Many people wonder what options are out there for managing Sleep Apnea.
Options may vary depending on the sleep apnea severity and other medical conditions, lifestyle, and preference.
A therapy decision should always be made with consultation with your physician and after a proper diagnosis. So what are possible options?
While we have written about different treatment options for sleep apnea before,
we think it is important to continue to bring these options up and ensure people are aware of them.
The goal of any treatment for sleep apnea is to hold the airway open so you can breathe on your own, therapy for sleep apnea does not breath for you, it is not oxygen or a respirator. The two recommended treatments for sleep apnea from the Canadian Thoracic Society are Continuous Positive Airway Pressure (CPAP) Machines and Oral Appliance Therapy (OAT). There are also specialized machines called BiPAP that are for those who require even higher pressure for breathing in but need a lower pressure to breathe out. These are used for those who have a pre-existing lung or muscle condition. There is also a new daytime therapy called eXcite OSA, which has recently been approved by Health Canada to treat Snoring and/or Mild Obstructive Sleep Apnea.
How do they work? Continuous Positive Airway Pressure Machines (CPAPs) use continuous pressure room air delivered through a facial or nasal mask into your airway. The air pressure holds the airway open and allows you to breathe. CPAP Therapy should be overseen by a therapy professional, and a prescription is required to buy one. There are a few different types of facemasks that come in various sizes to get a good fit to prevent air leaks. Auto-CPAPs are smart enough to recognize when they need to increase air pressure for those times when you are having more apneic events. The minimum and maximum pressure the machine uses will be set by a Respiratory Therapist or Registered Polysomnogram Technician.
Most CPAPs will come with a humidifier to make them more comfortable. They have become quieter over the last decade with innovations in masks with softer cushions to increase comfort. They require power and distilled water, which might not be convenient for you depending on your lifestyle. A CPAP is extremely effective at lowering your AHI, but CPAP can be hard to tolerate for a lot of people. Discomfort from headgear, noise, and inconvenience are just a few of the reasons many do not continue to wear their CPAP. A 2016 study published in the Journal of Otolaryngology (Head and Neck Surgery) stated that adherence rates to CPAP Therapy range from 30%-60% (Rotenberg, B. et al 2016). This means that up to 70% of people do not continue to wear the CPAP they purchase. Because sleep apnea treatments are only effective while you wear them, the effectiveness of your therapy is dependent on your rate of wear. Side effects of CPAP wear can include dry mouth and changes in facial profile and occlusion in some patients (Tsuda, H et al 2010).
Custom Oral Appliances work by holding the lower jaw slightly forward and preventing it from falling back at night. This allows the airway to stay open and creates more space for the tongue as well. This therapy option should be overseen by a Diplomate of Dental Sleep Medicine for the best outcomes. A prescription is needed to be fitted with a Custom Oral Appliance. Custom Oral Appliances consist of an upper and a lower oral appliance that is custom fit to your teeth and mouth. There are many different kinds, but they all have some sort of mechanism to not only allow the jaw to stay forward but to allow you to make adjustments should you need to for effectiveness. The adjustments increase the protrusion of your lower jaw by 1mm increments which increases the efficacy of the appliance. Unlike a CPAP, an Oral Appliance is not a computer, and cannot automatically tell you which jaw position is best, but we are able to estimate a good start position for every patient based on our experience in treating thousands of patients. We also have a temporary appliance home study that can tell you ahead of time your best treatment position. This is called the MatRX Plus Study.
Our goal with an Oral Appliance is to reduce your AHI index by at least 50%. Sometimes it takes some adjusting to find the right spot for you that is comfortable and effectively treats your sleep apnea. In order to test for efficacy, you will have to do at least one other sleep study wearing the appliance, and sometimes you will end up doing a few while we find the perfect spot. We see over 90% of our patients continuing to comfortably wear their appliance all night, every night. Side effects of OAT wear can include extra salivation, changes in occlusion, and morning jaw stiffness in some patients.
The newest option to become available in the eXcite OSA. This is a daytime therapy, meaning you do not have to wear something every night all night. This therapy works for 20 minutes every day for the first 6 weeks, then 20 minutes twice a week for the remainder of your life. The eXcite OSA works by changing the muscle fiber types in your tongue using low-frequency pulses. 75% of the users of this therapy had a reduction in their AHI of 52% or more during the first 6 weeks of use. It is an available therapy by prescription for snorers and those with Mild OSA.
There are some other things you can add on top of your main therapy choice (CPAP or OAT) to increase the efficacy of your treatment that may include things like weight loss, Nasal Dilators or side sleeping depending on your situation. The excite OSA can also be used as adjunctive therapy with a CPAP or Oral Appliance and some patients have both CPAP and Oral Appliance allowing them freedom of choice of therapy based on situations, travel, power outages, preference, etc.
Many people also ask us about surgical options for sleep apnea. Surgeries such as a Uvulopalatopharyngoplasty (UPPP) were more common in the 80s-90s but there is little evidence they were successful at treating sleep apnea long term. Healthlink BC states “there is a little evidence that shows it helps 40-60 out of every 100 people who try it.” To see if surgery is an option for you, request a referral to an Ear, Nose, Throat (ENT) Specialist from your family physician. ENT’s are also an important step for those dealing with other airway issues such as deviated septum and other nasal issues and tonsils.
Nowadays, there are options for you to treat your sleep apnea. Prior to 1980, a tracheostomy which creates a permanent hole in your windpipe was the only treatment for sleep apnea. We are very glad the medical world has come up with better alternatives than that! CPAPs and Oral Appliances are first-line options for those with sleep apnea, and it is important that everyone has the information they need to be informed about the treatment they choose. Remember, this is a therapy that you will be wearing all night, every night!
If you have questions about your sleep or the sleep of someone you know reach out to us today
604-58SLEEP (604-587-5337) or
604-98SLEEP (604-987-5337)
info@sleepbetterlivebetter.ca www.sleepbetterlivebetter.ca
Sleep Better Live Better
Accredited by the College of Physicians and Surgeons of BC for Home Sleep Apnea Testing and CPAP
Qualified Diplomate American Board of Dental Sleep Medicine Provider
We are your
Centre for Excellence in Accredited Home Sleep Diagnostics and Non-Surgical Sleep Therapies including
Custom Oral Appliances, CPAP and exCite OSA
References
Tsuda H, Almeida FR, Tsuda T, Moritsuchi Y, Lowe AA. Craniofacial changes after 2 years of nasal continuous positive airway pressure use in patients with obstructive sleep apnea. Chest. 2010 Oct;138(4):870-4. doi: 10.1378/chest.10-0678. Epub 2010 Jul 8. PMID: 20616213.
HealthLink BC. Sleep Apnea: Should I Have Surgery? https://www.healthlinkbc.ca/health-topics/aa71542#:~:text=There%20is%20no%20good%20evidence,100%20people%20who%20try%20it.&text=You%20may%20still%20need%20CPAP%20after%20this%20surgery.
Rotenberg, Brian W et al. “Trends in CPAP adherence over twenty years of data collection: a flattened curve.” Journal of otolaryngology – head & neck surgery = Le Journal d’oto-rhino-laryngologie et de chirurgie cervico-faciale vol. 45,1 43. 19 Aug. 2016, doi:10.1186/s40463-016-0156-0
