As of Wednesday, May 29, 2013
DEAR DOCTOR K: I have sleep apnea. My doctor has urged me to use a CPAP machine, but it’s too uncomfortable. Are there other options?
DEAR READER: Sleep apnea is a condition in which breathing stops or becomes shallower many times each night. Obstructive sleep apnea (OSA) occurs when your upper airway collapses or gets blocked during sleep. These airway obstructions starve your brain of oxygen and stress your cardiovascular system. Untreated sleep apnea increases your risk of high blood pressure, stroke and premature death.
OSA can be treated with a continuous positive airway pressure (CPAP) machine. A CPAP machine keeps your airways open as you sleep by delivering continuous air pressure through a mask worn over your nose and mouth. But many people find it uncomfortable, and as a result, they use CPAP inconsistently — or not at all.
Some new treatments may provide more comfortable alternatives. Discuss the pros and cons of these options with your doctor:
— APAP is an “autotitrating” version of positive airway pressure (PAP). It continuously adjusts the pressure in your airway as your needs fluctuate during the night.
— Custom-made mouthpieces slide your jaw forward to keep your airway open. They are called “mandibular advancement systems,” or “MAS” for short. In recent years, studies have shown that MAS devices really work — and nearly as well as CPAP and APAP. For people who cannot tolerate CPAP, these devices can be valuable.
— Another device called Oral Pressure Therapy creates a negative pressure that “sucks” the tissues in the back of your throat forward, preventing the collapse of the upper airway. This device is approved for use in the United States by the Food and Drug Administration, and received recognition in the 2012 Wall Street Journal Technology Awards, for which I have served as a judge.
— Expiratory pressure resistance valves are disposable devices that stick to your nostrils. The valves force your own breathing to pressurize your airway and hold it open. These devices have not yet been as carefully studied as the MAS devices.
You should also talk to your doctor about medications you’re taking. Medications can help or hinder sleep apnea. For example, narcotic painkillers, sedatives and muscle relaxants can worsen sleep apnea. On the other hand, a sleep drug might help when you’re first getting used to a treatment device.
Lifestyle changes can also help. If your sleep apnea occurs only when you sleep on your back, switch to sleeping on your side. Try losing weight, which almost always reduces the severity of apnea. In some people, it eliminates the problem altogether. Finally, limit your alcohol intake. Alcohol may make you sleepy, but it can worsen your sleep apnea symptoms.
When a person’s obstructive sleep apnea is caused by very enlarged tonsils, surgery (tonsillectomy) can cure the condition. However, it is unusual for there to be such a correctable cause of sleep apnea.
If you do decide to try a treatment device, remember that it works only if you use it.
Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.