5 Steps to Consider if You Have Given Up on Sleep Apnea CPAP Therapy

So you’ve been diagnosed with obstructive sleep apnea (OSA). You’ve received a night-time breathing device – CPAP, (continuous positive airway pressure). You’ve made it this far. Yet, you are still having difficulty sleeping and may have already given up on using your CPAP machine! You are not alone. Let’s review 5 potential steps you can take to not only treat your sleep disorder, but improve the quality of your life.

Woman in bed not using CPAP machineIt has been estimated that as many as 50 % of patients (and possibly much more) struggle with using their prescribed CPAP device.  Whether or not you experience symptoms often associated with apnea such as daytime sleepiness, morning headaches, or poor sleep, don’t give up.   Untreated apnea can lead to a higher risk of having high blood pressure, cardiac arrhythmias, stroke, erectile dysfunction, insomnia, weight gain and much more.

You may have given up with CPAP, returned the device, or tossed it into the corner of the room now covered with clutter. BUT the fact is, you still have apnea whether you may or may not be dealing with noticeable symptoms of this common yet serious sleep disorder.

So what do you do now? Here are a few potential action steps to take today on your path to restful sleep:

 

1. Sleep technologists are available and can help tackle the most common obstacles of CPAP therapy.

Man wondering what to do with CPAP maskIncreasingly, insurance companies are ‘skimping’ on health care dollars and guidance. It’s getting more common to hear of air pressure devices such as CPAP machines being mailed to patients in a self- guided format. Or some facilities do little in regards to instruction and troubleshooting with common patient obstacles.

Knowledgeable technicians can help you towards more successful CPAP therapy. Areas that sleep technologists can be of help include mask selection, allergic reactions, and traveling tips. Depending on the mask you have, you may need additional equipment such as a chin strap should your mouth drop open when using CPAP.

In addition to a variety of CPAP machines and masks that are available, there are other types of air pressure devices that may be prescribed and better tolerated. In addition to CPAP devices,  APAP or BiPAP devices may be prescribed.

APAP (automatic positive airway pressure) therapy: APAP therapy automatically adjusts the pressure at any given moment and senses subtle changes in your breathing needs.

BiPAP (bilevel positive airway pressure) This device uses two levels of pressure: a higher pressure during inhalation and a lower pressure during exhalation.

Other obstacles such as skin irritations, dry mouth, or sinus issues that may be adding to your sleepless nights can be addressed for possible solutions.

To find additional help with your CPAP obstacles, call your sleep trained physician or facility and ask if you can meet directly with a trained sleep technologist.

 

2. Insomnia is commonly found alongside with apnea and should be evaluated and treated.

Man with insomniaA recent study has found that approximately 30% to 70% of insomnia patients also suffer from sleep apnea, and on the flip-side, 40% to 60% of sleep apnea patients report insomnia symptoms.

Depending on where and which physician helped in your initial diagnosis of sleep apnea, proactive treatment in relation to insomnia may have been instituted or unfortunately bypassed. Ideally, treatment for insomnia reaches beyond a sleep-aid prescription.

Significant research has demonstrated that treating insomnia early on and alongside with apnea treatment often sets the patient up for quicker success and resolution of apnea symptoms. Clinicians trained in Behavioral Sleep Medicine (BSM) or Cognitive Behavioral Therapy for Insomnia (CBT-I)  can help individuals with insomnia symptoms as well as CPAP adherence. BSM and CBT-I focuses on how thoughts, behaviors, and emotions cause or maintain problems with sleep. Cognitive behavioral therapy for insomnia helps you overcome the underlying causes of your sleep problems, unlike sleep-aid prescriptions.

As helpful as behavioral sleep medicine can be in conquering sleep issues related to insomnia, CPAP adherence or other sleep disorders, very few sleep medical facilities contain this area of service at their locations.

If you have insomnia or need help with CPAP adherence consider seeking help from a licensed clinical psychologist trained and board certified in behavioral sleep medicine or CBT-I.

 

3. Seek out well researched CPAP alternatives such as commonly prescribed oral appliance therapy often referred as  “dental sleep apnea mouthguards”.

Dentist and patient consultationWhether you have mild, moderate, or severe obstructive sleep apnea, symptoms can be debilitating. At other times, even for severe apnea, you may not have any noticeable symptoms at all. But it’s wise to be aware that there are dangers behind the ‘health scene’ that are not visible. The repeated events of obstructive sleep apnea result in oxygen starvation in your blood which eventually reaches your brain and can cause a slew of medical problems.

If you have given up on CPAP or similar therapy, oral appliance therapy may be the answer to your prayer. Oral appliance therapy most often involves  fabrication of a custom-made dental retainer similar to a sports mouthguard.

According to most recent medical recommendations of the American Academy of Sleep Medicine, oral appliance therapy is approved medically for not only mild and moderate OSA, but for all levels of OSA in which  CPAP therapy was attempted and not successful. Dental sleep apnea mouth guards are also prescribed for obstructive sleep apnea patients at any level of apnea who prefer to try oral appliance therapy as their first choice.

Although oral appliances are not always as effective as CPAP type devices, they are tolerated far more and typically worn for more hours of sleep. Because of this, the overall effectiveness can reach close to levels of CPAP therapy in many OSA patients.

There are dozens of oral appliances or custom sleep apnea mouth guards for OSA available. There are 2 broad categories: mandibular advancement devices and less popular tongue-retaining devices. If you choose the path of oral appliance therapy, going to a qualified dental provider is very important.

Some patients may even wear an oral device alongside CPAP to lower pressure settings, which can help improve CPAP success and compliance.

If you would like to explore oral appliance therapy, ask your sleep physician to refer you to a qualified dental provider trained in dental sleep medicine or visit the American Academy of Dental Sleep Medicine Find-a Dentist page.

4. Consider surgical options to help improve obstructive sleep apnea treatment results.

Business woman with sinus pain

There are several types of surgeries for snoring and apnea. Surgical options are often a multi-step process involving more than one procedure and rarely chosen as a 1st step treatment for apnea.

If sinus issues are present, nasal or sinus surgeries may reduce the resistance in the air passage also lowering air pressure needs. The decreased pressure often makes for an easier transition to CPAP or a similar device. Sometimes nasal and sinus surgeries can also improve the results of oral appliance therapy.

Surgeries that may be prescribed for obstructive sleep apnea sufferers may include adenotonsillectomy, maxillomandibular-advancement surgery (MMA) or hypoglossal nerve stimulation (Inspire). To read more on surgical options see the American Academy of Sleep Medicine’s patient resource center on surgeries.

If you would like to know more about surgical options to treat apnea, contact your sleep trained physician to discuss options best suited for you.

 

5. Consider aggressive weight loss efforts and healthy lifestyle adaptation.

Overweight boy eating carrotsObstructive sleep apnea (OSA) and weight are related in a variety of ways. Although there is a significant proportion of thin people who have OSA, an individual’s increase in weight is often one of the most likely contributing factors in having apnea. On the flip-side, untreated apnea can make weight loss more difficult.

Seeking help from nutritionists, health coaches, physicians, and other health professionals to help pursue aggressive weight loss efforts may reduce the severity or cure the apnea in some cases.

Some obese apnea sufferers may consider and be candidates for bariatric surgery which promotes weight loss.

Consider seeking help from health coaches or professionals knowledgeable in establishing healthier lifestyle changes and weight loss.

If you are struggling with CPAP therapy and have given up hope, it is important to realize you are not alone. With all the dangers associated with untreated apnea, it’s important not to give up seeking ways to treat your sleep disorder. Is it time to consider seeking more information on the choices above?

 

References:

Brostrom, A., Arested, K. Stromberg, A., Ulander, M. Savanborg, E., ( 2010) The side‐effects to CPAP treatment inventory: the development and initial validation of a new tool for the measurement of side‐effects to CPAP treatment Journal of Sleep Research Vol.19 Issue4 Dec2010 p.603-611 

Weaver, T., Grunstein, R., (2007) Adherence to Continuous Positive Airway Pressure Therapy The Challenge to Effective Treatment , Nov. 30, 2007 https://www.atsjournals.org/doi/full/10.1513/pats.200708-119MG

Sutherland, K., Phillips, C.L. & Cistulli, P.A. (2015). Efficacy versus effectiveness in the treatment of obstructive sleep apnea: CPAP and oral appliances. Journal of Dental Sleep Medicine, 2(4), 175–181.

Almeida, F. R., & Bansback, N. (2013). Long-term effectiveness of oral appliance versus CPAP therapy and the emerging importance of understanding patient preferences. Sleep, 36(9), 1271–1272.

Ramar, K., Dort, L. C., Katz, S. G., Lettieri, C. J., Harrod, C. G., Thomas, S. M., & Chervin, R. D. (2015). Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: an update for 2015. Journal of Clinical Sleep Medicine, 11(07), 773-827.

Luyster FS, Buysse DJ, Strollo PJ, Jr. Comorbid insomnia and obstructive sleep apnea: challenges for clinical practice and research. J Clin Sleep Med. (2010) 6:196–204. 

Sweetman, A., Lack, L. Lambert, S., Gradisar, M., Harris, J. (2017) Does comorbid obstructive sleep apnea impair the effectiveness of cognitive and behavioral therapy for insomnia? Sleep Med.Nov;39:38-46. doi: 10.1016/j.sleep.2017.09.003. Epub 2017 Sep 22.

Pavwoski, P., Shelgikar, A. (2017) Treatment options for obstructive sleep apnea  Neurol Clin Pract.   Feb; 7(1): 77–85. 

Joosten, S. , Hamilton, G.,. Naughton,  M. ( 2017 )   Impact of Weight Loss Management in OSA  Chest, ISSN: 1931-3543, Vol: 152, Issue: 1, Page: 194-203 

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Lydia Sosenko, D.D.S.

Lydia Sosenko, D.D.S.

Dr. Lydia Sosenko, author of MySleepDevice.com, is a general dentist and Diplomate of the American Academy of Dental Sleep Medicine. Dr. Sosenko has worked closely with the dental and medical communities providing oral appliance therapy for snoring and apnea patients since 1996. She remains passionate in helping build awareness of the dangers of snoring and apnea and the importance of treatments, including oral appliance therapy.

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