Ask a Doctor
I just did a sleep study and my doctor determined I have sleep apnea. Despite the fact I don’t notice sleep problems and mostly feel rested in the morning, my husband insists I use a cumbersome CPAP (continuous positive airway pressure) machine because of my snoring. But what if I just slept in a different room, and went without treatment? How serious is sleep apnea?
You shouldn’t ignore this medical problem. Dangers of untreated sleep apnea can include development of high blood pressure, heart disease, heart attacks, heart rhythm disturbances, chronic fatigue, memory and attention problems, and accidents. Appropriate treatment of sleep apnea is essential when the diagnosis is made in order to treat the symptoms, but more importantly, to prevent the significant co-morbid conditions associated with untreated sleep apnea.
The good news is the overall outlook for sleep apnea is favorable as long as it is recognized, diagnosed, and treated early. As you say, the main problem with CPAP is patient adherence. The machine and mask may be bothersome, bulky, and restricting; thus, patients may not wear them all night or every night.
There are other approaches to sleep apnea treatment, however.
An important part of the treatment for sleep apnea may include behavioral modifications and lifestyle changes.
Many individuals with sleep apnea may have fewer episodes of apnea if they sleep in certain positions. Most commonly, lying on the back can induce more episodes; therefore, sleeping on the side may be a simple step to improve sleep.
Other behavioral modifications may include improvement of the bedroom setting to induce sleep, good sleep hygiene, avoiding eating or exercising prior to sleep, and using the bedroom only for sleeping. Excessive alcohol intake, smoking, and other drug use should be avoided. Complying with the treatment of other diseases is also essential to the adequate therapy for sleep apnea.
Other Devices for Sleep Apnea Treatment
For some patients with central sleep apnea a noninvasive positive pressure ventilation device (NIPPV) may be more beneficial than a CPAP. The difference is that a NIPPV device can be set to provide a back-up respiratory rate in individuals who have central sleep apnea due to hypoventilation (breathing less than the normal rate). This assures that a minimum number of breaths are taken regardless of the patient's own respiratory drive.
Oral or mouth devices are also available for sleep apnea. In general, these oral appliances are made to keep the oral airway open by protruding the jaw forward, and preventing the tongue from falling on the back of throat and causing limitation of air flow. Some studies have shown clinical benefit with these mouth devices in mild to moderate (but not severe) obstructive sleep apnea by reducing the apnea-hypopnea index. It is best to have these oral devices made by a specially-trained dentist for adequate fitting and adjustment.
Studies comparing CPAP to mouth devices for sleep apnea have found more objective improvement of sleep based on polysomnographic data using a CPAP machine than with an oral device. However, subjective data (sleep quality and improvement of daytime symptoms reported by patients) favored the oral devices.
Custom fitted pillows for patients with sleep apnea have also been studied. These pillows work by extension (backward stretch) of the neck, thereby increasing the caliber of the oral airway and decreasing the degree of obstruction. At present, the available data fail to conclusively support their use or effectiveness; however, some studies suggest these sleep apnea pillows to be beneficial in mild obstructive sleep apnea based upon both subjective reports and overnight sleep studies. It is generally not recommended to use these pillows for moderate or severe sleep apnea or as a replacement for CPAP.