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)

IN CASE YOU MISSED IT: Our most popular posts in April

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THANK YOU FOR VISITING! TELL YOUR FRIENDS! --The Curator

Posts

• April 15 || JUST BREATHE: Upper airway resistance. It's a thing. And it matters
• April 8 || JUST BREATHE: What happens if I don't treat my sleep apnea?
• April 30 || JUST BREATHE: "Heard About Sleep?" APNEA... If not, listen in here
• April 10 || JUST BREATHE: How to find out if you have a sleep breathing disorder 
• April 23 || JUST BREATHE: Hope2Sleep's "Dangers of Untreated Sleep Apnoea" infographic
• April 23 || JUST BREATHE: Go to the dentist to fix your apnea?
• April 21 || JUST BREATHE: CPAP basics--how to get through the adjustment, how to improve long-term outcomes
• March 24 || INSOMNIA: Why is it linked to depression?
• April 20 || JUST BREATHE: Twelve of our best previous posts on sleep breathing disorders
• April 6 || Today is Drowsy Driving Awareness Day in California: How sleep apnea fits into this concern, and why we should ALL be observing this day
• April 30 || JUST BREATHE: What happens if I don't want or like PAP therapy? You have options
• April 29 || JUST BREATHE: No, there are no magic pills for sleep apnea, and some magic pills just make it worse
• November 29 2014 || SHED SOME LIGHT || Ask the Expert: Misconceptions about Circadian Rhythm Disorders

Pages

• WHY SLEEP MATTERS
• MEDIA
• SLEEP DISORDERS
  

Alternatives: Therapies for Sleep Apnea that don't involve a mask

One of the concerns that some patients have when they consider that they might suffer from sleep apnea is whether they will have to use a CPAP machine and mask as therapy.

CPAP (Continuous Positive Airway Pressure) therapy is considered the gold standard for treatment of obstructive sleep apnea; until the 1980s, we didn't even have CPAP as an option, and the only way to treat sleep apnea was to perform a tracheostomy (by cutting a hole through the tissue in the throat to open up the airway). Therapy for obstructive sleep apnea, and especially CPAP, has come a long way for those who suffer from severe sleep breathing disorders. Machines are smaller and quiet and masks are smaller with more comfortable headgear and a better fit.

Still, some people may try CPAP treatment but find they cannot tolerate it. Others may have a milder form of sleep apnea and may possibly do just as well by undertaking an alternative treatment. There are other options, after all. Some of them are more invasive, or more controversial, or more useful to certain patients over others. They all have risks and costs to consider as well, and the rate of effectiveness for each alternative varies widely and depends upon a multitude of variables.

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. But if you are thinking you might qualify for a CPAP alternative or are willing to try other approaches, read on.

ALTERNATIVE DEVICES

• Oral devices.
  These are various kinds of dental devices which are molded to your unique jawline; they may help to realign the jaw overnight so that your airway can be opened while you sleep. These are not the over-the-counter mouthpieces; you must be fitted for one through a dentist with sleep dentistry credentials. Insurance is now starting to cover these devices and labs now have technologists who can help patients titrate them for optimal treatment.
• 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.

SURGICAL PROCEDURES

• 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 stimulation.

  

  © UMM/Inspire Medical Systems Inc

  This 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.

Image courtesy NightBalance

LIFESTYLE CHANGES

• Positional therapy.
  This is admittedly "old school," but training yourself to sleep on your left or right side and avoiding sleep on the back or belly may help keep the airway open and reduce airway collapse leading to sleep apnea. Some patients sew tennis balls into the fronts or backs of their nightshirts to prevent them from rolling onto either of these sides.
• 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.
  
  For those who are morbidly obese, gastric bypass and other surgical weight loss procedures 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.
• Quit smoking.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.

  

  "Didgeridoo - U. Dist Street Fair 1993 - 1"
  by Joe Mabel. CC BY-SA 3.0 

  
  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. Read more.

Things that likely don't work.

• Oxygen therapy.
  This definitely can't work for someone who's airway is collapsing as they sleep. An oxygen tank and cannula delivers oxygen, but it is not pressurized to the level necessary to open up the airway. PAP stands for "positive airway pressure," and it is this air pressure itself, not merely the presence O2, which makes the therapy useful.
• Nasal strips.
  Some people swear by these but theoretically they are only useful for nasal congestion. Problems with upper airway are not limited to the sinuses and nasal passages, but extend into the mouth, the larynx and parts of the upper pharynx, which is where obstruction takes place.
• Snore pillows.
  If these work, it is because they force you to practice positional therapy (see Lifestyle Changes, above), not because of the particular contour of the pillow. They are expensive and not largely proven to be any more effective than just choosing to sleep on your side.
• Sleep apps for your smartphone.
  There is no way you can treat sleep apnea, snoring or upper airway resistance using a phone app. All of these are mechanical issues of the airway that require some kind of physical application of external, manipulative or surgical therapy. It's not even clear whether any of the smartphone apps sold to help you identify sleep problems are even useful for predicting any kind of sleep quality. They do not tap your brainwaves like an electroencephalogram (EEG) does, so you can't be sure they are truly measuring any kind of sleep, much less specific stages; also, these apps cannot measure drops in nocturnal oxygen saturation or capture pertinent muscle movement. The one way you can use your phone is as a device for video and/or audio recording, of yourself or others while asleep, in order to demonstrate the potential presence of apnea or heavy snoring in action, but that is about it.
• Drugs.
  Nope, there's not a pill for sleep breathing disorders, which are mechanical issues of the upper airway and, therefore, not treatable by medication. In fact, many drugs (over the counter, prescription and illicit) can depress the upper airway or worsen underlying apnea, snoring or upper airway resistance. Right now there's research into medications for these issues, but that is about it.

Finally, here's a great article from Sleep Review that analyzes various alternatives to CPAP.



A friendly reminder that links to websites offering products does not imply endorsement by SleepyHeadCENTRAL.com.

SleepyHeadCENTRAL strongly encourages people with ongoing sleep health problems to approach a medical professional to determine appropriate differential diagnoses and treatment. This post, like all other posts on SHC, is not intended to substitute for medical advice.  

Sleep Hygiene Tip of the Week: Resolve to achieve better sleep in 2015

'Tis the season to list some personal goals and establish a plan for achieving them. When it comes to sleep, you'll find there is no variation from this recurring theme: it's always going to be about self-improvement and the shedding of bad habits.

Listed below are ten popular New Year's resolutions, not ranked in any special order, just pulled from multiple top ten lists scattered across the web.

Check out how each of them has a connection with your sleep health in some way. Then consider how any of these might provide you with the foundation for setting your ow personal goals for more and better sleep in the new year.

Lose weight.
Here's something interesting to consider: by sleeping more and better, you may actually improve your metabolism and achieve weight loss. A little, anyway. On the flip side, if you lose weight, and you snore or have (or think you might have) obstructive sleep apnea, you may improve your sleep and reduce the impact your sleep breathing issues have on preexisting conditions like hypertension or diabetes. There are so many good reasons linking weight loss to better sleep health that this perennial resolution favorite deserves to be number one on every overweight American's goal list.

Get more and better sleep.
Yes, this is one of the top ten resolutions and for good reason: We need more and better sleep!

Quit smoking.
If you're a smoker, you've heard it all by now--all the reasons to quit. Here's one you may not have thought of. Quitting smoking may improve your sleep health. You may feel that smoking helps you relax so you can asleep, and that's partially true. But smoking has both a relaxing and a stimulating effect on the body. If you smoke and suffer from insomnia, the smoking might be part of the root cause of your sleepless nights. Smoking also impairs your body's ability to practice gas exchange (taking in oxygen, releasing carbon dioxide) and can result in sleep breathing disorders which, over time, can be difficult to treat. It may also mean that when you hit your golden years, you'll need an oxygen tank at your bed's side just to get through the night.

Save money or resolve debt.
These are two popular hand-in-hand resolutions that may not easily translate to better sleep or a better life. But consider the related notion of taking fewer days off from work due to illness or poor sleep; for someone who punches the clock, that's money in your pocket and you will probably be more productive and happy at work, too, if you had more consistent quality sleep. Salaried workers fare no better and productivity goes down when sleeplessness goes up, and this costs American businesses way more money than you would think. Or, think about one of the biggest risks of sleep deprivation: the bills incurred that are related to a drowsy driving accident, which could be a catastrophic amount of money if you are in a car accident and hurt yourself, another person or damage property. Even if nobody gets hurt and you have insurance, the property damage alone could cost you in raised automobile insurance rates, and there will likely be a polysomnogram in your future to determine why you are so sleepy. Deductibles for sleep studies can also be steep if you have a minimal plan or live where diagnostic studies run in the thousands.

Travel more.
Seems silly to say this, but it's not silly if you have moderate to severe sleep apnea and allow it to get in the way of any travel you might want or need for your work or personal life. Portable sleep apnea devices are a reasonable solution and airports are now quite familiar with these passing through security. They are more common than you think and absolutely liberate many people who might not otherwise travel because they don't think they can take their PAP machine with them.

Volunteer, or give to charity.
If you have a sleep disorder already, you can sign up to participate in clinical trials to help sleep researchers to learn more about the sleep and wake cycles of the brain and body. Or you could give a gift of money to the National Sleep Foundation so they can continue their good work.

Learn a new language or skill.
It doesn't have to be a foreign language or exotic skill. It could be the vocabulary necessary for good health literacy or a new relaxation technique. Learn what it means to get a good night's sleep by learning and practicing good sleep hygiene, which are habits that set you up to succeed in falling asleep and remaining asleep at night (see "Live sustainably").

Live sustainably. 
The notion of "going green" (or practicing sustainable habits) has a counterpart here: mindful self care when it comes to sleep, or two often repeated words at SHC: Sleep Hygiene. Find ways to improve your sleeping environment. Turn off your devices an hour before bed. Practice bedtime relaxation. Avoid food and drink and behaviors like late meals and heavy exercise before bed. Go to bed when you are sleepy; rise at the same time every day. These are great sustainable practices for better sleep, and with better sleep, you can be a more energized, more productive and efficient version of yourself.

Better dental hygiene.
Imagine making a trip to the dentist's for a cleaning and discovering you are a potential candidate for a sleep test. It's likely this will be a norm in the future as many dentists are now becoming trained in sleep dentistry, and one of the things they can help to identify is potential sleep apnea. The presence of worn teeth might suggest bruxism (or teeth or jaw clenching) which can fit the pattern for sleep apnea. Also, certain kinds of cranial formations in the area of the jaw are consistent with sleep breathing problems (such as a severe overbite).

Do something big.
Some people may decide to go back to school. Others might run a marathon. These are tremendous goals, but so are any concerted efforts you make to end your insomnia, become compliant with PAP therapy or succeed in diagnosing and treating your new sleep disorder. Taking your sleep as seriously as someone might take the training for a marathon can only lead to success, and on top of that, the spoils that come with helping your body to function better. Better sleep means a sharper mind during the day, a stronger body at the cellular level, a more effective immune system, even healthier skin! Don't shortchange you this opportunity to improve your life. Make more and better sleep the priority and raise the limits of what you can accomplish!

Sleep News || June 2014

JUNE 2
The Consumer Electronics Association has teamed up with the National Sleep Foundation to create valid standards for new wearable devices which allow consumers to measure their sleep patterns.

The FDA recently approved the first-ever device used in the treatment of Restless Leg Syndrome

JUNE 4
People with Alzheimer's might benefit from circadian stimulation

JUNE 11
Check it out: Digital sleep dentistry

JUNE 12
Hearing loss and sleep apnea... a connection?

JUNE 16
Learn what "junk sleep" is and how to combat it.

JUNE 17
The National Sleep Foundation has created a new website to help consumers to make their bedrooms the most conducive sleeping environments possible.

JUNE 25
A British man claims he did not rape his wife because he was asleep.

JUNE 27
Health spas are taking an interest in their sleep-deprived clients.

The debate over mandatory sleep tests for public transportation operators continues unabated.

JUNE 29
Are you a morning lark or a night owl? Your preference for "morningness" or "eveningness" may say something about your driving skills. 

If you're middle aged and have insomnia, you might be at risk for losing your (cognitive) mind.

Corporations may begin to include sleep health in their wellness programs after statistics show alarming rates of sleep deprivation among workers, which can lead to poor job performance and even the inability to handle daily job tasks

Sleep apnea is not just an adult disease; if your kids snore, they might need to be checked for sleep apnea

JUNE 30
Treatments for sleep apnea may also help those who suffer from Post Traumatic Stress Disorder