December 2, 2013

A CPAP Failure? You Are Not Alone and Not Out of Options


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For those who are diagnosed and being treated for Obstructive Sleep Apnea, a condition affecting approximately 30 million people in the United States, you know that your treatment options are few and many tend to be on the invasive side.

Obstructive Sleep Apnea, OSA, is caused by the airway collapsing during sleep, causing the sufferer to stop breathing. The condition is characterized by gasping and choking during sleep and, most commonly, loud chronic snoring. Long-term, untreated sufferers are susceptible to co-morbidities like hypertension, heart disease and impotence from the oxygen deprivation and vascular damage associated with the condition.

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The “gold standard” for treatment is Continuous Positive Airway Pressure, CPAP. CPAP is a machine that blows air into the throat, increasing the pressure internally so that the airway cannot collapse or become blocked. The causes of these blockages typically are the tongue and soft tissues falling into the throat or excess weight around the neck collapsing the airway.

A person using CPAP therapy wears a mask, much like an oxygen mask used in a hospital, which is attached to the machine with a hose. A prescribing physician sets the air pressure level based on the person’s OSA severity. The increased pressure keeps the airway open, allowing the OSA sufferer to breathe normally, without cessation throughout the night. Patients who go on CPAP therapy for their OSA report increased energy during the day, better concentration and decreases in many other health conditions that associated with OSA.

While CPAP therapy is the best means of treatment for OSA, many patients have a hard time using the machine. In cases of severe OSA, the pressure setting can be quite high, making treatment difficult to tolerate. Compliance with CPAP therapy is around fifty percent. The most widely talked about problems patients have with CPAP is mask discomfort and throat irritation from the air pressure. Many times patients stop using CPAP therapy all together.

There are alternative treatments available for those who fail CPAP. The two most widely accepted in the medical community are surgery and Oral Appliances.

Surgery can be painful, invasive and ineffective. The most common surgical option is the Uvulopalatopharyngoplasty, or UPPP. The UPPP removes the uvula, the ball of skin that hangs in the back of the throat, some of the soft palate, and in extreme cases, part of the tongue. The procedure is very painful, recovery takes a long time and rarely does it completely solve the issue.

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Oral Appliances for the treatment of OSA, while having been around for the past 30 plus years, are a growing treatment options for many who have stopping using CPAP or have mild or moderate OSA. Oral Appliances work by gently holding the mandible, or lower jaw, forward, pulling the tissues that block the airway away from the throat and tightening the muscles in the neck further preventing collapse. The appliances look like orthodontic retainers or athletic mouth guards and are very comfortable to wear when made and fitted by a dentist who has been educated in the field of Dental Sleep Medicine.

If you are prescribed a CPAP and cannot tolerate it, talk to your primary care physician and dentists about alternatives. Obstructive Sleep Apnea is a serious condition and going without any type of therapy can be life threatening.

Dr. Michael Layton PostsDr. Michael Layton (DDS) is a dentist based in the South Surrey/White Rock, B.C. area. He has been in the dental industry for the last decade and received his Doctor of Dental Surgery from the University of Washington. He takes pride in providing positive and caring dental solutions for people of every walk of life. You can follow him on Google+.