It’s estimated that nearly one in fifteen adult Americans have sleep apnea, usually the variety known as Obstructive Sleep Apnea. This is when the muscles and tissues in the throat relax in deep sleep and block the airways, requiring the brain to wake up briefly and restore breathing. For those who have been diagnosed with this condition, the first treatment recommendation was likely a Continuous Positive Airway Pressure device (CPAP) machine. This instrument works by placing a mask over the nose and mouth with a hose that connects to the main unit. This unit collects, filters, and pressurizes air from the room before sending it through the hose and into the airway at a set, constant pressure (determined by the patient and doctor) that is sufficient to keep the airway open.
The CPAP machine has drawbacks. The masks and hoses can make the wearer feel closed in, and it produces a noise that can prove troublesome for a partner. Some patients experience excessive air in the stomach, causing bloat and gas. Some CPAP users complain of sore throats and difficulty sleeping on their backs or sides. These reasons may be why people who are issued CPAP machines often stop using them: studies in the early 2000s suggested that fewer than 40 percent of CPAP users use them every night.
What are other, non-CPAP treatments for sleep apnea?
Lifestyle changes and surgery
If you drink alcohol or use tobacco products, doctors suggest you stop or at least cut back. They also recommend losing weight. While difficult to commit and stick to, people would enjoy a wide range of health benefits – including better sleep – by following doctors’ recommendations.
Other treatments may include surgery. A variety of operations can help with sleep apnea. One common procedure is Uvulopalatopharyngoplasty (UPPP or UP3), which involves removing some of the tissue in the throat that might block the airway in Obstructive Sleep Apnea. A UP3 procedure requires an overnight hospital stay, has a recovery time that can last up to a few weeks, and might permanently change the voice. Another is the placement of a Hypoglossal Nerve Stimulator, sometimes called Inspire. Inspire involves installing devices in the upper chest and throat that monitor breathing and use pulses to get the tissue out of the way. Inspire can be installed in a single two-hour procedure. Recovery takes just a few days, but it requires a number of follow-up visits to fully calibrate the device.
If lifestyle changes prove ineffective for people with slight or moderate sleep apnea, and if a CPAP is undesirable, and if surgery is not preferred, then a person may choose to use an oral appliance. The most common type resembles a mouthguard or retainer that is specially fitted by a dentist. The patient wears this device at night by placing it over both the top and bottom teeth. When in position, the appliance pushes the lower jaw slightly forward, which alters the nighttime position of the tissues that relax in obstructive sleep apnea so that they no longer restrict. An appliance is easily portable, can be worn by those who sleep on the back or sides, and will put no restrictions on the wearer’s movement. It will also make no noise (and, in fact, will likely make the bedroom much quieter since a predominant sign of sleep apnea is loud snoring). The appliance will also allow the wearer to drink and be able to talk if needed.
Appliances also help with other conditions while treating sleep apnea. It is common for those with sleep apnea to grind their teeth at night (bruxism). In fact, one study suggests that over half of all people with sleep apnea have bruxism too. Scientists are not exactly sure if this is a simple correlation or if it’s a cause-and-effect issue with sleep apnea and bruxism. Some hypothesize that sleep apnea – or waking to restore breathing – may cause the teeth clenching and subsequent grinding attributed to bruxism. In fact, one study suggests that jaw clenching functions to tighten the muscles in the throat to restore breathing. The grinding is the consequence of the clenching.
Bruxism can cause several problems, including wear on the teeth, headaches, and strain on the temporomandibular joints (TMJ). An oral appliance can prevent all of these. Since it functions as a mouthguard, the teeth no longer contact each other.
Appliances have side effects, however: users report dry mouth and a tendency to salivate excessively. Slight jaw discomfort may be felt, and the bite may temporarily be altered. Finally, appliances are not permanent and need to be replaced after about two years.
A no-strings (or hoses) solution to sleep apnea
Sleep apnea can be treated in several ways. Lifestyle changes might be successful for some sufferers, and the surgical route might be beneficial for others. Many, however, start with a CPAP machine, though they often are eventually dissatisfied with it. An oral appliance is an excellent alternative for such people because it allows them to breathe right away without the recovery time of surgery or the masks, hoses, and noise of a CPAP machine. A consultation with one’s doctor and dentist will determine the best course of action.