Researchers call for a change in treating sleep apnea

Researchers call for a change in treating sleep apnea
Nearly half of all sleep apnea sufferers receiving treatment will give up on their CPAP machines
Nearly half of all sleep apnea sufferers receiving treatment will give up on their CPAP machines
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Nearly half of all sleep apnea sufferers receiving treatment will give up on their CPAP machines
Nearly half of all sleep apnea sufferers receiving treatment will give up on their CPAP machines

Sleep apnea is estimated to affect 30 million Americans, comparable to diabetes, but it can be incredibly difficult to treat, even more so given that devices used to alleviate it are abandoned by nearly half of those diagnosed. It’s also recently been linked to a greater risk of developing Alzheimer’s disease and related dementia conditions, plus other serious health concerns like cardiovascular disease and stroke.

Traditionally, the condition is first treated with a Continuous Positive Airway Pressure (CPAP) machine, which was invented in Australia in 1980 and led to the development of the BiPAP a decade later, providing life-saving medical intervention.

However, a team of researchers has questioned the treatment, highlighting how CPAP, which is much more affordable than the BiPAP system, isn’t effective for many sleep apnea sufferers and a more personalized approach to therapy could be far more beneficial long-term.

“Rather than everyone first trying CPAP – for whom we know at least 50% will fail – we flipped the model on its head and gave everyone a dental splint in the first instance,” said Danny Eckert, professor and director at the Adelaide Institute for Sleep Health: Flinders Health and Medical Research Institute Sleep Health Research Program. “This tends to be much better tolerated than CPAP, though it is less efficacious overall, as it works in about 50% of people.”

Eckert highlights the difficulties of treating sleep apnea, which generally requires the use of a breathing device or a dental splint. Both have a high rate of abandonment due to the stress caused. The failure rate of CPAP devices has been shown to be a huge hurdle in being able to effectively treat this serious sleep condition.

While not abandoning CPAP as crucial treatment, the researchers are urging for a broader approach to therapy, and informing patients of their options.

“We found that if the dental device alone was insufficient, we added extra treatments – and this combination of therapies fixed almost all the 50% of the remaining patients,” said Eckert. “We then added alternate and emerging therapies such as oxygen therapy, and novel medications informed by the findings of a detailed sleep study that we did which tells us exactly why each person gets their OSA (Obstructive Sleep Apnea).”

This approach could help empower sleep apnea sufferers to manage their condition better, and help those with other concerns such as anxiety, which may be amplified by using a CPAP device.

“If this combination approach didn’t fully work, we then gave CPAP, but only as a last resort,” said Eckert. “Using this new approach, we were able to treat almost all participants and only a few required CPAP.

“Essentially, we believe this outlines a whole new way of treating sleep apnea.”

While there have been inroads into novel treatments, most are still works in progress.

The research was published in the journal Annals of the American Thoracic Society

Source: Flinders University

Most CPAP users who fail tend to do so quite early in their treatment. I, myself had a bad reaction when I first used one (in a sleep lab)- I was unable to breathe properly and tore it off. Subsequently, I was able to adapt and have been very happy with CPAP since.

I have a bit of advice for new users: When you get your CPAP, don't try to use it when you go to bed as the first trial- instead, I recommend you sit in your easy chair and try to take a nap in the afternoon- you will more easily adapt while you are awake, and gradually get used to it. I have told this to several people, and they report more success.
Rick O
I recently restarted CPAP therapy, after trying it 15 years ago. I've had sinus and throat surgery to help with apnea, which helped marginally. I tried the dental device, but with no noticeable results, and waking up with my teeth hurting like hell for at least 3/4 of the day, I gave up on that one. Last time I tried CPAP, the "nasal pillows" they insisted that I use instead of a full face mask, caused my mouth to open randomly through the night, taking my breath away and waking me up violently. I would rip the device off my face and throw it aside, out of half asleep rage. I quit using it and sent it back.
Now I track my sleep with a smart watch and it, along with my tired-of-my-snoring-and-choking-in-my-sleep fiancé, told me I needed something. It took 8 months of waiting for appointments to get a new CPAP machine. Even though I was told "just try the nose pillows", I refused and was able to get a full face mask. That solved one issue, and the first night I slept absolutely fantastic. Second night was good, 3rd night less so, and so on. The "smart" CPAP keeps messing with airflows, basically trying to decide how much it wants me to choke to death in my sleep, and my watch tracking is showing a definite decline. I can't have my doctor make any changes, because the machine refuses to transmit data, even though it did so the first week, and has full cellular signal. The equipment provider says "there's nothing wrong with the machine, it just takes a while sometimes", even though I had feedback the first week within minutes of waking up.

So, the summary of that long winded sob story, is that I fully agree with the assessment of CPAP failing. In my opinion, it's more about the lack of provider availability, lack of proper understanding from most providers (they just listen to the generic talking points and can't think for themselves), and "advanced" equipment that is poorly programmed. I'm about ready to buy a message table so I can sleep face down and be able to breath....
Thanks Bronwyn, good article. Not everyone is aware of Sleep apnea, or know the causes of snoring. While dental splints do advance the mandible or jawbone effectively pulling the soft tissues out of the way of the airways, it requires a mouth appliance being tolerated and proof that it is effective. When the soft tissue blocks breathing, you don't immediately die, your body wakes you up enough to clear your airway before that point, but the decreased oxygenation (chronic) can lead to hypertension, DM-II, Coronary disease, all kinds of inflammatory issues. If only dental splints were a quick fix - but they do work for some people!
My watch is why I'm on a CPAP for almost 5 years. Noticed my heart rate was spiking in the 90 bpm at times while sleeping.
Did a sleep study. Had mild/moderate apnea. I LOVE my CPAP machine. Now I sleep most nights, without "waking up to go to
the bathroom" (what I was actually my body waking me up because I stopped breathing)
I've been using a CPAP for more than 15 years - I wouldn't take a 5 minute nap without it. Resign yourself to it from the start and always use it - you'll get used to it.
spanky rascal
i tried the cpap 3 times over 5 years. a new doctor gave me 30 days of a sleep medication. it worked great and have been using a auto cpap for 20 years
Jimmy the Geek
I agree with Eggbones, I wouldn't attempt to sleep without the Cpap. Early on I tried the dental device without much luck. Auto adjusting Cpap has come a long way in the past few years.
Natty Dred
Glad they're looking at the efficacy these treatments.

My sleep apnea was fixed by partially tapping my mouth closed at night to force me to breath through my nose. Also by not eating within 3 hours of sleep.

The first week I woke up with the tape dislodged. My sleep improved and stress reduced noticably after that. After about 6 weeks it was no longer necessary to take my mouth shut.

At the same time I was doing this, I was training myself to only nose breath during exercise and running.

Seems like something worth trying.
I found the nasal pillows uncomfortable at the start but now I sleep all night every night with it. My father died of a heart attack and when I was diagnosed with Sleep Apnea realised that was what had caused his heart attack. Never had a problem with the mouth opening when using the nasal pillows in fact it forces the mouth shut.

When diagnosed I was stopping breathing for 30 seconds every two minutes. They viewed me as an oddity at the time of diagnosis in that I was young and of a very slim build. I've had three units to date clocking up some 22,000 hours on each.

If you have sleep apnea or suspect it, seek resolution, and don't play Russian roulette with your life for your sake and your family's that is parents, siblings partner, children etc.
Exercise will improve your body's need to balance itself. We were made to function in a certain way and avoid eating certain foods and ingredients, you need to balance yourself.
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