CPAP – Alternative Therapies

Continuous Positive Airway Pressure (or CPAP for short) is a treatment for sleep apnea. While the CPAP machines have undergone significant upgrades over the years, most patients still find them hard to use after the first few months. More CPAP machines are sitting in patients’ closets rather than next to their beds. Considering the severe medical implications of sleep apnea, the patients cannot afford not to follow the doctor’s orders. So what are some CPAP alternatives out there since so many patients stop using their CPAP after only a few months?

Sleep Apnea – A Sleeping Disorder

Sleep apnea is a sleeping disorder because it only occurs when the patient is sleeping. For a long time, the medical profession incorrectly diagnosed sleep apnea patients as narcolepsy patients. And that’s because sleep apnea has some signs and symptoms common to narcolepsy. However, the two conditions are not the same.
Before a patient can successfully use a CPAP alternative, we need to know more about their type of sleep apnea. Medically, sleep apnea is divided into two categories. In one the apnea is due to a malfunction in the central nervous system (e.g., the brain). This condition is termed Central Sleep Apnea (CSA). In the other type, apnea stems from obstruction of the airway. Obstructive Sleep Apnea (OSA) accounts for nearly 80% of all apnea cases. And these are the patients that benefit from alternative therapies.

So how do we find out what type of sleep apnea is affecting the patient? One way is by relying on percentages. Since 8 out of 10 cases are due to OSA, chances are many patients with sleep apnea have OSA. But a more scientific way to diagnose the type of sleep apnea is by performing a “sleep study.”

Sleep Study – What Is It?

A “sleep study” is a diagnostic test used to record a set of crucial data from the patient while they sleep. Afterward, a medical doctor who is also a trained “sleep specialist” reviews the data. The doctor then diagnoses the type of sleep apnea (e.g., OSA vs. CSA) and its severity (e.g., mild, moderate, or severe). Patients with mild to moderate OSA can be successfully treated with CPAP alternatives. And this is excellent news because alternative treatment options are way more comfortable to use than CPAP machines for most patients.

CPAP Alternative Treatments

In broad terms, alternative CPAP therapies are divided into surgical and non-surgical groups. It is essential to understand that some alternative forms of treatment may not be suitable for all patients. For example, if a patient has a tiny mouth or a colossal tongue, non-surgical options will not provide much relief. After performing the sleep study, it is imperative to evaluate the patient thoroughly to determine the leading cause of sleep apnea. Then the doctor can use the most appropriate CPAP alternative to treat the patient more successfully.

Surgical Treatment Options

Depending on what is obstructing the airway, there are different surgical options. And the goal of all of these CPAP alternative therapies is to remove or reduce the blockage in the airway. Sometimes the obstruction is from the lower portion of the airway, meaning everything below the throat level. Tonsils and adenoids can often be quite large and cause severe narrowing of the airway. Removing these will significantly improve the airway for better breathing. An Ear/Nose/Throat specialist typically performs this procedure.

The obstruction can also stem from the upper portion of the airway. The upper part consists of our nose and the roof of our mouth. Correcting the defects in these areas by re-shaping the roof of the mouth or nasal corrective surgery can make dramatic improvements in the airway. Oral surgeons and ENT specialists are involved in these procedures.

The middle portion of the airway (i.e., the tongue and the lower jaw) can also be a potential source of airway blockage in OSA patients. The tongue is a powerful muscle under voluntary muscle control. However, when we sleep, this same muscle becomes very relaxed and, therefore, can block the path of the airway. The tongue’s size relative to the mouth and its normal resting position also have a significant impact on the blockage. Treatment aims to reposition the tongue while the patient sleeps by neural stimulation or re-shaping of the tongue (ouch).

Inspire Therapy is another surgical procedure where a medical device is implanted under the skin to monitor breathing while the patient is sleeping. If it detects inadequate breathing, it will generate an impulse resulting in the opening of the airway. It is a battery-operated device that the patient turns on before going to sleep.

Non-Surgical CPAP Alternatives

Several factors contribute to the development of OSA. And it is essential to realize that success is minimal at best when we control or treat only one of the many contributing factors. And conversely, the more of these factors we influence, the better the outcome.

Body Weight

One of the first items to look at is the patient’s weight, specifically their BMI. And the reason is that the more “overweight” a patient becomes, the higher the risk of developing OSA. So if a patient suffers from OSA and is overweight or obese, then a weight management program will help the patient immensely when used in conjunction with other aids.

Alcohol

Another factor to consider is alcohol consumption. Alcohol depresses the central nervous system, making it harder for the brain to do its everyday functions. Our brain is in charge of our daily lives. It’s also in charge of controlling our vital bodily functions in the background. When an officer of the law challenges a suspected drunk driver with a balance or an alphabet test, they want to see if the brain can do what it would typically be able to do. And they take a failed result as evidence of impairment. When that same patient sleeps, their brain will not perform the more primitive functions (e.g., breathing, sleeping, etc.) as it usually does either. You don’t have to give up drinking altogether. Drink in moderation and stop drinking at least an hour before sleeping (ideally 2-3 hours). Drink plenty of water as your body needs it to help metabolize the alcohol as well.

Nasal Strips

If the OSA is due to nasal and sinus issues (e.g., deviated septum, polyps, etc.), the nasal strips can provide relief. Nasal strips are sold over the counter in both retail and online stores. They look like little band aids that you place over the ridge of your nose. It is used to elevate the soft tissue over the nasal airway, thus making breathing thru the nose easier.

Custom Mouthguards

If the tongue is the reason for the blockage, then a custom mouthguard can benefit the patient. With these adjustable types of mouthguards, the obstruction caused by the tongue can be alleviated. Some patients with sleep apnea also suffer from TMJ. For this group, the mouth guard is designed with TMJ considerations in mind. These devices are highly sensitive, and a great deal of engineering is used in fabricating them. Only a dentist with specialized training in TMJ and sleep apnea can adjust these devices appropriately for the patient.

Orthodontics

Sometimes the teeth are the culprits. By intruding on the tongue’s space, they cause the tongue to shift backward, narrowing the airway. Using orthodontics to correct these cases can lead to a better resting tongue position, improving the airway.

Conclusion

Sleep apnea affects over 25 million people in the United States alone. The complications of untreated sleep apnea create severe and dramatic personal and professional problems. When it comes to treatment, CPAP is the primary choice of sleep doctors. However, because patients often stop using it after only a short period, alternative CPAP therapies have proven more valuable and effective in treating sleep apnea. Our doctor at TMJ and Sleep Apnea Center in San Marcos has extensive training in treating sleep apnea and TMJ. If you suffer from sleep apnea, or TMJ or simply snore loudly, our dentist can help. Give us a call at (760) 510-9009 or email us so we can help you take control of your health and improve this serious condition.