Non-PAP options for OSA
Over the years, I have learned that one of the reasons people don’t want to have a sleep study is because they don’t want to wear a CPAP. Many choose to delay their sleep clinic visit and aren’t aware that there are other options available. While CPAP is often the most popular option, there are other very viable options that effectively treat sleep apnea.
In order to understand these better, let’s take a quick look at what happens when someone has OSA.
The airway collapses, causing your brain to awaken briefly or your oxygen level to drop. We can treat this with CPAP, which splints your airway open, or by doing something else to pull your jaw forward which makes the airway larger and less prone to collapse.
Oral Appliance Therapy: an oral appliance is custom-fit by a sleep dentist. The idea is to bring the jaw forward in an attempt to open up the airway.
Nasal EPAP device: This is a one-way valve that opens when you inhale and closes when you exhale. This traps air in the airway to keep the airway open. These devices there are at least two devices that utilize this technology. One is Provent – this is an adhesive, disposable valve. There are a number of studies on this device showing that it is an effective way to treat sleep apnea. BongoRX uses the same type of valve but it is attached to a nasal dilator. This allows for more air when you inhale but still closes the valve when you exhale in order to treat the sleep apnea.
Weight loss: all of these devices are treatment, not cure. Weight reduction can be an effective way to eliminate sleep apnea. We know that even a 10-20% weight loss can significantly improve sleep apnea. There is also data showing that people who are more physically fit have a lower risk of OSA, even if they are obese.
Hypoglossal Nerve Stimulation: this is an implantable device that treats OSA. It consists of a small generator that is placed under the skin on the chest wall. There is a wire that senses when you breathe and another that feeds into the nerve that stimulates your tongue. It works by stimulating your tongue to open up the airway as you sleep. It is operated by a remote control. Once you turn it on, it will move your tongue out once to let you know it has been activated. It will then allow you 20-30 minutes to fall asleep naturally before turning on to take care of your sleep apnea all night. It isn’t meant for everyone. Before having this device implanted, an ear, nose and throat surgeon will take a look in your airway. They give you medicine to allow you to sleep. They look at your airway to see why you have sleep apnea – is it because your tongue flops backwards OR is it because your whole airway narrows? If it is because your tongue flops backwards, you may be a good candidate for this device. This will also depend upon the severity and type of sleep apnea you have. Your local sleep specialist can help you decide if this is a good option for you.
SURGERY
UP3: Uvulopalatopharyngoplasty -this is a procedure that opens up the back of your throat. It removes or shortens the uvula (the dangly thing at the back of your throat) and removes any extra tissue you may have (including tonsils) that might cause snoring and sleep apnea. It is best for people who snore or who have mild sleep apnea with a large uvula or large tonsils.
MMA: Maxomandibular Advancement- this is a procedure that pulls the jaw forward. It is very effective for sleep apnea but is an involved procedure. Your jawline changes and is usually more prominent. Many patients prefer this look. Some patients will require dental braces to shift their teeth before the procedure so that when the jaw is advanced, the teeth line up.
Gastric Bypass: This procedure, or other weight loss surgeries, can help to treat sleep apnea by causing significant weight reduction.
As you can see, there are plenty of options available to treat obstructive sleep apnea that don’t involve wearing a mask at night. Our goal is to first see if you have sleep apnea, then partner with you to find a treatment solution that works for you and your lifestyle. If you think you might have sleep apnea, please consider talking to your physician or one of ours.
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