Treating sleep apnea can help you feel more energized during the day, decrease your risk for health conditions such as heart disease and high blood pressure, and lessen fatigue-related accidents and injuries. Here are some FDA-approved therapies that may help:
CPAP (continuous positive airway pressure) is an increasingly popular treatment option for sleep apnea; but what options exist if it does not suit?
CPAP
Continuous positive airway pressure, or CPAP, is the go-to treatment for obstructive sleep apnea. A CPAP machine supplies pressurized air through a mask worn over mouth or nose while sleeping to maintain openness in airways and ensure uninterrupted breathing throughout the night.
CPAP can be beneficial in most instances; however, not everyone responds positively. Nonetheless, it’s essential to keep trying as untreated obstructive sleep apnea can contribute to serious health issues; increasing your risk for high blood pressure, abnormal heart rhythms and depression while contributing to fatigue which increases risk for motor vehicle or workplace injuries as well as stroke due to ruptured or blocked arteries supplying oxygen to the brain.
People who cannot tolerate CPAP may benefit from other conservative and device-based therapies to treat obstructive sleep apnea, including oral appliances like mandibular advancement devices that hold the tongue in place or ease jaw forward; such devices can reduce snoring while helping improve mild-to-moderate obstructive sleep apnea; similarly, nasal expiratory airway pressure (EPAP) devices generating backpressure during expiration may provide another form of therapy.
Positional therapy involves altering your sleeping habits to decrease obstructive sleep apnea or snoring by moving from side sleeping positions to back. Diet and weight loss can also help alleviate its severity.
Myofunctional therapy may also be an option; this involves exercises designed to strengthen tongue, face, oral, pharyngeal structures or increase muscle tone on tongue, palate throat or jaw in order to offset anatomical mechanical loads that contribute to airway narrowing when snoring and obstructive sleep apnea occur. Unfortunately, research on myofunctional therapy remains limited and an European task force did not endorse its use as standard treatment for OSA.
Many CPAP users experience complications with their machines, including leaky masks, discomfort, dry nose/mouth conditions, difficulty sleeping/waking up and sores. If this is the case for you, it is essential to discuss alternatives with a sleep specialist or CPAP therapist as soon as possible.
Oral Appliances
Although CPAP remains the gold standard treatment for OSA, oral appliances can also help. Oral appliances have proven effective at reducing snoring and improving sleep quality in adults and children alike. Similar to orthodontic retainers or athletic mouth guards, these devices keep tongue and lower jaw protruded, helping prevent airway obstruction during sleep. More than 100 different oral appliances have received FDA clearance to treat OSA.
Mandibular advancement devices (MADs) are among the most frequently prescribed oral appliances. These work by moving the lower jaw forward and keeping tongue from falling back and blocking airway passageways.
Tongue-stabilizing devices, which hold the tongue forward in order to prevent it from collapsing over the airway, can reduce snoring and improve mild-to-moderate OSA symptoms. Rapid maxillary expansion (RME) devices expand upper palate and throat size in order to open airway passageways more freely; studies indicate RME devices may help stop snoring while increasing quality and duration of sleep for children with OSA.
While these devices are very popular among both doctors and patients alike, they’re not as effective at treating obstructive sleep apnea as CPAP is. Furthermore, these appliances may cause unpleasant side effects, including excessive salivation, dry mouth discomfort, permanent changes to occlusion, TMJ pain or permanent changes in occlusion; many individuals cannot tolerate these side effects and so discontinue use of the appliance altogether.
Sleep specialists can help you select an oral appliance tailored to your diagnosis of obstructive sleep apnea and physician recommendations. They’ll recommend a custom-fitted device and monitor its use to track progress while offering guidance and solutions when issues arise. In collaboration with physicians and dentists, this teamwork approach may give you the restorative sleep needed for living an enjoyable, fulfilling and healthy life.
Positional Therapy
People suffering from mild to moderate positional obstructive sleep apnea can benefit from adopting sleeping postures that improve airflow, oxygen levels and rest quality during sleep. Our dental team in Burlington CT encourages this simple treatment approach as part of their holistic sleep management plans.
Research has demonstrated that individuals are more prone to sleep apnea events while sleeping on their back than on their side, prompting sleep apnea specialists to advise patients to use pillows designed to elevate the head, wearable belts with foam inserts that prevent rolloff, vibration alarm systems that activate when moving between sleeping positions, or vibration alarm systems that activate when they shift from side sleeping position back onto back sleep while asleep.
The European Respiratory Society Task Force on Non-CPAP Therapies for OSA recommends positional therapy as an effective secondary treatment option (Randerath 2011). A Cochrane review of studies showing this effect found an average reduction of 1.58 points when using positional therapy; this may not meet clinically meaningful differences; perhaps due to confounding factors like BMI.
However, the review did find that people tend to adhere better to positional therapy than CPAP and that it may help in reducing snoring, apnea events and quality-of-life measures for those intolerant of it. Positional therapy can also be combined with lifestyle modifications like weight loss strategies to lower airway pressure as well as forgoing alcohol or sedatives before bedtime in order to improve symptoms associated with sleep apnea.
Our team of oral surgeons can work in collaboration with your healthcare provider to devise an individualized treatment plan for sleep apnea that may include positional therapy and/or other appliances or surgical options depending on your individual needs and the results of a sleep study. In addition, we can offer resources and recommendations regarding additional treatments like teeth whitening or orthodontics that could also improve overall health and wellbeing beyond sleep apnea treatment.
Surgery
Patients unable to benefit from CPAP therapy due to intolerance, poor adherence or compliance issues, or having a high baseline severity of sleep apnea should also explore conservative, pressure-based and surgical modalities as non-CPAP solutions. A systematic selection process based on patient characteristics, efficacy research results and recent guidelines will guarantee successful treatment results in these instances.
Surgery as a therapy alternative for sleep apnea involves procedures designed to open or widen the upper airway, such as uvulopalatopharyngoplasty – altering the shape of soft palate and roof of mouth – or mandibular advancement devices – both of which have proven highly successful at relieving OSA symptoms and increasing quality of life for individuals living with OSA.
Behavior changes may also be beneficial to those suffering from sleep apnea, especially when the root of their problem lies within lifestyle habits. Losing weight, quitting smoking and alcohol consumption altogether and sleeping on one’s side are among many behavioral changes which could help alleviate OSA symptoms or eliminate them completely; they could even improve health conditions associated with sleep apnea like cardiovascular disease and diabetes.
Positional therapy is a noninvasive form of sleep apnea therapy that encourages patients to sleep on their sides rather than back or stomach, which may help relieve airway blockage for some individuals with OSA. Positional therapy may be ideal for mild-moderate cases as it’s relatively inexpensive.
Myofunctional therapy for sleep apnea involves performing exercises to strengthen facial, tongue and oropharyngeal muscles to promote neuromuscular compensation for airway narrowing. Though not generally recommended by European task forces due to limited clinical impact evidence and low quality research findings, myofunctional therapy may prove useful for patients who fail to respond to other treatments.
Sleep Better Columbus professionals specialize in various sleep apnea therapies, and can assist you in finding an appropriate solution for you. Reach out now to make an appointment for a consultation session!
