Sleep apnea is a medical condition that causes intermittent breathing interruptions during sleep. The most common type is obstructive sleep apnea (OSA). Untreated sleep apnea can lead to serious medical complications, including heart disease, stroke, diabetes, and even sudden death.
Positive airway pressure (PAP) therapy, usually with a continuous positive airway pressure (CPAP) device, can help to manage symptoms and prevent complications. PAP therapy involves blowing pressurized air into the airways during sleep using a small mask placed over the nose or nose and mouth.
A 30-year study of people with obstructive sleep apnea found that using CPAP for over five years significantly reduced the risk of death, as well as developing diabetes or heart disease. But CPAP machines are only one option for treating and managing sleep apnea.
This article will discuss sleep apnea devices, including PAP machines, pillows, mouth guards, and implant systems. It will also explore getting used to your sleep apnea device, factors to consider when choosing one, and what to do if your sleep apnea symptoms persist.
Types of Sleep Apnea Devices
There are many different devices you can use to help with your sleep apnea symptoms. Your healthcare provider can guide you toward the device most appropriate for your condition.
CPAP machines are the most common sleep apnea devices. They include a mask, filter, and tubing that connects to a device that blows compressed air into your lungs as you sleep.
The definitive way to diagnose OSA is through an overnight home or in-laboratory sleep study (polysomnogram). During a sleep study, your eye and leg movements, heart rate and rhythms, and breathing rate will be recorded while you sleep.
The sleep specialist will also record your apnea-hypopnea index (AHI), which measures the number of breathing interruptions you experience in an hour. Your AHI will determine whether you have mild, moderate, or severe sleep apnea.
Diagnosis of OSA is usually followed by treatment with auto titration positive airway pressure (auto PAP). If auto PAP therapy is found to be not working adequately after 31 to 90 days, you may undergo an in-lab titration study to identify appropriate treatment pressure levels.
If OSA is found to be severe during at least two hours of the diagnostic in-lab recording, you may undergo a split-night study, which means that titration with PAP will be initiated during the same night.
During a split-night study, titration will occur, which determines what level of air pressure will resolve your sleep apnea symptoms. You can then be fitted properly for a CPAP mask to ensure that it doesn’t leak. For best results, you should use your CPAP mask every night.
CPAP Mask Options
Consult with your sleep specialist about which mask options are best for your PAP therapy. These include:
- Nasal CPAP mask: This covers the nose from the bridge to your upper lip. It is an option for those who need a higher pressure setting as well as those who move around a lot during sleep. There is a vast choice of designs.
- Nasal pillows: Nasal pillows sit at the nostril entrance, sealing it and sending pressurized air into the nose. People who need low to moderate pressure settings can use them.
- Full-face CPAP mask: This covers the nose and mouth. They are appropriate for people who need a higher pressure setting, as well as those who primarily breathe through their mouth.
In a 2016 study, people with moderate to severe OSA who regularly used a CPAP device experienced long-term improvements in their quality of life.
Bilevel PAP (BiPAP) may be used when pressures required for CPAP are relatively high and some people have difficulty tolerating high CPAP pressures. Further, BiPAP machines deliver compressed air at different pressure levels as you inhale and exhale. Furthermore, The differences in pressure may help you avoid gas, bloating, and other potential CPAP side effects.
Auto-adjusting, or AutoPAP, devices can also be easier to tolerate than CPAP machines if higher pressure disrupts your sleep. AutoPAP machines adjust the air pressure level throughout the night to keep it as low as possible.
Some people with OSA find that sleeping on their side or adjusting their position during sleep can help with snoring, gasping, and choking during the night. You can also use pillows for sleep apnea in addition to PAP therapy.
To assist with positional therapy for sleep apnea, you can try:
- Firm contoured pillows to prop you up while you sleep on your side
- Adjustable wedge pillows to keep your head elevated and avoid nasal congestion
- Memory foam pillows with cutouts to accommodate your CPAP mask
Oral appliances move the jaw forward, which pulls the tongue forward, leaving more room at the back of your throat. This allows air to flow in and out during sleep and avoids obstruction.
These devices may be especially helpful for people who have OSA due to anatomical features (such as a small jaw). However, people without teeth are not candidates for this therapy. Oral appliances for sleep apnea work best if they’re placed and fitted by a dentist.
Implant systems, such as Inspire, consist of small devices that use neurostimulation to keep the airways open. If it is appropriate for your condition, the device is surgically implanted into the neck and chest wall. It senses your breathing and stimulates the nerves of your upper airway and tongue to keep your tongue from blocking your airway.
Early research shows that these devices could be effective in treating sleep apnea, although the evidence for their long-term use is still inconclusive. They’re also not always covered by health insurance policies, so this option may be prohibitively expensive.
How to Get Use To Sleep Apnea Device
It can take some time to get used to your CPAP machine at first. Here are a few ways to make sure that you feel as comfortable as possible.
- Clean your device regularly: It’s important to clean your CPAP device, including your mask, as often as instructed in order to avoid infections and other health complications.
- Consider buying a humidifier: Some people find the dry air that pumps through a CPAP device difficult to tolerate. Some CPAP machines come with a built-in humidifier. If yours doesn’t, you might want to buy one for your bedroom.
- Practice wearing your mask during the day: If you’re finding it hard to get used to your CPAP mask, start slowly and work your way up to wearing it overnight.
- Mask the noise: Modern PAPs do not make a loud noise as was more common with older models. If you’re bothered by noise anyway, wear earplugs or use a white noise machine to mask the sound.
What To Do, If Sleep Apnea Symptoms Persist
If your sleep apnea symptoms persist despite regular use of a CPAP device, talk to your healthcare provider. You may notice any of the following signs or symptoms:
- Excessive daytime sleepiness
- Loud, frequent snoring
- Difficulty concentrating
- Dry mouth
- Falling asleep during the day
- Waking up throughout the night
If your sleep apnea symptoms aren’t getting better, your doctor may recommend that you try a different mask or device. It might also be time to adjust the pressure levels of your machine (titration).
What Is Complex Sleep Apnea?
Complex sleep apnea is a combination of OSA, in which the upper airways collapse during sleep, and central sleep apnea (CSA), in which the brain doesn’t send the right signals to the body to help you continue breathing through the night. After using CPAP therapy, mixed apnea may also occur in a small minority of people.
Moreover, if CPAP therapy doesn’t help you or actually makes your symptoms worse, you could have complex sleep apnea.
In addition to using your sleep apnea devices as prescribed, there are a number of ways you can prevent and manage your OSA symptoms. These behavioral changes may include:
- Getting regular physical activity
- Eating a healthy diet
- Losing weight, if necessary, as obesity is a risk factor for OSA
- Quitting smoking
- Reducing alcohol intake
- Managing stress
- Establishing healthy sleep habits and a consistent bedtime routine
By making these changes and using your CPAP device regularly, you can also lower your risk of developing complications from OSA, such as heart disease, stroke, and diabetes.
Factors to Consider
There are several factors to keep in mind when you choose the best CPAP device for you, including:
- Noise: Some CPAP machines are quieter than others or come with white noise options.
- Size: Some CPAP machines are bulky, while others are small enough to fit into a small suitcase. Choose the size that works best for you and your available space.
- Pressure relief: Certain CPAP machines have adjustable pressure relief settings that give you a chance to “catch your breath” with a drop in pressure during exhalation.
- Ramping: Some CPAP users prefer devices with ramping options, which allow you to fall asleep as the air pressure level gradually increases.
- Mask size and shape: Your mask should fit comfortably and snugly around your nose or nose and mouth, without being either too tight to breathe comfortably or loose enough to leak. Nasal pillows and chin straps can help if you’re having trouble with your mask.
Cost is important to consider as you choose the sleep apnea device that works for you. Most health insurance plans will partially or completely cover the cost of your CPAP machine if you have a diagnosis of OSA. These are the approximate costs of each device after insurance coverage. But note that this will vary by location and provider.
|Average Cost of Sleep Apnea Devices|
Keep in mind that there may be additional costs associated with each of these devices. These may include copays, follow-up visits, and accessories.
For example, you’ll most likely need to replace the mask, tubing, and/or filter on your CPAP device every few months. If you purchase an additional CPAP machine—such as a portable model for travel—you’ll likely need to cover that cost out of pocket.
Surgery and Anesthesia
While CPAP therapy is the preferred treatment for most patients with sleep apnea, surgeries can help in certain cases. These are normally performed by an ear, nose, and throat (ENT) surgeon or an oral and maxillofacial specialist. Some of the most common surgical procedures used to treat sleep apnea include:
- Trans-oral robotic surgery (TORS): In this procedure, a surgeon can trim the epiglottis (the flap of cartilage in the throat preventing food and drink from entering your windpipe) and remove tissue behind the tongue in order to expand the airway and prevent obstruction.
- Uvulopalatopharyngoplasty (UP3, or UPPP): In this operation, the uvula is removed, in addition to part of the soft palate and tissue from the back of the throat. It typically requires several weeks of recovery time.
- Maxillomandibular advancement (MMA): This procedure widens the airway by advancing the upper and lower jaw. It is complex, and recovery time is usually fairly long.
Sleep Apnea and Anesthesia
Waking up from anesthesia can pose additional risks and challenges for patients with sleep apnea. It’s important to let your medical team know about your sleep apnea diagnosis before you undergo any surgical procedure involving anesthesia.
Sleep apnea is a common medical condition that causes intermittent pauses in breathing during sleep. The most common type is obstructive sleep apnea (OSA). Untreated sleep apnea can lead to serious health complications, such as heart disease and stroke, as well as sudden death.
The first choice of treatment for OSA is positive airway pressure (PAP) therapy, usually with a continuous positive airway pressure (CPAP) machine. In addition to CPAP machines, other sleep apnea devices include BiPAP machines, AutoPAP machines, positional therapy, oral appliances, and implant systems. In certain cases, surgery may be an option.
If you have a CPAP machine, it’s important to use it every night to reduce your risk of sleep apnea-related health complications. If your sleep apnea symptoms persist despite regular use, you may need a new mask, a different device, or a second titration study to determine your optimal air pressure level.
You can also prevent and manage sleep apnea symptoms with lifestyle changes, such as exercise, healthy sleep habits, weight loss, stress management, quitting smoking, and reducing your alcohol intake.