Episode 61

Non-CPAP Options

If entering the 3rd year of the pandemic wasn’t bad enough for your sleep, many of you may have been told at some point you have sleep disordered breathing and are unable or unwilling to use a CPAP device - now what? 

One of the most frequent causes of disrupted sleep and feeling poorly rested upon waking is sleep disordered breathing. Recent changes have made access to the gold-standard treatment for this condition harder than ever. But historical acceptance and adherence to the treatment was already abysmal. 

In this episode, I take a look at some non-surgical treatment options for the management of sleep disordered breathing if the gold standard positive airway pressure devices are unavailable or declined.

The most common disruptor of sleep, leading to symptoms like insomnia, daytime sleepiness and just feeling poorly rested - not to mention all sorts of physical and mental health consequences - is sleep disordered breathing. 

We’ve discussed this several times before, including episodes 40 and 46. The most conservative estimates places about 1 billion people world-wide with sleep disordered breathing. 

And studies of thousands of individuals using the most accurate sleep test indicate over 72% of adults over the age of 35 have sleep apnea. So chances are, you either already have it, or will get it in your lifetime. 

And the symptoms don’t always illuminate the cause, ranging from anxiety and depression, to ADHD, to metabolic syndrome, to cardiovascular disease. 

So if you’re not waking feeling well rested most days, and something about your daytime function just doesn’t feel like it’s supposed to, you should probably look more closely at your sleep, and specifically, how effective your breathing may be during sleep. 

But recent large scale forces have made access to the primary treatment very difficult for most people, with wait times lasting months and potentially longer. 

While CPAP and BPAP - continuous and bilevel positive airway pressure - remain the gold standard in the treatment of sleep disordered breathing, availability of or unwillingness to use these devices should encourage us to pivot and evaluate other treatment options, both surgical and non-surgical. 

Most of these treatments are only indicated to treat the milder end of the spectrum of sleep disordered breathing. But even for severe sleep apnea, any reduction in severity of the disease and its symptoms is preferable to no treatment at all. 

In this episode I discussed oral appliances, specifically mandibular advancement or repositioning devices. 

On average, they significantly improve breathing during sleep as well as improve sleepiness and daytime function. Customized and adjustable devices delivered by a board certified sleep dentist are more effective than off-the-shelf versions

I also discussed sleep positioning therapy devices, which help to keep you off of your back by buzzing you with some gentle vibration. 

While the DIY sew a tennis ball in the back of your shirt technique may work for a small number of people, head-to-head comparisons show that the prescription devices are not only significantly more effective, but also more comfortable, more likely to be used, and actually improve sleep quality, which the tennis ball technique did not. 

I discussed again the device mentioned back in Episode 53 using neuromuscular electrical stimulation. 

This endurance training for the tongue is the only FDA authorized treatment for sleep apnea that is never used during sleep - just 20 minutes during the daytime is all it takes for results. 

It is currently authorized to treat snoring and those with an apnea hypopnea index lower than 15 per hour. 

I discussed nasal EPAP or expiratory positive airway pressure. These nostril plugs are as low tech as you can get in the management of sleep disordered breathing, and they workThey may cut oxygen changes and apnea hypopnea index by over 40% and are super portable, able to be used on planes, camping, etc. 

And lastly I discussed intermittent negative airway pressure. By using a vacuum pump, the tongue and soft palate can be suctioned into position closer toward the front of the mouth (aka, their natural waking position), preventing their collapse backwards into the airway, blocking off vital oxygen delivery. Once the vacuum seal is created, the pump turns off for the vast majority of the night, and is very quiet when it does turn on. Unlike the other PAP alternatives, negative airway pressure is FDA cleared to treat the severe end of sleep apnea as well as mild to moderate. 

So if you find yourself impacted by a recall, semi-conductor shortages, logistical and shipping delays, or have tried and failed or just despise the idea of using CPAP or BPAP, have no fear. In addition to the several surgical options that can be delivered by a board certified sleep otolaryngologist, these other devices have proven their worth in the management of sleep disordered breathing. So check with your local board certified sleep medicine provider to find out more.