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If you breathe irregularly as you sleep, wake up gasping for breath, or feel excessively sleepy during the day, you may be experiencing symptoms of sleep apnea.
The most common type of sleep apnea is obstructive sleep apnea (OSA). If you are diagnosed with obstructive sleep apnea, your health care provider may prescribe a continuous positive airway pressure (CPAP) machine for treatment. A CPAP machine delivers pressurized air as you sleep to ensure your airway stays open.
However, CPAP machines are not the only treatment for OSA. Your doctor can help you determine what treatment might work best for you.
Why Use an Alternative to a CPAP Machine?
Obstructive sleep apnea (OSA) affects between 10% and 30% of adults in the United States and up to 5% of children.
While CPAP machines are the most common treatment for OSA, people with the condition may seek out CPAP alternatives for a number of reasons. These concerns should be discussed with a doctor, who can offer advice on what alternatives may be more suitable.
- Cost: The machine’s out-of-pocket cost starts near $500 and can be up to $1,000 or more. Those who use insurance to get a CPAP machine may be required to enroll in a rent-to-own plan with strict compliance requirements.
- Compliance requirements: Insurers such as Medicare require CPAP machine users to adhere to a 30-day compliance period , using the machine for at least four hours a night on 70% of nights. CPAP users may struggle to meet these requirements or feel it is an invasion of privacy.
- Side effects: Side effects vary among CPAP users. Some find the mask uncomfortable or experience dry mouth, red or itchy eyes, and a dry, stuffy, or runny nose. CPAP users and their sleeping partners may also be affected by noise caused by mask leaks. All of these side effects impact adherence, or how often a person uses their CPAP machine.
- Adherence: Adherence rates for CPAP machines may be as low as 50% .
Alternatives to CPAP for Treating Sleep Apnea
Though CPAP therapy is the most commonly recommended treatment for sleep apnea, there are other options that people with sleep apnea can discuss with their doctor. Potential alternatives to CPAP therapy include other positive airway pressure (PAP) machines, lifestyle changes, devices, and surgery.
Alternative PAP Therapies
CPAP machines deliver a constant stream of air at the same level throughout the night. Some people may find this pressure uncomfortable. Though CPAP therapy may be prescribed first, there are alternative PAP machines and emerging treatments that may be considered.
- BiPAP: Bilevel positive airway pressure (BiPAP or BPAP) machines allow for different pressure settings for inhalation and exhalation. Users who find it uncomfortable to exhale against the constant pressure of a CPAP machine may prefer the lower expiratory pressure on a BiPAP machine.
- APAP: An auto-adjusting positive airway pressure (APAP) machine, or auto-CPAP, responds to changes in the user’s breathing patterns.
- EPAP: Expiratory positive airway pressure (EPAP) therapy is a newer alternative to CPAP. Instead of using a machine that delivers pressurized air, a nasal EPAP device uses valves to create air pressure when the user exhales, keeping the upper airway from collapsing.
- Emerging treatments: Research into emerging treatments is ongoing. CPAP alternatives such as continuous negative external pressure (cNEP) and oral pressure therapy (OPT) may be effective at treating OSA.
Weight Loss and Exercise
Obesity is a risk factor for OSA, but the relationship between weight and sleep apnea is complex. It is important to consult with a medical professional when considering weight loss to treat symptoms of sleep apnea.
Research shows that losing excess weight can reduce the severity of OSA symptoms. A combination of a change in diet and moderate exercise may be recommended. However, weight loss alone cannot completely eliminate OSA.
People who lose weight and change their sleeping positions see better results than those who only lose weight.
Sleeping in a supine position, or back sleeping, can increase the number of apnea episodes a person has in a night. In this sleep position, the tongue and larynx can obstruct breathing . One study found that nearly 62% of people with OSA have supine-predominant sleep apnea.
Instead of back sleeping, experts recommend side sleeping to reduce the impacts of OSA. Studies have shown that patients who wear devices that alert them when they are on their backs have fewer apnea events . However, adherence to use of these devices is an issue, and the technology itself needs improvement.
Alcohol use can worsen OSA symptoms in many people. The American Academy of Sleep recommends avoiding alcohol as one of the first steps in treating OSA, along with losing excess weight and changing sleep position.
Mandibular Advancement Devices
Mandibular advancement devices cover the upper and lower teeth and keep the jaw in a position that prevents it from blocking the upper airway. These devices are silent, easy to use, and less expensive than CPAP machines. However, mandibular advancement devices work best for people who have mild OSA or those who experience OSA only when sleeping on their back.
Tongue Retaining Devices
Tongue retaining devices keep the tongue forward so that it does not block the airway. These devices also help reduce the number of apnea events experienced, although studies have shown issues with compliance. People tend to prefer mandibular advancement devices over tongue retaining devices.
Myofunctional therapy, or therapy for facial and mouth muscles, may help reduce apnea events. This therapy includes exercises to strengthen the muscles in the tongue, soft palate, lips, and face. Correcting the position of the tongue can help prevent it from blocking the airway.
A number of surgeries can reduce apnea events, though the evidence for their efficacy is limited to small studies.
- Maxillomandibular advancement: The upper and lower jawbones are repositioned to help keep the upper airway open.
- Uvulopalatopharyngoplasty: This surgery includes removal or repositioning of tissue from around the upper airway.
- Hypoglossal nerve stimulation: For this treatment, a surgeon inserts a stimulator into the nerve that controls tongue movement. When this nerve is stimulated, the tongue is positioned to keep the airway open.
- Adenotonsillectomy: Commonly, children who have OSA will have their tonsils and adenoids removed.
Choosing CPAP Alternatives
Talk to your health care provider about which CPAP alternative treatments may be appropriate for you. Take note of your symptoms and sleep habits to help your doctor have a clear picture of how OSA affects your life. Together, you can develop a treatment plan to help reduce your apnea events.
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