CPAP alternatives open up
by Kathryn Nielson · Feb 20, 2023
For years, the CPAP (continuous positive air pressure) machine has been the gold standard in treating patients with sleep apnea, but a newer non-invasive method has become recognized as a viable and effective treatment for sleep apnea.
Dr. Rod Willey, a Samaritan Ministries member and the founder of Koala Center For Sleep and TMJ Disorders, says it’s estimated that, out of 350 million Americans, 54 million Americans suffer from obstructive sleep apnea, with 75 to 80 percent of those cases going untreated. An estimated 22 million Americans suffer from moderate to severe sleep apnea.1
What is sleep apnea?
Obstructive sleep apnea, the most common form of sleep apnea, results from a restricted airway. When we fall asleep, our muscles relax, the jaw falls back, and we enter the deep reparative sleep needed for the body to do its repair work. If the jaw falls back too far, our airway becomes restricted. Snoring, the most common indicator of a restricted airway, is caused by the vibration of the uvula and surrounding tissues. Snoring stops when the airways become too restricted, causing the breathing to stop. Oxygen levels drop, blood pressure rises, and the heart begins to beat faster.
“At this point, the brain only has one of two choices: kick you out of the deep sleep or let you suffocate,” Dr. Willey says. “So it’s constantly kicking you out of that deep sleep.”
This vicious cycle of going in and out of deep sleep all night long is followed by daytime fatigue. Sufferers then use power drinks, power naps, and cups of coffee in an attempt to push through the day only to go back to bed and spend a night of being kicked out of that deep, restorative sleep.
And over and over it goes.
The CPAP works by forcing air down the throat to keep the airway from collapsing. Although the machines work 100 percent of the time on a mannequin, 40 to 60 percent of people cannot use the masks because of claustrophobia, air leaking out the side, the noise or appearance, or sinus problems. For those without these problems, it will work—if they can keep it on their face and continue using it.
One alternative is the oral appliance, a device invented in the early 1990s. By 2006, it was accepted as a bona fide treatment for sleep apnea. It’s rated equally with the CPAP machine for those with mild to moderate sleep apnea, working as a brace to hold the lower jaw forward, keeping the airway open so the patient can breathe and sleep at the same time.
The oral appliance usually results in a two-thirds reduction of severe apnea, causing it to be reduced dramatically but not eliminated if it’s too severe.
For the more severe cases, Willey says there’s only so far that the jaw can be moved forward, and a CPAP system is rated higher than the mouth appliance for the 50 percent who are not pulling the mask off at night. In more severe patients, however, combined therapy—using both the CPAP and an oral appliance—has improved results.
“Research has proven that you can reduce the pressure on a CPAP by 4 points if you’re using combined therapy on the average,” Willey says, comparing the pressure on the face from a CPAP at a level 12 to a 40-mph wind going down the throat all night long. That level is so aggressive that it creates more leakage of air out of the sides of the mouth. The amount of air flow the person is having to deal with can be difficult. By doing combined therapy, using the appliance to pull the jaw forward as a brace to hold it in place, a patient can use a minimally invasive CPAP that fits just on the nose and can then reduce the level to an 8 or 7.
“Now you’ve got something that can be very successful and much more comfortable,” Willey says.
Willey recalls a patient he treated who stopped breathing 105 times a night and couldn’t use a CPAP system. A tracheotomy was scheduled as a last resort. Additionally, the patient was in the process of going on disability. Willey fitted him for an oral appliance. The follow-up sleep test showed a drop of breathing stoppage from 105 to 30 times per night. It saved his life and his career. They then added a minimally invasive CPAP nose mask, reducing the number of times he stopped breathing per hour even further to three and eventually to none at all.
Why is it such a big deal?
Without deep reparative sleep each night, over time our bodies pay the price in multiple ways. If sleep interruption happens for too long, we end up with repair sleep deprivation, which affects the body in multiple ways.
We can experience brain fog, short-term memory loss, difficulty thinking, anxiety, and depression. If it continues for too many years untreated, early on-set Alzheimer’s or dementia results.
When there is a low oxygen environment, the heart works harder to get whatever oxygen is left, resulting in high blood pressure, atrial fibrillation, an enlarged heart, and even potentially a heart attack. Researchers have found that patients with obstructive sleep apnea are more than 2½ times as likely to experience sudden cardiac death between midnight and 6 a.m. as those without obstructive apnea.
“In the 90 percent of people who die in their sleep due to heart attack, the root cause is sleep apnea,” Willey says. “When you’re not breathing, it puts extra stress on the heart.”
Like all other bodily systems, our hormones reset as well in deep sleep. If that isn’t happening, an imbalance of insulin, hormones, thyroid issues, or issues with metabolism can result. Without quality sleep, we can struggle to lose weight and suffer from indigestion among other things.
Patients with sleep apnea may be at a 60 percent higher risk for cancer, according to several studies. When we stop breathing while sleeping, the oxygen level in the blood plummets, potentially triggering the growth of cancer cells. Cancer cells thrive in a low-oxygen environment.
Not only is the quality of life reduced for someone suffering from sleep apnea, but the life span of those with the condition may be reduced by seven to 15 years because the body simply wears out faster. Those with sleep apnea may have a higher risk of stroke as well.
“The bottom line is, our body requires sleep because we require repair time in the body,” Willey says. “If we’re not getting that, it’s going to show up wherever the weak point is in the body.”
If you suspect you have sleep apnea, whatever you may decide to do, be sure to consult your personal physician for guidance. And take it to the Lord as well.
The information provided in this article is for educational purposes and is not meant as medical advice. It is the opinion of the writer. The information is not meant to replace a one-on-one relationship with a qualified health professional.