Alternatives to CPAP Therapy
Although CPAP remains the most effective treatment for sleep apnea, there are a variety of alternatives to CPAP therapy. They can be viable for effectively dealing with the symptoms and the negative health implications of OSA. As we look at some of these alternatives, it's important to remember one thing. Since every human being is different, so too is their OSA and its effects. This article serves as a basic introduction to these alternatives.
Dental appliances have a fairly long history alongside CPAP therapy. They have proven to be effective for people that snore in a general sense. Similar in appearance to mouth guards, these devices are designed to move the tongue or lower jaw forward, opening the airway making it easier to breathe. These devices have are somewhat effective for those with mild OSA. However, there has been concern about how the dental appliance impacts the jaw in the long term.
One of the more recent CPAP therapy alternatives is Expiratory Positive Airway Pressure (EPAP). Once again this is a treatment designed to eliminate snoring as well as OSA. The Nasal EPAP utilizes the user’s own breathing to create positive airway pressure to prevent obstructed breathing.
The devices generally consist of small patches with two plugs that fit into the nostrils. A valve opens upon inhalation to permit free air flow. When the wearer breathes out, the valve closes and air forcibly moves out through a smaller channel. This results in the creation of back pressure that works to keep the breathing airway open.
Limited studies have shown significant reductions in the apnea hypopnea index (AHI), oxygen desaturation index (ODI) and sleepiness in patients with mild OSA.. Nevertheless, EPAP therapy has so far had limited research studies performed with limited numbers of participants. Unlike the proven widespread efficacy of CPAP therapy, these limited trials and use have yet to show a widespread effectiveness across OSA populations.
While there are many different options for surgical treatment, they bring the greatest amount of risks and costs. Like CPAP therapy, surgical procedures are highly dependent on the needs of each individual OSA patient and must be tailored accordingly. Unlike CPAP therapy, these drastic measures show potential for only a small number of patients suffering from the most severe forms of OSA.
Two of the most prevalent procedures are Maxillomandibular advancement and Uvulopalatopharyngoplasty. Although both procedures seek to surgically expand the size of the airway, they each use different approaches that range from complex skeletal structure changes to the removal of excess tissue to accomplish their goal.
One of the latest surgical techniques utilizes an implantable device that is meant to stimulate the hypoglossal nerve, which runs just beneath the base of the tongue and controls its movements. During sleep, the device electrically stimulates the nerve with each round of breath.
Currently, this form of surgery is just now exiting the experimental stage with very limited use as it is only suitable for the most severe forms of OSA. In addition, there is some concern regarding long-term side effects of continuously stimulating the hypoglossal nerve.
These and other alternatives to CPAP therapy range from drastic to complimentary and have grown out of the desire to provide an alternative for those patients that find the CPAP mask uncomfortable. As medical research and development moves forward, it is sure to produce new methods of treating OSA.
What is unclear is if they will ever outpace or outperform the increasing developments of CPAP therapy. As CPAP therapy moves forward, it continues to become more effective for a wider population while also becoming less obtrusive. CPAP masks have become lighter, more comfortable and extremely effective. The result is a that only a small percentage of people have difficulty tolerating the therapy process.