Alternative forms of sleep apnea treatment

In this series, we rarely take the time to discuss alternative treatment options for those with sleep apnea. However, given that the American Thoracic Society has just released a short summary of alternative treatments, this seems like a great time to summarize a few.

As many are aware, continuous positive airway pressure (CPAP) is the most commonly used treatment for obstructive sleep apnea. It is known as the gold standard. Although this machine may seem obtrusive and archaic, it remains the overall most effective treatment option. When used correctly, some people are able to rid themselves completely of apneas. However, CPAP is not made for everybody. For some, alternative options simply work better.

Oral appliances look similar to a mouth guard or a night guard. They are small devices that are custom fit to the teeth. They are set so that the bottom jaw sits forward a few millimeters in front of the top jaw. A sleep physician determines the proper “forwardness” setting in a similar manner that they determine the proper CPAP pressure. Although it may seem uncomfortable to have your jaw pulled forward, oral devices should not cause any discomfort. This device works because pulling the jaw forward creates a large space in the airway that minimizes collapsing (obstructions) that lead to apneas. This device is generally effective for those who have mild-moderate sleep apnea.

Positional therapy is another alternative to more traditional therapies. There is an old wives’ tale that says sewing a tennis ball into the back of someone’s shirt will prevent snoring. This particular wives’ tale actually holds some weight, as that would force the wearer to sleep on their side or stomach. For some, sleep apnea is worse when lying on their back. This is because as gravity takes over, fatty tissue in the back of the airway falls backward, and the airway becomes more collapsible. By sleeping on the side, some are able to minimize or eliminate sleep apnea. These days, nobody (that I’m aware of) wears a shirt with a tennis ball attached. Instead, they use positional devices that make it uncomfortable to sleep on the back. Eventually, the discomfort stops and these individuals always sleep on their side out of habit.

Finally, we must discuss weight loss, as it is not only a treatment, but also a possible cure for sleep apnea. Weight loss is hard, or else we would all do it. However, the leading cause of sleep apnea is excess weight, so minimizing excess weight does help. I tend to think of weight loss as a complementary treatment to pursue while also using another more immediate treatment. For example, weight loss should be a goal, but it should be sought while CPAP or an oral device is being used.

For now, the message as always is to get treated and stay treated. For some, that means using a machine and a long tube, for some it is a mouth guard, and for some it is a tennis ball. Do what works for you, and don’t give up!

See the American Thoracic Society summary here: http://www.atsjournals.org/doi/abs/10.1164/rccm.1912P1?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed#.VL7uEIcsY5h


Janna Mantua

Author

Janna is a PhD Student / Graduate Research Assistant at University of Massachusetts Amherst with a background in clinical sleep research and psychology. Janna Mantua is a PhD student in the Behavioral Neuroscience department at the University of Massachusetts. Her research focuses on sleep and aging, with specific projects on cognitive health, inflammation, memory formation, and neuroimaging. Prior to her PhD work, Janna was involved in research on sleep apnea and cognitive decline at the NYU Sleep Disorders Center.



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