SLEEP APNEA AWARENESS WEEK || Other Apnea Therapies to Consider

In case you missed it || What SleepyHeadCENTRAL has already posted about Other Therapies To Consider: 

• Go to the dentist to fix your apnea?
• Inspire to stimulate your airway
• Therapies for sleep apnea that don't involve a mask
• What happens if I don't want or like PAP therapy? (You have options)

JUST BREATHE: What happens if I don't want or like PAP therapy? You have options

It's no secret that some people don't like PAP therapy (nor is it a secret that some people swear by it). Therapies that require the use of devices can be challenging for some people and even with their best efforts, they may not  be able to use them effectively.

Below is a list of options for those who have tried and failed at PAP therapy for whatever reason. It is not the purpose of this website to favor one therapy or another, or to compare and contrast, but rather to illustrate the variety of options that patients with sleep-disordered breathing may have.As always, your diagnoses and treatments are best discussed with your sleep physician, as this website cannot diagnose your problem or prescribe or advise as to which options are best for you. Whether you qualify for any of these treatments is going to be a decision you make with your physician. 

• Oral devices. Read here for a more detailed discussion about sleep dentistry and how it might help you. 
• Expiratory positive airway pressure. This is a kind of nostril patch device that works by blowing against the patches during exhale, which may improve the "patency" or rigidity of the upper airway tissue and provide, for some, a kind of "tracheal traction" to create greater ease in inhalation. 
• Oral pressure therapy. This works by using a small oral suction tube to draw the soft palate forward, which may stabilize the tongue and keep it from blocking the airway during sleep.
• Pillar procedure. This is a minimally invasive surgical procedure in which tiny implants are inserted into the soft palate. Their presence may reduce tissue vibration which can lead to snoring, sleep apnea and upper airway resistance syndrome. 
• Somnoplasty. This is a minimally invasive surgical procedure using radio frequency (RF) energy to sculpt upper airway tissue under local anesthesia; this may effectively open the airway.
• Upper airway neurostimulation. The Inspire is a small device implanted into the chest to deliver to deliver carefully timed mild stimulation to the airway during sleep. This controlled neurostimulation may achieve "patency" or firmness of the tissues in order to prevent their collapse. 
• Uvulopalatopharyngoplasty (UPPP). This surgical procedure removes excess tissue in the throat, soft palate, uvula, tongue, tonsils, and/or parts of the pharynx to create more space in the upper airway; this may prevent collapse airway collapse during sleep.
• Adenoidectomy. Removal of the adenoids (tonsils) make help make space in an otherwise crowded airway.
• Numerous other surgeries used to correct obstructive sleep apnea have been outlined clearly at this page hosted by the American Sleep Apnea Association.

Certain lifestyle changes or habits may not "cure" your sleep apnea, but they can certainly give you some relief. These include: 

• Positional therapy. Read here for a more detailed discussion about how just changing your sleep position can help those who snore or have mild apnea.
• Weight loss. Losing a few pounds, even just ten, can help shrink fat cells. Smaller fat cells retain less water and place less pressure on the tissues of the upper airway during sleep. This may reduce, if not completely eliminate, obstructive breathing patterns. Remember, even if you don't have noticeable fat pads in your neck, you may carry extra water weight in your feet during the day; when you lie down, the fluid recirculates and plumps up fat throughout the body, including in the neck area. 
• Gastric bypass or other surgical weight loss procedures. For those who are morbidly obese, these options may also help prevent obstructions secondarily, but these patients may need to have a sleep study prior to surgery to identify any preexisting sleep apnea so that the pre-surgical team can prepare proper anesthesia and respiratory therapies prior to the operation. 
• Smoking cessation. Smoking (of tobacco or any other substance) may inflame the upper airway and, in the case of tobacco, create a "rebound effect" in the upper away during the night because of short-term nicotine withdrawal. Smoking may also lead to Chronic Obstructive Pulmonary Disease, a chronic and irreversible respiratory disorder which can severely impact one's ability to breathe, especially at night while asleep.
• Daily aerobic exercise. Daily aerobic exercise may help to improve the tone of the tissues in the upper airway and may lead to weight loss and the shrinkage of fat cells which are partly to blame for obstructions of breathing at night.
• Change pillows or reduce the number of pillows used. If your pillow seems to be pushing your chin forward, it may be contributing to the mechanical obstruction of the airway. Find a pillow that allows your head to lie flat while still supporting your neck. Also, propping one's head up with multiple pillows may do the same thing. If you struggle to sleep with your head flat, it could be that you have a severe obstructive respiratory condition, and you should discuss this with your physician. 
• Play the didgeridoo. Seriously. There's some evidence that playing some form of wind instrument may help improve airway tone and build a skill called "circular breathing" which allows for better gas exchange. 

For more information about alternative therapies for sleep apnea which don't involve using PAP, click here. 

JUST BREATHE: Go to the dentist to fix your apnea?

Many of us have an underbite that could be the culprit
behind our sleep breathing issues.

While Positive Airway Pressure (PAP) therapy maintains its position as the gold standard among sleep professionals for the treatment of obstructive sleep apnea (OSA), it may be getting some serious competition from dentists who have a different mechanical approach to treating sleep apnea.

Oral Appliance Therapy (OAT) can be used to treat mild to moderate cases of OSA (as determined by an overnight sleep study to measure severity and to confirm diagnosis of your sleep breathing disorder). However, rather than using PAP therapy, which forces air pressure into the airway to open it up, an oral appliance is used to reposition part of the mouth (tongue or jaw) by way of a specific mouthpiece which allows for a larger opening at the back of the throat where tissue may otherwise collapse during sleep. Sometimes OAT can even be combined with PAP, as well, to combat stubborn cases of OSA.

There are a host of OAT devices to choose from; the American Sleep Apnea Association lists as many as 80! The TAP and Herbst devices are currently the most commonly used. There are two main categories of OAT: Some use a suction device to manage tongue position and prevent it from blocking the airway (tongue retention). Others force the jaw slightly forward to open up space for breathing (mandibular positioning).

The TAP Device

The Herbst Device

The SUAD Device

Generally speaking, most OAT devices are comfortable and simple to wear. Most patients acclimate to them within a couple of weeks. They are great for people who travel a lot; they require very basic cleaning and, with good maintenance, should last several years. Though not all devices are covered by insurance, the nightly use of them over a period of years makes them cost effective for patients who are adherent.

(Curator's note: I use an OAT; mine--an SUAD--is five years old and still works great! I paid $1000 out of pocket, which over five years' usage is not expensive, and I still have years to go. This is just my story, but I know others who use OAT who have found it to be a worthwhile, cost-effective treatment as well.)

Patients who qualify for this kind of therapy to treat their sleep breathing problems include:

• those who have mild to moderate sleep apnea or UARS or primary snoring
• those who do not/did not respond well to PAP
• those who are not overweight
• those who do not qualify for surgical procedures like tonsillectomy to treat OSA
• those for whom positional therapy is not an option

These devices resemble common mouthguards, but they are actually much more complex, as they include specific parts which help to move the lower jaw forward. They require special fitting and construction via a dentist specially trained and board certified in the field of sleep dentistry.

Make no mistake: these are handmade devices that are built to fit an individual and are not something you can pick up at the local drugstore, boil in some water and be done with. The Ohio Sleep Medicine Institute says it most clearly: "Prior to electing any form of treatment, patients should undergo an initial evaluation with a board certified sleep specialist practicing in an accredited sleep disorders center." These devices require professional fitting and testing even after they have been trialed by the patient to ensure they work.

There is no LEGAL over-the-counter option for oral devices to treat OSA at this time. OAT requires a doctor's prescription and a clinical diagnosis. 

Once you received your custom-fitted device, you will have follow ups to ensure it is treating your sleep apnea effectively, to make sure it is still in working condition, and to check for both comfort and fit issues. Your primary care physician, your sleep specialist and your dentist should all be on board together to handle these follow ups.

As with any medical therapy, there are risks and disadvantages. Some patients who try OAT discover problems with TMJ, too much saliva, dry mouth or mouth discomfort. Long-term problems may include tooth misalignment or changes in bite (though some devices offer a realigning mouthpiece for the morning after to help reposition the jaw).

People interested in locating a dentist who can assist with creating, fitting and follow up on oral appliance therapy can click this link.



Sources

American Academy of Dental Sleep Medicine || Oral Appliances
American Sleep Apnea Association || Oral Appliances
Ohio Sleep Medicine Institute || Are you a candidate for dental sleep apnea treatment?