. Equipment will take readings while you sleep. One
of those measurements is your AHI (Apnea Hypopnea Index). It indicates the
number of apnea and hypopnea events you experience during each hour of sleep. Events
that last for at least 10 seconds and are associated with a decrease in blood
oxygen level will be recorded.
drop in blood oxygen levels and poor sleep can lead to many health
complications, some very serious (including death). Aside from health problems,
the dangers of untreated sleep apnea include poor performance at work and
causing car accidents. Don’t look at this as just a snoring problem.
BOOSTING CPAP ADHERENCE
CPAP is considered to be the
“gold standard” treatment for sleep apnea. The only treatment with a higher therapeutic
success rate is a tracheostomy. However, for CPAP
to work you have to use it. Studies have found that as many as 46% to 83% of patients with OSA
to the treatment. That’s a lot of PAP machines sitting in closets.
There are several reasons why people stop using CPAP, use it less often or
for shorter periods than they should, can’t get past the first week, or can’t
try it at all.
Better outcomes with CPAP can be achieved:
The right mask for you, properly fitted, with the right cushions, and maybe a chin strap to keep your mouth shut. (some claustrophobic people find the full face mask less claustrophobic than the nasal mask)
Sleep clinics are now able to
offer patients effective alternatives
Studies into the efficacy of
for example, are showing encouraging results.
And this article in Sleep Review analyzes nine new
treatments and alternative treatments for sleep apnea, including a digital
alternative for the tennis-ball-sleep-shirt.