Sleep Apnea Treatment Options Can Help You Enjoy a Good Night’s Sleep

If you sometimes wake up gasping for breath, have a history of breathing irregularly during sleep, or feel sleepy during the day, you may have been diagnosed with obstructive sleep apnea (OSA) and prescribed a continuous positive airway pressure (CPAP) machine. While CPAP therapy is the gold standard for moderate to severe sleep apnea, many who are prescribed CPAP are not comfortable wearing the facial mask that is a crucial part of the system, so noncompliance is common.

If you have given up on CPAP or use it only sometimes, you’re not alone. Studies show adherence rates for CPAP machines may be as low as 50 percent. Fortunately, CPAP is not your only effective option. Alternatives to CPAP for OSA include surgery, changing sleeping positions, and oral appliances, among other things.

Surgical Alternatives

Hypoglossal Nerve Stimulation. “In cases where the person can’t tolerate CPAP, one of the things we consider is hypoglossal nerve stimulation (HNS),” says Daniel Barone, MD, associate medical director, Weill Cornell Center for Sleep Medicine. Here’s how HNS works: A tiny device (made by Inspira Medical Systems, Inc.) is implanted under the skin near the collarbone to stimulate the hypoglossal nerve, which controls the muscles in the throat. During sleep, the device sends signals to the nerve, like a gentle reminder for the throat muscles to stay active and open. “HNS is a one-to-two-hour procedure that is generally well tolerated,” explains Dr. Barone.

Uvulopalatopharyngoplasty (UPPP). UPPP, also known as upper airway surgery, involves removing or shrinking parts of the tonsils, the uvula, and the soft palate. The soft palate contributes to airway blockages in more than 90 percent of people with OSA. “This is not something we typically recommend because it is not guaranteed to treat the sleep apnea, though it may make snoring better,” says Dr. Barone.

Maxillomandibular Advancement (MA). This is a more complex surgery for OSA, but it has a better success rate, says Dr. Barone. In MA surgery, the upper airway is made larger by surgically moving the jaw forward. “This is highly effective, but extreme,” he says. “This surgery is warranted in very severe OSA cases where no other options can cure the problem.” Studies show MA was considered a success in nearly 86 percent of people who had it. The surgery also led to at least mild improvements in nearly 99 percent of cases.

Additional Options

Oral Appliance. Another alternative to CPAP is an oral appliance. These custom molded mouthpieces address anatomical factors that contribute to sleep apnea, such as a small lower jaw or a tongue that obstructs the airway. “Your dentist would make this device for you by molding it to your upper and lower teeth so when you put it in your mouth it pulls the lower jaw forward a few millimeters, which takes the tongue away from the back of the throat,” explains Dr. Barone. These devices work best for people who have mild OSA or those who experience OSA only when sleeping on their back.

Changing Sleeping Positions. For some people who have OSA, an effective alternative to CPAP is simply a change of sleeping position. One study found that nearly 62 percent of people with OSA sleep on their back. “Sleep apnea gets worse when patients sleep on their back. I tell my patients to stay off their back, and if they have to be on their back then sleep on an incline with their head raised,” says Dr. Barone.

Losing Weight. Sometimes weight loss is recommended for people who have OSA. Dr. Barone cautions that healthy-weight people should not assume that this recommendation means sleep apnea is not a concern for them. “People often associate sleep apnea with overweight men, but thin people get sleep apnea and so do women. In fact, the risk for this sleep disorder rises with hormonal changes that occur after menopause,” explains Dr. Barone. Basically, if you are a healthy weight postmenopausal woman and you are extremely tired during the day, you might be experiencing breathing irregularity during sleep. You should discuss this with your physician and be evaluated for sleep disorders, including sleep apnea.

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