Continuous positive airway pressure therapy (CPAP) has become the leading treatment for OSA since it was introduced in the early 1980s. However, not everyone finds CPAP easy or comfortable.
Over the years new technology has meant new ways to diagnose and treat sleep apnea. These new methods point to potential future trends in the treatment of sleep apnea.
DiagnosisDiagnosis is key for treating sleep apnea. However, many people remain undiagnosed and unaware they have this sleep disorder, which can be treated. Prime symptoms of OSA include:
- frequent awakenings, sometimes gasping for air
- morning headaches
- dry mouth in the morning
- daytime fatigue
- poor concentration
- high blood pressure
Previously, if your physician suspected sleep apnea you would have been referred for a sleep study. This would involve an overnight stay at a sleep lab where your sleep is monitored.
Blood oxygen levels, brain waves, breathing patterns, heart and lung function as well as sleeping position are among the data recorded. A diagnosis for sleep apnea and its degree of severity is determined from the results.
In-home Sleep Apnea Test
In recent years, a more convenient in-home test has become available. The kit involves a clip placed over your finger at night, which is attached to a small monitoring device.
This diagnostic test also measures breathing patterns, blood oxygen, heart rate, snoring, body position and movement while sleeping. An Auto CPAP is then prescribed and responds to abnormalities on a breath by breath basis.
If it is determined that an Auto CPAP is not the appropriate device to treat your disordered breathing, then you may still require another sleep study to determine pressure settings for other more sophisticated positive airway pressure devices.
“Wearables” like watches provide real-time health monitoring and the information they provide patients and their doctors is growing. While smartphone apps have attempted to track sleep disturbances, wearables connected via Bluetooth and a mobile device have given people a greater appreciation of sleep physiology.
Wearable technology has the potential to benefit sleep apnea patients.
As well as diagnosing sleep apnea, such devices may be used more to monitor your sleep, sending the data to your physician or sleep specialist for analysis.
Being able to supply such information from the comfort of your home saves on trips to clinics, making it far more convenient and potentially aiding compliance.
Alternatives to CPAP
While CPAP is the leading treatment for OSA, it is estimated that 40% of users do not comply fully with the treatment course. Even a single night without CPAP can result in symptoms returning. However, for some people the pressurized air can be hard to adjust to, while the mask can leak, cause irritation or feel claustrophobic. CPAP can also cause friction with your sleep partner.
Options for Mild OSA
For mild OSA, your physician may recommend lifestyle changes such as exercise and an improved nutritional diet. Weight is a primary contributing factor for OSA, and therefore measures to lose weight can help reduce symptoms. Weight loss can still be important for those with moderate to severe OSA. You may also benefit from an oral device that is worn like a dental retainer, and helps to keep airways open to prevent mild to moderate sleep apnea symptoms.
There are increasing options for treating people with more severe OSA who struggle to adapt to CPAP. A recent advance focuses on the hypoglossal nerve that controls the tongue. A small device can be fitted into the chest which stimulates the nerve, pushing the tongue out to help widen the airways and improve the flow of air into the lungs. Two implants which use this advance in bioengineering to help treat OSA without CPAP include:
Inspire – FDA cleared since 2014, Inspire uses a small pacemaker-style device to gently stimulate the tongue and palate as you sleep. This allows you to breathe and sleep more comfortably. You can have the device fitted in a day as an outpatient and be back at work within a few days.
ExciteOSA – approved by the FDA in 2021, this is aimed at mild OSA and is the first daytime device to become available. The device stimulates the tongue using a mild electrical pulse. Users reported sleeping better and a reduction in snoring after using this device for 20 minutes a day for six weeks.
The aim of all trends is successfully treating OSA in a way which is comfortable to the individual. In the case of the Inspire device, nearly 80% of patients reported a reduction in sleep apnea events, while 94% preferred it to CPAP.
While such advancements have been FDA cleared, there can be side effects including an increase in saliva levels, tingling in the tongue, tongue or tooth discomfort and a metallic taste in the mouth. A small number of people using implants to treat OSA have reported more severe side effects including bleeding and heart attack. This is also quite a bit more expensive than CPAP and insurance approval is not as common as with CPAP.
Surgery is also an option, with tonsillectomy the main form. This involves removing the tonsils and tissues toward the back of the throat in order to open up the airways.
It is the collapse and blocking of the airways which causes the breathing pauses associated with OSA. Side effects of such surgery include potential difficulties when swallowing and voice changes.
A more recent ‘multilevel’ surgery could represent the next future trend for treating OSA for those who are not comfortable using CPAP. With this surgery, the tonsils are still removed, while the palate placement is adjusted, and the size of the tongue is marginally reduced using radio-frequency energy. This multilevel surgery is expensive and isn’t typically approved by insurance companies for reimbursement. Craniofacial surgery requires significant post operative recovery time.
Researchers continue to understand who is affected by OSA and the potential links to other conditions.
While men tend to be more prone to sleep apnea then women, this can level out after menopause. Such research in gender differences could help with treatments which specifically targets men and women.
Treating sleep apnea could also help prevent dementia, as research has found a possible link to the abnormal protein that harms the brain of people with Alzheimer’s.
CPAP compliance has also been shown to reduce the risk of serious health issues such as heart disease and diabetes.
Therefore, future trends in sleep apnea treatment could help treatment of further significant health conditions.