In the United States, it is estimated that 50-70 million adults experience insufficient sleep on a regular basis, with sleep apnea being one important cause. Depending on whom you ask (sleep physician, dentist, respiratory therapist, ENT surgeon, oral surgeon, dietician) you’ll get a wide variety of opinions on the best sleep apnea treatment options.
Regardless of which treatment is chosen to address apnea, attention to nasal breathing is the key. The oxygen that passes through your nose is filtered, warmed, humidified and combined with nitric acid, all of which increase the percentage of oxygen absorbed in your lungs. In my practice, we work hard to combine the best of multiple treatment strategies to result in outcomes that speak for themselves. We consistently hear commentary that indicates that the treatment strategies employed are truly working. It is not uncommon for my patients to tell me how much better they sleep.
“For the first time in ten years I wake up refreshed and I no longer fall asleep at my desk at three in the afternoon.”
With a focus on individual attention and quick responsiveness to a patient’s needs we, often treat these problems with multiple therapies; sometimes during the same night and/or week. The successful outcomes of this approach have become the foundation of our care. These are the five sleep apnea treatment options that my office relies upon.
5 Options For Sleep Apnea Treatment
1. CPAP (Continuous Positive Airway Pressure)
CPAP continues to be first line therapy for most severe and some moderate apnea patients. The problem is that more than 50% of those who choose CPAP discontinue using it within 6-12 months. In most of these cases, it is because they can’t tolerate the facemask (or even partial mask) due to feelings of claustrophobia, the noise of the machine, or its interference with comfortable sleep positions.
For others, the airflow can be cold and feel dehydrating, which prompts them to remove the mask in the middle of the night. Although quieter machines with built-in humidifiers and heaters are now available, leakage of the masks often produces distressing drafts across the face and less than adequate efficiency.
For young patients, the CPAP sleep apnea treatment option often does not sit well, especially when dating and establishing new relationships. As a result, compliance suffers.
2. Oral Appliances
[Oral appliances] (or MRDs) are mouthpieces that move the jaw forward and subsequently move the tongue base forward. This is designed to keep the airway open. These devices are most effective when custom-made, adjusted, titrated and watched over by a dentist with expertise.
This sleep apnea treatment option has been shown to be extremely effective in patients with mild and moderate apnea and less problematic sleep-related breathing disorders, which are often associated with social snoring.
Approximately 25% of my patients who use an oral appliance will alternate with CPAP. Sometimes switching randomly during the week. It is also commonplace for some of my patients to go to sleep with CPAP then switch to the oral appliance in the early morning hours. This way they get the best of both worlds. In many cases, a patient will use an oral appliance when traveling instead of transporting his or her CPAP machine.
These strategies help minimize the complications of a full-time oral appliance which can include jaw discomfort, bite changes and moving teeth.
Note: It is essential that people who use oral appliances be monitored by their dentist. Monitoring by home pulse oximetry and home sleep studies ensure the effectiveness.
3. Nasal Plugs
Some of my patients have had success with nasal plug therapy called Provent. Nasal plugs make it easy to breathe in, but hard to breathe out. This leaves some air chambered (like the air in a balloon) and supports the soft nasal tissues which can collapse and cause apnea.
When tolerated, nasal plugs are a worthwhile option but require clear nasal pathways to work. In a patient who has nasal obstructions due to a deviated septum and/or enlarged turbinates (the shelves on the inside of the nose) the complaint “I was suffocating with the plugs in place” is not uncommon.
Recently a patient developed jaw soreness wearing a night oral appliance, switched to this option with success, and is now splitting the week between these two options.
4. Positional Apnea Aids
Many people experience breathing interruptions only when they are sleeping on their backs. To keep a patient from sleeping on his or her back, I recommend sewing two tennis balls into a tube sock and attaching it to the back of pajamas. The discomfort of the tennis balls forces the patient to stay on his or her side.
In one study, 38% of people who tested this method were still using it six months later.
Body positioners are also available and can be purchased online. This effort to promote side sleeping is essential and when used with oral appliances, can reduce the amount of jaw positioning required. This is what we strive to achieve.
5. Weight Loss
A big risk factor in the development of obstructive apnea is obesity. Since stress often promotes overeating, I have begun to put into place programs that address stress-related behaviors. The challenge here is to build and maintain collaborative relationships with other health care providers, as well.
Sleep apnea treatments used in combinations seem to be the best way to address the problem at this juncture. The key to more successful outcomes in the future will require the integration of medical, dental and other health related practitioners. This still remains to be achieved, but we are getting closer.
In the meantime, I will continue to bring together the latest ideas and technologies available and will share them with you here.
Note: The Centers For Disease Control and Prevention has designated insufficient sleep as one of our most serious public health problems. To find out more: [http://www.cdc.gov/features/dssleep]