CPAP (continuous positive airway pressure) machines are a standard treatment for sleep apnea patients. Patients suffering from sleep apnea are offered relief via CPAP machines, as these machines ensure airway stays open and free for proper breathing during the night. However, as of late there have been records of CPAP intolerance, which has become a persistent problem for numerous patients. Even though CPAP remains the most efficient sleep apnea treatment, clinicians and researchers are advising there should be alternatives to the CPAP treatment.
Therefore, in the following paragraphs, we’re going to look at the current best alternatives to CPAP treatment. We will review each alternative and look at the safe practices you can apply if the CPAP treatment is not a safe option for you. So, let’s get started!
Sleep Apnea Oral Appliances
With CPAP machines losing popularity among sleep apnea patients, oral appliances are surely gaining attention and popularity. Oral appliances have shown to be effective in the treatment of obstructive sleep apnea. They are worn in the mouth during sleep and act the same as a sports mouthguard or orthodontic appliance. The way oral appliances work is that they’re holding the lower jaw forward during the sleep. This way the airways are open, the tongue and the muscles in the mouth and jaw are relaxed and kept from blocking the airway. Both FDA and AASM (the American Academy of Sleep Medicine) have approved oral appliances as a part of obstructive sleep apnea treatment or as a combination therapy together with CPAP machines.
You can get your oral appliance by paying a visit to your dentist. The dentist will evaluate your teeth, mouth, and jaw to ensure everything is healthy and strong enough to handle the oral appliance. The dentist will also create a model of your teeth and provide a custom oral appliance. An oral appliance is very comfortable to wear, and unlike the majority of the CPAP machines, it is also quiet, easily portable and very easy to maintain and clean. If you want to try out mouth dental appliances, you can check the following ones;
- Neomen Professional Dental Guard – this dental guard is intended for cases of teeth grinding and bruxism, but can be used temporarily to help ease the symptoms of sleep apnea. The mouthguard is FDA approved and is safe and comfortable to use. However, we do not recommend this as a permanent solution. The specific sleep apnea mouthguard still needs to be custom-made by your dentist.
- LORIOUS Mouthguard – this particular mouthguard is also made for cases of bruxism and teeth clenching. However, it can be trimmed and customized to fit your particular mouth and teeth shape. The mouthguard can act as a temporary solution until you get the actually fitted sleep apnea mouthguard from your dentist. The product is very affordable and a good way to see whether such appliances can help you with sleep apnea.
Upper Airway Stimulation
Hypoglossal or upper airway stimulation is a relatively new approach to treating obstructive sleep apnea. The treatment includes several components being placed under the skin of the neck and chest area. A simulator, often a small, pacemaker-like device, is responsible for stimulating the nerves in the tongue and the throat muscles. It is placed below the collar bone, and from there, it stimulates breathing and keeps the airways open during sleep. The stimulator is usually accompanied by a small remote controller which can help you turn it off or on.
The device is made to fit the patient’s sleep behavior and therapy needs, making it possible to be stopped or started whenever it is needed. It is also almost undetectable, but if the stimulation becomes bothersome, the patient can easily adjust and reprogram the device. The upper airway stimulation therapy is approved by the FDA, however, only one device of such nature is available for use. Because this therapy option is relatively new, we can expect more devices on the market, available for more patients.
Sleep apnea patients can also choose oral surgery as an alternative to CPAP treatment. Because sleep apnea obstructs breathing and keeps the airways closed or blocked during sleep, oral surgery can help clear the breathing passages once and for all. Even though many people fear seemingly unnecessary surgeries, oral surgery can create a big difference in the quality of sleep for sleep apnea patients.
The oral surgeries intended to treat sleep apnea include soft palate procedure, UPPP (uvulopalatopharyngoplasty) procedure, sphincter pharyngoplasty, lateral pharyngoplasty, tongue radiofrequency, genioglossus advancement, hyoid suspension, and many others. Jaw advancement surgery is also an option is certain to sleep apnea patients. The most common sleep apnea oral surgeries are;
- Removal of tonsils and adenoids – if tonsils and adenoids are enlarged, then a CPAP treatment alternative is the removal of this enlarged tissue in the upper throat area. Tonsils, in particular, can create an issue in airway obstruction and snoring, so if enlarged, their removal is most likely.
- Uvulectomy or UP3 (uvulopalatopharyngoplasty) – this treatment option includes surgical removal of the excess tissue in the soft palate. The objective of the procedure is to widen the airway so that the air can flow through the throat without any obstruction. Patients who are dealing with snoring or obstructive sleep apnea are usually recommended this procedure in case CPAP is not an option.
- GGA (genioglossus advancement) – this treatment option includes a portion of the chin being surgically moved forwards. What this does is pull the base of the tongue muscles forward as well, resulting in a widened airway.
For more information about these surgeries make sure to consult a medical professional. Sometimes oral surgery is not an option of certain sleep apnea patients, so it is always important to discuss such a topic with a medical professional or a personal doctor.
One of the least invasive alternatives to CPAP therapy is positional therapy. Positional therapy includes a change in sleeping position for patients with sleep apnea. For example, sleep apnea patients are advised not to sleep in the supine or back position. Sleeping on the back can actually worsen the sleep apnea symptoms and make the airways completely closed. Sleeping on the back can, therefore, be extremely dangerous for sleep apnea patients, especially if they are not undergoing any therapy.
Therefore, sleep apnea patients need to undergo positional therapy and adjust their sleeping position to side sleeping or sleeping on the stomach. There are numerous ways patients can get used to these sleeping positions; from pillow support to special devices that keep you from lying on your back (these devices are attached to the waist and prevent the patient from turning onto their back). Because positional therapy is not invasive, it is always recommended as an initial alternative to CPAP therapy.
Another non-invasive alternative to CPAP machines is training therapy. Physical activity has always been recognized as imperative for good health. Therefore, sleep apnea patients are advised to start a physical activity program that will help reduce breathing problems, reduce the chance of cardiovascular issues, impaired glucose tolerance and fatigue. Not to mention that physical activity helps with weight loss. Excessive weight can actually make sleep apnea issues worse, so it is essential to losing weight in order to see any improvement to sleep quality. Moreover, physical activity and regular exercising are seen to improve the upper airway dilator functions during sleep and diminish excess arousal and adrenaline before and during bedtime. Regular exercise also maintains healthy blood pressure and sugar levels and improves the overall sleep apnea treatment outcomes.
Lifestyle and Dietary Changes
As mentioned in the previous paragraphs, physical activity and weight loss are an important part of sleep apnea treatment and a great alternative to CPAP therapy. This also belongs to the lifestyle changes which are strongly recommended as a form of sleep apnea therapy.
First of all, dietary changes are essential is sleep apnea cases. Studies have shown that the Mediterranean diet is the best choice for sleep apnea patients. This diet is generally considered to be the healthiest diet in the world. It is abundant in olive oil and is based on plants and fish. Frequent consumption of vegetables, omega 3 oil, and olive oil helps regulate one’s metabolism, immune system and lowers the risk of cardiovascular diseases. Furthermore, the Mediterranean diet helps weight loss and acts therapeutic in sleep apnea cases, as it helps regulate the sleep onset and sleep patterns.
Other Alternatives to CPAP Treatment
- Oral Pressure Therapy – OPT is a CPAP treatment alternative. It includes vacuum pressure therapy where the soft palate is sucked towards the middle of the mouth. The goal of this therapy is widening of the nasal airway. This means that the chances of nasal congestion or airway obstruction are minimal.
- Continuous Negative External Pressure – cNEP treatment revolves around applying constant negative external pressure to the neck area. The goal is to widen and expand the airway just like in the OPT. This therapy alternative is relatively new and more research on this is expected in the future.
- EPAP Valve (Expiratory Positive Airway Pressure) – also known as Provent Therapy, the EPAP valve is a sleep apnea treatment where a so-called MicroValve is attached to each nostril using hypoallergenic adhesive. Such devices create resistance during exhaling. The devices are also newly recommended as sleep apnea treatment options, so there should be more research and studies coming soon.