Proven Alternatives to PAP therapy for you
Looking for CPAP alternatives? You’re not alone. We’re here to help you investigate your options.
So, grab a pen and paper or cue up a new computer document file and let’s go.
Here is a list of twenty-plus alternatives to CPAP and in no particular order:
(1) Weight Reduction is a common assumption to partially solve sleep apnea. It has been proven to improve breathing patterns during sleep. Even more, losing weight also improves the quality of sleep and reduces daytime sleepiness. However, it isn’t an end all solution. Remember, losing weight can reduce the intensity of other treatment options. In other words, it can only help one’s sleep by losing weight and maintaining a healthy weight with custom diet/lifestyle/exercise solutions, especially when combined with other sleep apnea treatment options.
(2) Positional therapy is another option which can lead to moderate reductions in sleep apnea events, especially when someone is younger, has a low AHI and is less obese. But this choice is clearly inferior to CPAP and, therefore, cannot be recommended except in carefully selected people who have met Long-term compliance with positional therapy is historically poor.
3) Apnea triggered muscle stimulation is another option but cannot be recommended as an effective treatment of OSAS in this moment in time. Electrical stimulation of muscle tissue in the throat (where lazy tissue predominantly resides) is impractical, surgical in nature and is largely unproven.it works based on your unique breathing patterns; the system delivers mild stimulation to the hypoglossal nerve which controls the movement of your tongue and other key airway muscles. By stimulating these muscles, the airway remains open during sleep.
The Inspire obstructive sleep apnea device is controlled by a small handheld sleep remote. The remote allows you to turn Inspire therapy on before bed and off when you wake up, increase and decrease stimulation strength, and pause during the night if needed.
Proof of sleep apnea relief is largely undocumented to offer a definitive recommendation. Seek the assistance of an ENT specialist with this option.
4) Although tongue muscle training is good like exercise for the body is, it is not the go-to solution in the treatment of sleep apnea in general. This is because weak muscle tissue typically surrounds the tongue or is in the throat area (internally). Unfortunately, this tissue is not re-trainable to maintain any rigidity. Therefore this type of approach has a low return of benefit.
5) Mandibular advancement devices (MADs) reduce sleep apnoeas and subjective daytime sleepiness, improve quality of life compared with control treatments, and are recommended in the treatment of patients with mild to moderate obstructive sleep apnoea (OSA) There is emerging evidence on the beneficial cardiovascular effects of MADs. However, tongue retaining devices (TRDs) cannot be highly recommended.
7) Drug therapy is not recommended as treatment for OSA (i.e. mirtazapine and protryptilline). This is due to constant dosage adjustment, doctor visits, etc.
8) Nasal dilators are not recommended for reducing snoring, or for improving sleep disordered breathing or sleep architecture in OSA . They may be beneficial for nasal passage clearance and clear nostril breathing relief only.
9) Nasal surgery as a single intervention cannot be recommended for treatment of OSA because surgery is not 100% proven. Specific assessments by an Ear Throat Nose Doctor before this option is worth it.
10) Intranasal corticosteroids have been known to improve mild to moderate OSA in children with co-existing rhinitis and/or upper airway obstruction due to adenotonsillar hypertrophy. They may also show some benefit with respect to both symptoms and some sleep parameters. Intranasal corticosteroids can be recommended as concomitant therapy in these situations.
11) Tonsillectomy as a single therapy can be recommended for treatment of OSA in the presence of tonsillar hypertrophy in adults. Adenotonsillectomy can be recommended in the presence of adenotonsillar hypertrophy associated with paediatric OSA (C). Radiofrequency tonsil reduction is not recommended as a single procedure for the treatment of OSA (negative recommendation.
12) Uvulopalatopharyngoplasty (UPPP) is a single-level surgical procedure effective only in selected patients with obstruction limited to the oropharyngeal area. When proposing UPPP, potential benefits should be weighed against the risk of frequent long-term side-effects, such as velopharyngeal insufficiency, dry throat and abnormal swallowing. UPPP cannot be recommended except in carefully selected patients
13) Laser assisted uvulopalatoplasty has not demonstrated any significant effect, either on OSA severity or in symptoms or quality of life domains, and is not recommended (negative recommendation.
14) Due to insufficient evidence, radiofrequency surgery of the soft palate may only be considered in patients with mild disease refusing or not requiring CPAP, as long as the TABLE 1 Evidence levels 1a Systematic analysis (systematic review) of RCTs with homogenous results 1b Particular RCT with limited dispersion 1c Therapy, before its introduction all patients died 2a Systematic review of cohort studies with homogenous results 2b Particular cohort studies or RCT of lower quality 2c ‘‘Outcomes’’ research; ecological studies 3a Systematic review of case–control studies with homogenous results 3b Particular case–control study 4 Case studies and cohort studies or case–control studies of limited quality 5 Expert opinions RCT: randomised controlled trial. TABLE 2 Grades of recommendation A Consistent level 1 studies B Consistent level 2 or 3 studies or extrapolations of level 1 studies C Level 4 studies or extrapolations of level 2 or 3 studies D Level 5 or inconsistent studies of other levels W.J. RANDERATH ET AL. ERS TASK FORCE: NON-CPAP THERAPIES FOR OSAS c EUROPEAN RESPIRATORY JOURNAL VOLUME 37 NUMBER 5 1001 individual anatomy appears suitable. It cannot be recommended except in carefully selected patients.
15) Uvulopalatal flap as a single intervention can only be recommended in selected cases for treatment of OSA (C). Studies investigating the uvulopalatal flap with tonsillectomy for OSA show a significant improvement of the severity of OSA and quality of life, and this combined intervention can be recommended in selected patients (B).
16) Pillar1 implants may be considered in patients with mild to moderate OSA, who are suitable with regard to their overall physical condition (not or only moderately obese, no or small tonsils and no sign of retrolingual obstruction), if conservative approaches are not accepted by the patient. Pillar implants cannot be recommended except in carefully selected patients.
17) Due to insufficient evidence, radiofrequency surgery of the tongue base as an isolated or combined procedure cannot be recommended and may only be considered in selected patients intolerant to conservative treatment as long as the overall condition appears suitable (non- or only moderately obese patients with retrolingual obstruction.
18) Due to insufficient evidence, hyoid suspension cannot be recommended and may only be considered in carefully selected patients (C) and may be combined with other procedures in multilevel surgery (MLS).
19) Procedures such as laser midline glossectomy and tongue suspension (Repose1) have a small role as a single treatment option for obese patients with moderate to severe OSA and cannot be recommended. There are at present no data about their role in patients with mild disease.
20) Genioglossus advancement cannot be recommended as a single procedure for the surgical treatment of OSA.
And the final two
21) Maxillomandibular advancement (MMA) seems to be as efficient as CPAP in patients with OSA who refuse conservative treatment, particularly in a young OSA population who don’t have excessive body mass index (BMI) or other comorbidities.
22) Distraction osteogenesis (DOG) can be recommended in congenital micrognathia or midface hypoplasia (mandibular lengthening: B; midface advancement.
23) And of course the APAP (Auto-positive airway pressure) unit gives variable pressures instead of one pressure (from a CPAP) to keep the airway open. APAP has been proven effective in individuals who clearly cannot sleep with CPAP.
And of course, please consult your Sleep Doctor or A specialist (Eye Ear Throat Nose Doctor, etc.) for further details about the list of alternatives above.
Still have questions?
Edited by Bill Bistak B Sc.,SEO/SEM Spc, CRT
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