In our last post, we discussed what Obstructive Sleep Apnea (OSA) is, and we covered many of the ways that it can make your life unpleasant.
We shared that the majority of adults — two out of three — don’t get the recommended 8 hours of sleep each night. As you stare at this page looking for answers, likely enduring some of the many irksome symptoms of poor sleep — headache, insomnia, trouble focusing, fatigue, etc. — chances are pretty good that you could be among the 1 in 7 people dealing with sleep apnea.
Without sounding alarmist, if you have reason to believe you suffer from sleep apnea, you don’t want to wait. Each night of subpar sleep causes further damage to your health and happiness.
The National Sleep Foundation advises that anyone suffering from OSA should “refrain from driving or operating heavy machinery until their [OSA] and excessive daytime sleepiness have been optimally treated.”
So, what is the optimal treatment? While that is a decision that should be made with a trusted medical provider, we took a deep dive into all of the methods for treat OSA and analyzed the evidence for their effectiveness.
The Standard Treatment for Sleep Apnea: Positive Airway Pressure
The “gold standard” for OSA treatment involves using a mask or device to adjust the pressure of the airway during inhalation and exhalation.
Positive airway pressure (PAP) is a method of respiratory ventilation in which the upper airway is prevented from collapsing during sleep through the use of a small blower delivering air pressurized to 5-20 cm H2O. The method requires use of a mask — either of the nasal, full-face or nasal pillow variety.
When used correctly and consistently, PAP treatment is extremely effective. Patients using PAP therapy report dramatically improved quality of sleep, less Excessive Daytime Sleepiness (EDS) and happier moods and more productivity. Use of PAP has also been shown to decrease the occurrence of motor vehicle accidents.
Among this category, there are three varieties — Continuous positive airway pressure (CPAP), Bilevel positive airway pressure (BPAP) and Autotitrating positive airway pressure (APAP).
With CPAP devices, users receive a consistent, fixed pressure that remains constant during inhalation and exhalation. With BPAP, the air pressure is higher during inhalation than during exhalation. With APAP, the inhalation pressure is the same as the exhalation pressure, but that pressure varies depending on certain conditions, such as the presence of apneas or snoring.
CPAP is a very common and well-regarded PAP system. At Dream Again, we believe strongly in the power and utility of CPAP — so we will focus on that in the analysis and comparison that follows.
Surgical Intervention to Treat Sleep Apnea: maxillofacial surgery
For some people, the structure of the face is a major contributing factor for sleep apnea.
In such cases, a trusted medical provider might recommend surgery.
The two types of facial surgery available to treat sleep apnea are uvulopalatopharyngoplasty (UPPP) and maxillofacial surgery. UPPP has fallen out of favor due to poor results — while the procedure was successful at addressing breathing concerns caused by the palate obstructing airflow, it wasn’t useful in addressing concerns caused by the base of the tongue obstructing airflow. Maxillofacial surgery addresses tongue obstruction.
In addition, for patients who are obese, bariatric surgery may be recommended in some cases in order to combat the problem on multiple fronts.
Surgery vs. CPAP: Which is Best?
It might be tempting to think that the most invasive OSA treatment is the most effective.
But various studies have found that that isn’t necessarily the case.
A 1990 study examined maxillofacial surgery and CPAP therapy in order to determine which was better at treating sleep apnea
First, it should be noted that CPAP is the most common method to treat sleep apnea — its efficacy, sustainability and accessibility are tough to beat. The 1990 study opened with an acknowledgment that surgery was being examined as a potential alternative to CPAP due to the fact that some patients did not keep going with their CPAP treatment. Quitting was the main cause of failure.
In the study, 30 patients with severe OSA used CPAP therapy initially and underwent maxillofacial surgery subsequently to compare results. The extent of each patient’s OSA was tested and quantified using polysomnography. CPAP therapy was used and the apparent efficacy of the treatment was observed and recorded.
Following the establishment of results from CPAP, a type of surgery called advancement was performed. In advancement, bone and muscle are pulled forward in an attempt to enlarge the airway. The surgery included three types of advancements — maxillary and mandible (of the jaw) and hyoid (moving the U-shaped bone at the front of the neck).
Six months after the surgery, the initial CPAP results were compared with the post-surgery results.
The post-surgery comparison and analysis tested seven parameters:
– How often the patient stopped breathing while asleep (respiratory disturbance index, or RDI)
– Lowest amount of blood oxygen saturation
– Number of blood oxygen saturation falls below 90 percent
– Total sleep time (TST)
– REM sleep percent
– Frequency of night wakeups (wake after sleep onset)
Amazingly, there was no statistical difference between the results for each of the above factors for CPAP versus surgery!
While both CPAP and maxillofacial surgery are highly effective in treating sleep apnea, surgery has the drawbacks of being expensive and invasive. This is one of the reasons why the National Sleep Foundation recommends CPAP as the universal sleep apnea treatment.
What Is the Best Way to Treat Sleep Apnea?
By now, you’re probably seeing why CPAP is the go-to treatment for sleep apnea sufferers.
In the past few decades, there have been a few attempts by scientists and innovators to reinvent the wheel — by refining the type of surgery used to address sleep apnea, by inventing new wearables and appliances, etc. One new treatment, Hypoglossus Nerve Stimulation (HGNS), was only approved 5 years ago. It’s a nerve stimulator that’s implanted in a patient’s chest and connected to a nerve that controls tongue movement and to a breathing sensor.
We’d be remiss if we didn’t mention that certain behavioral adjustments — such as reducing or eliminating alcohol or other depressants or losing weight — are generally considered to be beneficial in fighting sleep apnea. But while these behavioral changes can represent a positive first step, they are likely not powerful enough to make an immediate difference in people who suffer from anything stronger than mild OSA.
For cases of positional OSA — that is, sleep apnea that only presents when a person sleeps on the back — devices and wearable sensors may be helpful. Their utility is in teaching positional OSA sufferers to avoid the bodily positions that trigger OSA symptoms, even while sleeping. As with the lifestyle modifications listed above, expect modest results.
In the nearly 40 years since CPAP machines were first invented, researchers have been impressed with their remarkable efficacy. At one point, there was some reluctance to accept CPAP as the best universal option to treat sleep apnea due to the fact that no randomized control study with a placebo had been performed.
Enter a study that appeared in the American Journal of Respiratory and Critical Care Medicine.
The 10-author study, called “Effectiveness of CPAP Treatment in Daytime Function in Sleep Apnea Syndrome: A Randomized Controlled Study with an Optimized Placebo,” silenced the doubts.
The study consisted of 48 patients who were divided into four categories depending on severity of sleep apnea symptoms. The 48 subjects were placed into two test groups and observed for six weeks.
The first group used an optimal CPAP machine; the second group used a “sham CPAP” — it looked and felt like a CPAP device, but it had been modified so that it wasn’t actually doing anything believed to help with sleep apnea symptoms.
Then, the sham CPAP group used the optimal CPAP machine and the results were compared against the sham CPAP results.
Amazingly, the optimal CPAP group showed considerably greater improvement in the relief of sleepiness. Also, vigilance and general productivity increased by a statistically significant amount.
For the group that began with sham CPAP treatment, sleep apnea symptoms were reduced once treatment with the optimal CPAP was administered.
As the authors rightfully stated: “Our study provides strong evidence of the effectiveness of CPAP treatment in improving symptoms and perceived health status in moderate to severe [sleep apnea].”
CPAP Has Been Shown to Improve Quality of Life Among Sleep Apnea Sufferers
By now, you’ve seen the diverse and compelling evidence that CPAP machines work, and that they work consistently and sustainably.
But it’s understandable if you’re reluctant to make a change. Change is scary, and the unknown is daunting!
When you’re used to dealing with the discomfort that comes with sleep apnea, it can be hard to imagine how drastically your life could improve if you could just eliminate those dreadful symptoms.
A 2012 study in the journal “Sleep and Breathing” attempted to quantify just how much improvement was possible.
A group of 50 patients — 41 men and nine women — were diagnosed by polysomnography at the study’s outset. Then, each patient was treated with CPAP therapy for six months.
During the six months of treatment, health-related quality of life and sleepiness were assessed using a variety of quantifiable factors. Those factors were assessed following the conclusion of the study as well.
The results? There were nothing short of remarkable:
Regarding the patients’ symptoms, improvement was noticed for “sleepiness while watching a spectacle” (96%), “reading” (95%), “carrying on a conversation” (95%), “driving” (92.9%), “restless sleep” (87.8%), and “urinating more than once per night” (84.8%). Smaller improvements were observed for the reported “dry mouth–throat upon awakening” (36.1%),“excessive fatigue” (54.5%), and “decreased energy” (55.3%).
Based on the noticeable improvements to quality of waking life, as well as the marked changes in quality of sleep and rest, the study authors concluded that when people adhere to CPAP therapy for a period of at least six months, the result is an improvement in overall quality of life.
Get Started: Here’s What to Do Next
The evidence is clear: CPAP therapy can be life-changing for sleep apnea sufferers.
So … where do you find out more about the CPAP machine?
While the answer to such a question used to be something like “plan to spend the next week on the phone with your doctor’s office and your insurance provider,” Dream Again believes there’s a better way.
We believe you deserve answers fast and relief A.S.A.P.
If you haven’t yet, go ahead and take our quiz to assess how things are going between the sheets. From there, we’ll send you a simple home sleep test to take whenever you’re ready. We’ll set you up with a one-on-one video consultation with our sleep doctor to discuss your results. Armed with all this knowledge and awareness, you can then make an informed decision about what you need for perfect sleep, and we’ll deliver it to you monthly.
You shouldn’t have to lose more sleep over the fact that you’re losing sleep.
Our philosophy at Dream Again is that there’s beauty in simplicity. We believe in straightforward answers, no-nonsense communication and gimmick-free interactions. We want you to get the tools you need to put an end to your sleepless nights as fast as humanly possible.
Dream Again believes there’s a better way.
We’ve designed our service so that you can seek answers and treatment all from the comfort of your home. Get cozy. Go ahead and call us in your jammies — they’ll be your favorite outfit very soon, once we tackle your sleep issues and help you get the ZZZs you deserve.
Remember, Dream Again is all about NO. As in: No copays. No deductibles. No office visits. No reimbursement hassles. No long-term contracts. No insurance frustration.
We believe that great sleep is a necessity that everyone deserves. Our sleep therapy programs are user-friendly and affordable — starting at $99/mo. With Dream Again, it’s never been easier to get the best rest of your life.