Sleep Apnea Treatment Options

This may leave you wondering about your various options.  CPAP therapy is the definitive leader for several reasons. There are several other alternatives that you may want to explore.  In this article, we will explore some of those options. We will also look at why they may or may not be the right one for you.

CPAP or BiPAP Therapy

While many people call this a breathing machine, the reality is that it does no breathing for you.  It is actually an advanced pressure stint device.  These devices hold the airway open to allow you to execute breathing in a normal fashion.  This is the preferred method of treating obstructive sleep apnea.  One of the biggest reasons that this is the preferred method is that the appropriate treatment device like a Respironics Dreamstation Auto or a Resmed Airsense 10 Auto can measure its performance and let you know how well it is controlling your condition.  The machines are also adaptable and can adjust to correct your OSA as your needs change.  These devices receive a lot of ridicule.  The reality is that these devices do amazing work at keeping people asleep all night.  The device is also the most common option for people with all levels of severity of Obstructive Sleep Apnea.

MADs or Mandibular Advancement Devices

These mouth pieces are great tools for controlling mild OSA and in some cases moderate OSA.  The device works by using the upper teeth as an anchor to pull the lower jaw forward.  This in turn opens up the bottom half of the airway in the back of the throat. Doing that should encourage nasal breathing.  They come in a variety of different customization levels and the level of customization generally determines the expense.  There are types that you boil and adjust yourself that are fairly inexpensive. There are also types that a dentist mold to fit your specific mouth.  With these devices you generally get what you pay for.  One should not expect life changing results from a do-it-yourself kit of mandibular advancement.  This device can not be spot checked by itself.  It can however pair with a home sleep test to determine its effectiveness.  This gives a qualified medical professional a great idea about how well these devices are controlling your OSA.

EPAP Therapy

Provent is the most common type of EPAP therapy.  There are also devices that insert in the nose that claim a similar effect.  Provent works by sticking a one way valve over each nostril. This valve then uses the back pressure created by the mostly closed valve to open up the airway. This in turn should prevent the airway from collapsing.  This is a great solution for the mild and moderate sufferers of OSA.  It is a measurable therapy as well.  It can be combined with a special Home Sleep Testing kit that allows qualified professionals to determine how well it is keeping the airway open.  Insurance does not always cover this option and generally costs in the neighborhood of $75 per month.  The biggest drawback is that the adhesive can cause the nose to become sore. For some patients long term consistent use becomes problematic.  These are also a great travel option for those with mild sleep apnea as well.

The Surgical Options

It is important to note here that there are several surgical options. Their effectiveness varies from patient to patient.  The expense is also typically the highest.

Uvulopalatopharyngoplasty

While this surgery definitely has a funny name, it is no joke.  People in the sleep field call this a UPPP or U Triple P for short.  This surgery in its most aggressive form involves removal of the Uvula, Tonsils, Adenoids, and in rare cases physically extending the tongue and jaw forward.  For the VAST majority of patients today, it is only the removal of the Tonsils, Adenoids, and Uvula.  While this may seem like a fairly simple procedure that all of your friends had when they were kids, let me warn that it is significantly more difficult for an adult to recover from.  Many of the patients that have these surgeries are unable to eat solid food for weeks, are on opioid pain killers for at least days, and can experience excessive bleeding in the mouth during the recovery process.  It is also important to consider the functions of the removed organs, and while the tonsils and adenoids don’t serve much of a function into adulthood, the uvula (the tinny thing hanging down in your throat) helps you to avoid choking on the food you are eating every day…and you thought it was just back there looking good.

The most severe patient require this surgery just to make PAP therapy an option for them.  In these cases the patient will have tried PAP therapy in a lab and been found to be uncontrolled with traditional PAP therapy, and will have to have their airway surgically opened in order to allow a PAP device to control their OSA.  This is extremely rare, but it does happen.

Implant devices

There are currently two different types of implant devices on the market, and both are typically difficult to get covered by your insurance.  The first stimulates muscles in your upper airway when it senses that you are having an apnea event.  The second stimulates your diaphragm when it senses that you are having a central apnea event.  These devices are very rarely used, and in 16 years of working in the sleep field, I have seen zero patients that have had one implanted.  Everything I have read about them shows to be promising in the control of sleep apnea, but they really are some of the newest treatments that have not had the chance to be tested like the other treatment methods.

In the end

Ultimately you need to have a relationship with your physician that is strong enough for you to have confidence in the treatment method that you choose.  If you have mild or moderate sleep apnea you have many more options available to you.  If your sleep apnea is severe you will likely want to get comfortable with the idea of sleeping with a PAP device.  It can be a positive life changing force that can help improve the quality of life tremendously.