Sleep apnea is a common disorder that affects sleeping and causes interruptions in breathing during the night. The three most well-known are obstructive sleep apnea, central sleep apnea and complex sleep apnea: The former is the most prevalent type and is characterized by the partial or complete blockage of the airway during sleep due to the relaxation of the muscles in the back of the throat. This decreases the amount of oxygen that circulates in the bloodstream and breaks the sleep cycle.
Despite the fact that the main therapy for this condition is continuous positive airway pressure, or CPAP, some patients face issues with using it. These patients should therefore consider options that are outside a conventional medical care model. Though not as effective as CPAP, they are useful in adding more tools for enhancing sleep and minimizing apnea episodes.
Positional Therapy
Positional therapy is targeted to eliminate supine position and thereby reduce the chance of having an apnea. Noninvasive studies show that back sleeping makes OSA worse in more than half of patients. The reason is that, when a person is lying down particularly on their back, the tongue and other soft tissues may roll over the airway due to the effect of gravity.
There are several methods patients can use to maintain a side sleeping or lateral position, including:There are several methods patients can use to maintain a side sleeping or lateral position, including:
- Stitching tennis balls to the posterior side of a t-shirt or pajamas.
- Stacks of wedges, pillows or cushions that can be placed to support the side
- Adjustable position trainers that shake when a person lays supine
- Overhead monitoring devices to capture patterns of sleep position
Stomach sleeping can be easily avoided and there are no side effects or complications arising from its avoidance, which may help potentially decrease the number of apneic events in some patients. The same research revealed it could be resolved just by changing the position of the patient during the night and in more than 50% of the cases, OSA became worse.
Oral Appliances
These are oral devices which are customized to fit the mouth of the patient by moving the lower jaw forward during sleep to ensure that the air passage is widened. They can be used to treat patients with mild to moderate OSA if the patient has been diagnosed with this condition. Oral appliances function in the same way that CPAP does in regards to increasing the pharyngeal space but are not as cumbersome as wearing a CPAP mask and machine.
MADs are the most prominent among several oral appliances that are currently used for the treatment of snoring. The effectiveness of MADs in the studies are that they have been able to cause a mean reduction of AHI by over 50 percent with the variability ranging between 25-75 percent. However, it is worth pointing out that the efficacy of the oral appliances depends on various factors such as the severity of apnea and the structure of the jaw. In mild patients that cannot use CPAP, oral appliances are a practical intervention.
Myofunctional Therapy
Myofunctional therapy is the relatively new OSA treatment that seeks to address the issue through performing exercises on the tongue throat muscles. This is done in a bid to develop the muscles of the airway, which does not collapse when one is asleep. Usually, a speech language pathologist instructs oral and facial procedures that people must do on a daily basis.
Sources suggest that myofunctional therapy might reduce the severity of apnea, sleepiness during the day, and snoring. It also assists individuals in the management of long-term consequences of OSA, such as mouth breathing and improper swallowing. Temporary and short-term therapy, such as myofunctional therapy that takes 2-3 months, yields a substantial reduction of apnea symptoms.
To be as effective as possible, most protocols encourage the doing of the exercises for not less than 3 months. Myofunctional therapy is effective in treating mild to moderate OSA if applied independently. Nevertheless, the use of SRS in combination with other treatments might have a positive impact on the overall survival of patients belonging to any of the categories mentioned above. Nonetheless, even extreme OSA sufferers employing CPAP might benefit from the breathing and swallowing remediation.
Other Alternative Treatments
There are a few other interventions available if patients with apnea cannot tolerate CPAP: positional therapy equipment, expiratory positive airway pressure (EPAP) therapy, and hypoglossal nerve stimulation.
Positional therapy devices are worn during periods of sleep since supine positioning should be avoided. There is the Night Shift is a backpack-like structure with a tennis ball inside it. At night when the patient turns on their back then the tennis ball will exert some pain encouraging them to change positions.
EPAP devices are characterized by a small valve that seals onto the nostrils. In an inhalation period, the valve opens and permits normal breathing to occur. While breathing out, it restricts the flow of air to produce positive pressure in the airway thus keeping it open. This splinting force relieves the obstruction and the apneas.
Hypoglossal nerve stimulation is another invasive implant treatment that is applied to severe OSA patients only. It excites the nerve supplying the tongue with the message to protrude forward of the tongue instead of rolling it back to the airflow path when asleep. While PGE2 analogs are effective and proven in the studies to be around 50%, the side effects make it a choice only after other treatments have been exhausted.
Choosing Wisely
In this regard, even though CPAP is still considered as the first-line treatment for OSA, its drawbacks such as uncomfortable feelings and inconvenience indicate the importance for the development of other treatments. Positional adjustments, oral appliances, as well as tongue and throat exercises are revealed as the most effective when used as add-on therapies. This list may be the only available options for Mild OSA suffers if CPAP adherence is a problem.
Those who are still undecided about which treatment for sleep apnea they should undergo then should consider having an overnight polysomnography or a visit to a sleep medicine physician. It remains unclear whether the right approach depends on each patient’s general medical condition and apnea levels. , sleep apnea, people have the ability to find a new way to begin breathing at night with a lot of care and patience.
