What Are Your Therapy Options?
Before we look at some of these alternatives, let’s re-visit what happens when you sleep. There are two different processes that can cause you to not breathe. There can be an obstructive component; where your airway closes off. Or there can be a brain signal component in which your brain doesn’t tell your body to breathe.
Here’s a look at each one.
Your airway is basically all muscle; and while you’re awake, muscle tone and healthy breathing are generally good enough to keep your airway open.
Once you’re asleep, however, muscles relax, and breathing slows down. Your airway becomes floppy, and can either partially or totally collapse; causing snoring and/or obstructive breathing. This is known as obstructive sleep apnea, sleep apnea, or just OSA.
In Central Sleep Apnea, or CSA, your airway remains open but your brain doesn’t send a signal to breathe. This is not necessarily because of any brain damage (although it could be); sensors in your brain simply don’t sense the need to breathe at that moment.
This can happen with certain heart disease, where your blood circulation is compromised. In people with atrial fibrillation, and congestive heart failure, for example; which if you remember from my last blog, are two heart conditions also associated with OSA.
Knowledge is power, so the more you understand the damaging effects caused by sleep apnea, and the more you’re aware of the various treatment options; the more likely you’ll be to use some form of treatment.
Now because we’re not all the same, different treatment options are available. Let’s have a look at some of your choices.
PAP stands for Positive Air Pressure, and because there are different ways your breathing can be compromised while you sleep, there need to be different ways to treat them. Following is a brief list of PAP treatment options:
CPAP, or Continuous Positive Air Pressure, is just what the name implies. Air pressure is continuous, and it is this pressure that helps hold your airway open. CPAP is the most common form of this treatment.
Bi-PAP has 2 settings: a higher pressure while breathing in, and a lower pressure while breathing out. This helps you take a deeper breath, and can be useful if you have certain lung or heart diseases; or if you can’t tolerate CPAP.
ASV, or Auto Servo Ventilation, is specifically for people who have mainly central sleep apnea.
For those who can’t tolerate PAP treatment, there are other options. Let’s take a look at some of these.
There are a number of variations on this theme. Generally, the idea here is to either hold your jaw or tongue, forward; and they work best on people with mild to moderate OSA. Although the devices tend to be better tolerated than PAP , they should really only be considered if you aren’t tolerating that form of treatment.
To be properly fitted, you must be referred to a dentist who will make a mold of your teeth, and then make an appliance custom fit for you. A follow-up sleep study might be required to assure proper adjustment of the appliance.
Prevent and Theravent
These are little devices that sit in the nostrils. There’s a sponge-like filter that closes when you exhale, which creates a pressure. And it’s that pressure that helps hold your airway open
They’ve been proven to be fairly successful, although you really should consult your Dr. on this as well.
If you’re presently on CPAP but not tolerating treatment, and have mild to moderate sleep apnea this might be a viable alternative. However, if you already have heart disease or other OSA-related issues, especially if your sleep apnea is severe, this might not be the most effective option.
Breathe Right Strips
This is a little strip that has adhesive on one side that allows it to stick to your nose. It’s made of a springy like material, so once attached, will pull your nasal passages open as it tries to return to its original shape.
It works well at opening up your sinus passages if you have nasal congestion, but does nothing as far as keeping the airway in your throat open, and this is where OSA occurs.
Other forms of treatment include…
Most sleep apnea is much more noticeable on your back, so just not sleeping that way can improve breathing quite a bit. That’s because your airway is more likely to collapse when you’re on your back, as gravity pulls your tongue and jaw down against your throat. Therefore, laying on your side makes it less likely this will happen.
And sometimes it doesn’t take much. For example, I saw a video of a sleep study, and the patient barely turned his head; but it was just enough to make his sleep apnea worse.
If you have sleep apnea but can’t tolerate pap treatment, and are a back sleeper, there are a few ways to keep you off your back. However, this does not guarantee you will no longer have sleep apnea; although positional therapy can reduce, and possibly eliminate sleep apnea.
And t arere are various ways to accomplish this feat. There’re the old do-it-your-self tennis balls sown into the back of a tee shirt trick. But also some more sophisticated stuff, like a device on the back of your neck that vibrates when you turn on to your back. There are also pillows which are shaped in a way that helps keep your airway open.
However, positional therapy is not effective on everyone; so a sleep study should be done first to see if OSA can be controlled on your side without CPAP treatment
Also positional therapy is generally considered a secondary option if CPAP has failed, usually because of intolerance to treatment.
Sleep apnea is very much affected by weight. And as such, weight loss can be a very effective way to reduce OSA. In fact, losing weight is so effective, that in some cases, sleep apnea has been eliminated altogether.
There’ve been some interesting studies done on the use of singing, or playing a wind instrument to exercise throat muscles. And although these exercises can reduce snoring, they’ve shown no change in day time sleepiness.
See below under ‘surgery’ for some information on this new device.
This is another option for those who can’t tolerate PAP. And although Surgery can reduce the severity of seep apnea, it might not eliminate it. You still could need CPAP after surgery, although possibly at a reduced pressure.
There are various degrees of surgery; depending on the severity of OSA, and also where the obstruction is.
These procedures range all the way from using a laser to cut excess tissue from the back of your throat, all the way up to surgically advancing your jaw, which literally re-structures your face. You can also have a hole cut in your throat and a tube placed to allow you to breathe.
Additionally, procedures can be done that reduce the size of your stomach, thus causing you to eat less.
There’s also new device called ‘Inspire Therapy’. This is a surgically implanted mechanism that delivers an electrical pulse to airway muscles, which causes your airway to stay open. However, at present, this device is mainly for people who can’t tolerate PAP treatment; and I believe it is quite a spendy little thing.
If you have sleep apnea, there are presently no medications that can cure that. But there are, however, some medicines that can help you stay awake; as well as some that can help you sleep.
A couple of the more common ones are:
Provigil (Modafinil)–This drug can keep you awake and alert for up to 40 hrs or more. It even improves your memory and enhances your mood. Once this drug wears off, you just have to catch up on some missed sleep.
Ambien, Sonata, and Lunesta, are all meds that will help you fall asleep.
So what’s the best treatment option? As we’ve seen, there isn’t a one size fits all.
And while there are many different therapy choices, PAP treatment remains the ‘gold standard of care; and has proven to be the most effective. But again, if you can’t tolerate PAP, it’s good to know there are other ways to treat sleep apnea
For those of you who have been following my blog you’re aware of the dangers of untreated sleep apnea; and now you’re more aware of some of the various treatment options as well.
So, if you, or someone you know has, or is suspected to have OSA, the sooner you get a sleep study the better. If you’re concerned about the cost of a study, what’s that compared to the value of your life? Sleep Apnea is that serious; don’t let denial kill you.
In my next blog I’ll walk you through a typical sleep study. Till next week, blessings…