Sleep News

Alternatives: Therapies for Sleep Apnea that don’t involve a mask

One of the concerns that some patients have when they consider that they might suffer from sleep apnea is whether they will have to use a CPAP machine and mask as therapy.

CPAP (Continuous Positive Airway Pressure) therapy is considered the gold standard for treatment of obstructive sleep apnea; until the 1980s, we didn’t even have CPAP as an option, and the only way to treat sleep apnea was to perform a tracheostomy (by cutting a hole through the tissue in the throat to open up the airway). Therapy for obstructive sleep apnea, and especially CPAP, has come a long way for those who suffer from severe sleep breathing disorders. Machines are smaller and quiet and masks are smaller with more comfortable headgear and a better fit.

Still, some people may try CPAP treatment but find they cannot tolerate it. Others may have a milder form of sleep apnea and may possibly do just as well by undertaking an alternative treatment. There are other options, after all. Some of them are more invasive, or more controversial, or more useful to certain patients over others. They all have risks and costs to consider as well, and the rate of effectiveness for each alternative varies widely and depends upon a multitude of variables.

It is not the purpose of this website to favor one therapy or another, or to compare and contrast, but rather to illustrate the variety of options that patients with sleep-disordered breathing may have.

As always, your diagnoses and treatments are best discussed with your sleep physician, as this website cannot diagnose your problem or prescribe or advise as to which options are best for you. But if you are thinking you might qualify for a CPAP alternative or are willing to try other approaches, read on.

ALTERNATIVE DEVICES

  • Oral devices.
    These are various kinds of dental devices which are molded to your unique jawline; they may help to realign the jaw overnight so that your airway can be opened while you sleep. These are not the over-the-counter mouthpieces; you must be fitted for one through a dentist with sleep dentistry credentials. Insurance is now starting to cover these devices and labs now have technologists who can help patients titrate them for optimal treatment.
  • Expiratory positive airway pressure.
    This is a kind of nostril patch device that works by blowing against the patches during exhale, which may improve the “patency” or rigidity of the upper airway tissue and provide, for some, a kind of “tracheal traction” to create greater ease in inhalation.
  • Oral pressure therapy.
    This works by using a small oral suction tube to draw the soft palate forward, which may stabilize the tongue and keep it from blocking the airway during sleep.
SURGICAL PROCEDURES
  • Pillar procedure.
    This is a minimally invasive surgical procedure in which tiny implants are inserted into the soft palate. Their presence may reduce tissue vibration which can lead to snoring, sleep apnea and upper airway resistance syndrome.
  • Somnoplasty.
    This is a minimally invasive surgical procedure using radio frequency (RF) energy to sculpt upper airway tissue under local anesthesia; this may effectively open the airway.
  • Upper airway stimulation.
    © UMM/Inspire Medical Systems Inc

    This is a small device implanted into the chest to deliver to deliver carefully timed mild stimulation to the airway during sleep. This controlled neurostimulation may achieve “patency” or firmness of the tissues in order to prevent their collapse.

  • Uvulopalatopharyngoplasty (UPPP).
    This surgical procedure removes excess tissue in the throat, soft palate, uvula, tongue, tonsils, and/or parts of the pharynx to create more space in the upper airway; this may prevent collapse airway collapse during sleep.
  • Adenoidectomy.
    Removal of the adenoids (tonsils) make help make space in an otherwise crowded airway.
  • Numerous other surgeries used to correct obstructive sleep apnea have been outlined clearly at this page hosted by the American Sleep Apnea Association.
Image courtesy NightBalance
LIFESTYLE CHANGES
  • Positional therapy.
    This is admittedly “old school,” but training yourself to sleep on your left or right side and avoiding sleep on the back or belly may help keep the airway open and reduce airway collapse leading to sleep apnea. Some patients sew tennis balls into the fronts or backs of their nightshirts to prevent them from rolling onto either of these sides.
  • Weight loss.
    Losing a few pounds, even just ten, can help shrink fat cells. Smaller fat cells retain less water and place less pressure on the tissues of the upper airway during sleep. This may reduce, if not completely eliminate, obstructive breathing patterns. Remember, even if you don’t have noticeable fat pads in your neck, you may carry extra water weight in your feet during the day; when you lie down, the fluid recirculates and plumps up fat throughout the body, including in the neck area.

    For those who are morbidly obese, gastric bypass and other surgical weight loss procedures may also help prevent obstructions secondarily, but these patients may need to have a sleep study prior to surgery to identify any preexisting sleep apnea so that the pre-surgical team can prepare proper anesthesia and respiratory therapies prior to the operation.

  • Quit smoking.Smoking (of tobacco or any other substance) may inflame the upper airway and, in the case of tobacco, create a “rebound effect” in the upper away during the night because of short-term nicotine withdrawal. Smoking may also lead to Chronic Obstructive Pulmonary Disease, a chronic and irreversible respiratory disorder which can severely impact one’s ability to breathe, especially at night while asleep.
  • Daily aerobic exercise.
    Daily aerobic exercise may help to improve the tone of the tissues in the upper airway and may lead to weight loss and the shrinkage of fat cells which are partly to blame for obstructions of breathing at night.
  • Change pillows or reduce the number of pillows used.
    If your pillow seems to be pushing your chin forward, it may be contributing to the mechanical obstruction of the airway. Find a pillow that allows your head to lie flat while still supporting your neck. Also, propping one’s head up with multiple pillows may do the same thing. If you struggle to sleep with your head flat, it could be that you have a severe obstructive respiratory condition, and you should discuss this with your physician.
  • Play the didgeridoo.
    “Didgeridoo – U. Dist Street Fair 1993 – 1”
    by Joe Mabel. CC BY-SA 3.0 


    Seriously. There’s some evidence that playing some form of wind instrument may help improve airway tone and build a skill called “circular breathing” which allows for better gas exchange. Read more.

Things that likely don’t work.
  • Oxygen therapy.
    This definitely can’t work for someone who’s airway is collapsing as they sleep. An oxygen tank and cannula delivers oxygen, but it is not pressurized to the level necessary to open up the airway. PAP stands for “positive airway pressure,” and it is this air pressure itself, not merely the presence O2, which makes the therapy useful.
  • Nasal strips.
    Some people swear by these but theoretically they are only useful for nasal congestion. Problems with upper airway are not limited to the sinuses and nasal passages, but extend into the mouth, the larynx and parts of the upper pharynx, which is where obstruction takes place.
  • Snore pillows.
    If these work, it is because they force you to practice positional therapy (see Lifestyle Changes, above), not because of the particular contour of the pillow. They are expensive and not largely proven to be any more effective than just choosing to sleep on your side.
  • Sleep apps for your smartphone.
    There is no way you can treat sleep apnea, snoring or upper airway resistance using a phone app. All of these are mechanical issues of the airway that require some kind of physical application of external, manipulative or surgical therapy. It’s not even clear whether any of the smartphone apps sold to help you identify sleep problems are even useful for predicting any kind of sleep quality. They do not tap your brainwaves like an electroencephalogram (EEG) does, so you can’t be sure they are truly measuring any kind of sleep, much less specific stages; also, these apps cannot measure drops in nocturnal oxygen saturation or capture pertinent muscle movement. The one way you can use your phone is as a device for video and/or audio recording, of yourself or others while asleep, in order to demonstrate the potential presence of apnea or heavy snoring in action, but that is about it.
  • Drugs.
    Nope, there’s not a pill for sleep breathing disorders, which are mechanical issues of the upper airway and, therefore, not treatable by medication. In fact, many drugs (over the counter, prescription and illicit) can depress the upper airway or worsen underlying apnea, snoring or upper airway resistance. Right now there’s research into medications for these issues, but that is about it.

Finally, here’s a great article from Sleep Review that analyzes various alternatives to CPAP.

A friendly reminder that links to websites offering products does not imply endorsement by SleepyHeadCENTRAL.com.

SleepyHeadCENTRAL strongly encourages people with ongoing sleep health problems to approach a medical professional to determine appropriate differential diagnoses and treatment. This post, like all other posts on SHC, is not intended to substitute for medical advice.  

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