CPAP Alternatives – The Path to Restorative Sleep

There are several treatment options for obstructive sleep apnea, one of which is a popular treatment known as a CPAP. However, CPAP can present some problems for the individual. Below, we talk about one of the best CPAP alternatives that offers an effective and permanent treatment option for obstructive sleep apnea:

OSA Treatment Options

The sleep market today is highly fragmented as practitioners from a wide variety of backgrounds have responded to the dramatic increase in recognition of the disease, and third party payers have initiated coverage for sleep apnea treatment, recognizing the tremendous long term savings by reducing the co-morbidities associated with the disease. However, only a limited number of third party health insurance plans, NOT including Medicare or Medicaid, will presently cover the costs of the MMA procedure at this time.  This is likely to change as more regulatory mandates, especially from federal oversight of the commercial trucking and airline industries, begin to require mandatory OSA testing and treatment verification for license certification in the near future.

Overnight Sleep Testing and CPAP

Most patients are diagnosed by means of 2 separate inpatient overnight sleep tests. The first quantifies the number of apneic and hypopneic episodes per hour termed AHI (apnea, hypopnea index). The second evaluates their response to and allows titration of CPAP which is the most common treatment modality.

CPAP is a highly cumbersome and burdensome modality. The individual must wear a mask not unlike a breathing mask utilized in anesthesia, which is connected to a device which generates positive pressure airflow through the mask thus distending the airway. The device is noisy, the mask has a tendency to become dislodged, and many patients feel that the CPAP treatment is more of an impediment to sleep than their disease. Travel with the device raises another set of problems. Individuals who use CPAP can suffer from dry mouth, sinusitis, sore throats, dry eyes, facial rashes and orthodontic movement of the teeth, to name but a few problems. It is estimated that CPAP use, as medically prescribed, is at best 35-45%.  Again, UNDER treatment of OSA with CPAP can be as potentially dangerous as NO treatment at all.  Many of those individuals who are actually compliant would welcome the opportunity to have a curative procedure to avoid the inconvenience and maintenance time and expense.

A number of minor surgical procedures termed Stage 1 procedures are frequently tried in an attempt to eliminate CPAP but these procedures are largely unsuccessful and costly. Success rates range from 30-60% in providing some degree of improvement. Dental appliances are frequently used but they bring a whole new set of associated problems, including TMJ pain, malocclusion and a dismally low success rate in all but the mildest cases.

Severe cases will sometimes undergo placement of a permanent surgical airway in the neck, a permanent tracheostomy, which is 100% successful, but is obviously a disfiguring treatment of last resort.

Sleepy Mike

Sleepy Mike’s 15 Common Complaints by Users of CPAP

  1. Claustrophobia
  2. Pressure Sores on Bridge of Nose
  3. Leaking Mask
  4. Skin Rashes on Face
  5. Belching (Aerophagia–swallowing of air)
  6. Nasal Congestion
  7. Dryness of Mouth
  8. Dry Eyes
  9. Mask Comes Off Face While Asleep
  10. Too Much Pressure
  11. Too Hot (Summer)
  12. Too Cold (Winter)
  13. Too Wet (Condensation around mask from warmed, humidified air)
  14. Strangling by Hose
  15. Everything Shifts at Night ( Mask, Face Straps, Hose)

The following all caused by HIGH inspiratory pressures of CPAP mask because many patients have SEVERE OSA—AHI typically greater than 20.

  • Recurrent Otitis Media (middle ear infections)
  • Recurrent Sinusitis—maxillary, frontal or sphenoid sinuses
  • Recurrent Conjunctivitis– (from dry eyes from lacrimal gland dysfunction)
  • Recurrent Dacrocystitis–(chronic inflammation of the lacrimal sac source of tears for the eyes)

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Next: The Diagnosis

Maxillomandibular Advancement (MMA)

MMA as it is currently provided is rarely recommended due to high costs, and morbidity though it carries a 95-99% cure rate for OSA. MMA is currently performed in the hospital setting by delivery of a procedure that takes from 6-12 hours and is generally associated with at least one night in the Intensive Care Unit and 3-4 days of hospitalization. Most patients are unable to resume normal activities for up to a month. For this reason it has traditionally been considered a treatment of last resort, much like tracheostomy.

By contrast, our proprietary Get2REM MMA  procedure is performed as a 2-3 hour outpatient operation with one first night observation stay in our facility and back to home the next day. Patients are on a soft diet for 2-3 weeks and normally can return to work within 7-10 days without difficulty.

Closed or collapsed airway during sleep

Closed or collapsed airway during sleep

Open airway during sleep

Open airway during sleep

The MMA works by moving the upper jaw and mid-face, as well as lower jaw and chin forward a predetermined amount. This results in dramatic increase in overall 3 dimensional area of the airway and a relief of the soft tissue obstructions from the nose to the trachea (as seen above in a 3D CT scan of one our actual patients).

Contact SleepApnea Surgicure to learn about surgical treatment for sleep apnea, especially if you’re looking for effective and permanent CPAP alternatives.