What are CPAP alternatives?
For some patients, a CPAP machine may not be the best treatment option. Those with mild sleep apnea or upper airway resistance syndrome (UARS) may be good candidates for CPAP alternatives.
In addition, those patients who are unable to tolerate the CPAP mask and are non-compliant with treatment may also be eligible for alternative treatments to CPAP. In some cases, cognitive behavioral therapy may be explored as a treatment option for non-compliant CPAP users before considering treatment alternatives, as this may improve compliance.
CPAP alternatives may include conservative therapies, other sleep devices, or even minimally invasive procedures or surgery, depending on each patient’s unique needs. Alternatives to CPAP sleep apnea treatment include:
Lifestyle modifications may consist of losing weight, quitting smoking, exercising regularly, avoiding alcohol, and other changes based on an individual’s needs.
Cognitive behavior therapy may help identify reasons for CPAP non-compliance, thereby improving the frequency of use.
Positional therapy involves changing the position in which you sleep to minimize the risk of airway obstruction. This may be beneficial for appropriate patients.
Medical management may be adequate to treat sleep apnea, thereby eliminating the need for CPAP in the appropriate patient group.
Oral appliance therapy involves the use of a custom-made mouthpiece that enlarges and stabilizes the airway by advancing the jaw and retaining the tongue – two factors that can help prevent blockage. Oral appliances, like CPAP, are worn on a nightly basis.
Inspire therapy is a small, surgically implanted device on the chest wall that delivers mild stimulation to open the airway during sleep, thereby treating sleep apnea and eliminating the need for CPAP.
Apnicure Winx therapy system is a light oral vacuum that rests inside the mouth while sleeping, gently stabilizing the soft tissue in the mouth to keep the airway open and optimize breathing.
Surgical options may be used in a select group of patients, typically with more severe OSA, or may be considered as a treatment option for children with sleep apnea. Surgical sleep apnea treatment options should be discussed with Dr. Clerk.
Why are CPAP alternatives used?
The most common reasons a patient may consider a CPAP alternative as a treatment option include:
The patient’s sleep apnea is not severe enough to warrant using a CPAP machine
CPAP compliance is a challenge for the patient
The CPAP mask is uncomfortable for the patient, producing effects such as nasal congestion, skin irritation or dry mouth
CPAP machine is hard to travel with
The patient does not wish to use CPAP but is looking to alleviate symptoms related to sleep apnea
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Other Alternative Sleep Apnea Treatment Options
Surgery - Surgical Procedures
There are many different types of surgery for sleep apnea and snoring. But CPAP is the first treatment option for anyone who has sleep apnea. Oral appliance therapy also is an alternative treatment option for people with mild to moderate sleep apnea. The members of the sleep team will help you decide if surgery is right for you.
Surgery may be a multi-step process involving more than one procedure. You may need to continue using CPAP even when surgery successfully reduces the severity of sleep apnea. It is important to follow up regularly with your sleep physician after surgery.
Surgical options include:
This procedure, and other types of soft palate surgery, targets the back of the roof of your mouth. It involves removing and repositioning excess tissue in the throat to make the airway wider. The surgeon can trim down your soft palate and uvula, remove your tonsils, and reposition some of the muscles of the soft palate. UPPP and other soft palate procedures are the most common type of surgery for sleep apnea. But UPPP alone is unlikely to cure moderate to severe sleep apnea. It may be combined with surgeries that target other sites in the upper airway.
Radiofrequency Volumetric Tissue Reduction (RFVTR)
Radiofrequency ablation is a treatment option for people with mild to moderate sleep apnea. It uses controlled cauterization to shrink and tighten the tissues in and around the throat. It can be applied to the soft palate, tonsils and tongue.
Septoplasty and Turbinate Reduction
These surgical options open your nasal passage to improve the flow of air. Septoplasty straightens a bent or deviated nasal septum. This is the divider that separates the two sides of the nose. Turbinate reduction reduces or removes the curved structures that stick out from the side of the nose. They can be enlarged for a number of reasons, including allergies. Medications also can help reduce the size of turbinates.
During sleep the tongue can fall back to block the space for breathing in your throat. This surgery moves the major tongue attachment forward, opening up space for breathing behind the tongue. It involves making a cut in the lower jaw where the tongue attaches. This piece of bone (but not the entire jaw) is then moved forward.
This surgery enlarges the space for breathing in the lower part of the throat. The hyoid bone is a U-shaped bone in the neck. The tongue and other structures of the throat like the epiglottis are attached to it. Hyoid suspension involves pulling the hyoid bone forward and securing it in place.
Midline glossectomy and lingualplasty
These two surgeries involve removing part of the back of your tongue. Making the tongue smaller can prevent airway blockage in some people with sleep apnea. These procedures are uncommon.
Maxillomandibular osteotomy (MMO) and advancement (MMA)
This type of surgery is a treatment option for severe sleep apnea. It moves your upper and/or lower jaw forward to enlarge the space for breathing in the entire throat. The procedures involve cutting the bone of your jaws, which then heal over the course of months. Your jaws may be wired shut for a few days. Your diet also will be limited for several weeks after the procedure.
Palatal implants may be effective in some people with snoring or mild sleep apnea. Small, fiber rods are inserted into the soft palate to stiffen the tissue and prevent airway blockage.
Weight loss surgery
Bariatric surgery can promote weight loss and may improve sleep apnea in people who are obese. But weight loss surgery usually is recommended because of other health risks related to obesity. Prior to weight loss surgery you may be referred to a sleep physician for an evaluation and sleep study. There are many types of weight loss surgery. Some procedures reduce the size of the stomach, making it harder to eat as much food. Each surgery has different risks and benefits. People who are obese should work with their doctor to implement other weight loss strategies before considering surgery. You should use CPAP before and after weight loss surgery.
Laser-assisted uvuloplasty (LAUP)
This procedure is not routinely recommended as a treatment for sleep apnea. The surgeon makes cuts using a laser to scar and tighten the soft palate. The uvula is trimmed over a period of several visits. It is less painful and has fewer side effects than UPPP. But it is also less effective.
This surgery is an effective treatment for sleep apnea. But it is a drastic option that is used in rare, emergency situations. Other treatment options are preferable for almost all patients with sleep apnea. It involves placing a hollow breathing tube directly into your windpipe in the lower portion of the neck. This tube can be plugged during the day, allowing you to breathe and speak normally through your nose and mouth. At night the tube is opened to allow you to breathe without any blockage in your throat.
Dr. Clerk makes the effort to determine the cause of CPAP non-compliance and may be able to offer recommendations that can help. Several sleep devices are available and may be recommended to improve sleep quality or CPAP compliance. CPAP alternatives may be considered as a treatment option based on patient factors.
What are the advantages of CPAP alternatives?
Some benefits of using CPAP alternatives include:
May improve treatment compliance, thus resulting in better treatment results
Can be customized based on a patient’s individual needs
If you are suffering from snoring or sleep apnea and are interested in learning more about continuous positive airway pressure (CPAP) therapy or CPAP alternatives, the first step is to schedule an appointment with a doctor who specializes in sleep medicine. Dr. Clerk is a trusted sleep specialist in the Bay Area, with extensive experience in treating patients suffering from all kinds of sleep disorders. Call (408) 295-4532 today.