Yes, There Are Alternatives to Prescribing a CPAP Machine

May 19, 2022

The CPAP market is expected to grow to $4.5 billion by 2024, and it’s not hard to see why. Millions of Americans have found relief by using these effective, noninvasive devices. But with the devices treating so many sufferers of obstructive sleep apnea (OSA), it’s worth it for practitioners to ask, “Are there alternatives to CPAP machines that I should consider for my patients?”

Yes, there are several alternatives worth considering as you work with your patient towards a solution. In this article, we will talk about the following topics:

  • What makes CPAP machines so popular
  • The drawbacks of CPAP machines, including compliance issues and cost
  • Other treatment options to consider, including oral devices and orofacial therapies

Keep reading to learn more.

What Is a CPAP Machine?

CPAP (continuous positive airway pressure) machines are one of the most common treatments for both central and obstructive sleep apnea. They work by delivering continuous pressurized air through tubing into a mask that patients wear while they sleep.

In both types of sleep apnea, the person’s breathing is interrupted during the sleep cycle. This can happen hundreds of times in a single night. These interruptions in breathing deprive the person of oxygen and lead to a higher risk for high blood pressure, heart disease, stroke, diabetes, and other health concerns. A CPAP machine eliminates this concern by keeping the airways open with a continuous stream of air.

CPAP machines aren’t the only PAP (positive airway pressure) device. While CPAP is the most common among these machines, a few other options include the following:

  • Bi-level PAP, which changes the pressure depending on whether the person is inhaling or exhaling
  • Auto CPAP, which self-regulates to use a range of pressures to keep airways open.
  • Adaptive servo-ventilation (ASV), which keeps the airway open by delivering a breath when necessary (This device treats central sleep apnea, not obstructive sleep apnea.)

Why Are CPAP Machines the Most Common Treatment for OSA?

There’s a reason your practice can purchase CPAP machines from any supplier. These machines are considered the treatment of choice for patients with severe OSA, according to the European Respiratory Journal, with an estimated success rate of 80 percent.

CPAP is a type of noninvasive ventilation and was invented by Dr. Colin Sullivan in 1980. He stumbled upon the solution when he was able to treat his dog’s breathing issues using a vacuum cleaner. It soon became clear that humans could benefit from the same type of therapy.

Dr. Sullivan proposed “an experimental therapy on humans with a machine he created using a vacuum cleaner motor and attached mask and hoses,” according to David Repasky at cpap.com. “After gaining the approval from his patient to try the experiment, he used the machine to circulate air through the patient’s respiratory system. . . . He realized he stumbled on to something that was going to help make a huge difference in the lives of patients.”

Before this invention, the most common treatment for OSA was surgically removing a portion of the respiratory system. This invasive surgery came with many risks, so the CPAP machine provided a much-needed alternative.

Now, the CPAP machine isn’t perfect, and patients may not feel relief right away.

“How long it takes for CPAP therapy to work is different for each individual,” says Brandon Peters, MD. “If sleep apnea is very severe prior to treatment, the improvement may be more obvious. However, when symptoms are mild, it may take longer to notice any changes.”

What Are the Drawbacks of Treating OSA with a CPAP Machine?

Besides taking a while to improve symptoms in some patients, what are other drawbacks of CPAP machines? What factors may make alternatives to CPAP worth considering?

They can make sleeping difficult. Having something attached to your face, being unable to roll over comfortably, and listening to the constant sucking sound of the machine can make it difficult to relax and sleep well through the night. Considering that’s what the machine is supposed to help with, it’s understandable why some patients wouldn’t want to stick with the treatment.

It can be a pain to travel with them. Patients have to make sure their equipment is dry, carry backup supplies with them, bring their prescription (just in case), find a source of distilled water, and ensure that their power cord is compatible with local outlets.

They can cause dry nose and mouth. There might be a leak, or perhaps the patient’s jaw drops open when they are using their nasal mask. Either way, it’s important to let patients know that if this happens, they should check their mask for leaks and consider putting a humidifier in their bedroom.

They can be expensive. “The machine’s out-of-pocket cost starts near $250 and can be up to $1,000 or more,” says Danielle Pacheco at Sleep Foundation. “If [patients] use insurance to get a CPAP machine, [they] often are required to enroll in a rent-to-own plan with strict compliance requirements.”

Compliance requirements can be prohibitive. Insurers may require patients to follow a 30-day compliance period. Medicare, for example, requires CPAP users to use the machine at least four hours a night on 70 percent of nights.

Not all machines are created equal. Just like any other manufactured product, CPAP machines can have unexpected issues. For example, in June 2021, Philips recalled thousands of CPAP machines, BiPAP devices, and ventilators “after discovering the polyester-based polyurethane sound abatement foam can break down and potentially enter the device’s airway. When this happens, chemicals or debris from the foam may be inhaled or swallowed, causing a health risk.”

What Alternatives to CPAP Are Available?

Despite these potential drawbacks, CPAP machines are often an excellent option for patients. But when CPAP machines aren’t quite right for a patient, there are more options. Here are a few alternatives to CPAP to consider:

Surgery

There are a few surgical options for children and adults. For children with OSA, removing their tonsils and adenoids may be a good route. For adults, surgical options often include the following:

  • Maxillomandibular advancement (MMA) surgery to reposition the upper and lower jawbones and help keep the upper airway open
  • Uvulopalatopharyngoplasty to remove tissue from around the upper airway
  • Tracheostomy to create a hole in the windpipe and insert a tube in order to improve breathing
  • Hypoglossal nerve stimulation (HNS), which inserts a stimulator into the nerve that controls tongue movement, helping the tongue stay in position to keep the airway open

Studies on the efficacy of these surgeries are limited, so it is important to consider other options, too.

Oral and Nasal Devices

Nasal expiratory positive airway pressure (nEPAP) devices are one-time use products that patients insert into their nostril before they go to sleep. This provides positive pressure when they exhale, thereby preventing the collapse of the upper airway.

Mandibular advancement devices cover the upper and lower teeth, keeping the jaw from blocking the upper airway. These devices work best for patients with mild OSA or for those who experience OSA only when they sleep on their back.

Tongue-retaining devices keep the patient’s tongue forward so that it does not block the airway. Studies have shown issues with compliance, with patients tending to prefer mandibular advancement devices over these.

Orofacial Therapy

Orofacial therapy teaches patients how to control and strengthen muscles in their tongue, soft palate, lips, and face. With these skills, patients can correct the position of the tongue so that it does not block the airway.

Lifestyle Changes

In patients who are overweight, research has shown that weight loss reduces the severity of OSA. This weight loss can be achieved through a combination of diet and exercise changes. Bariatric surgery has been shown to help, too.

If patients sleep primarily on their back, they can use devices that alert them when they are in that position so they can roll to their side. These devices can help reduce the number of sleep apnea events.

Alcohol consumption can make OSA symptoms more severe. As Sleep Foundation reports, “The American Academy of Sleep recommends avoiding alcohol as one of the first steps in treating OSA, along with weight loss and changing sleep position.”

Why Aren’t These Alternatives to CPAP More Mainstream?

CPAP is an incredibly effective treatment for sleep apnea. It was an impressive innovation that revolutionized the treatment of OSA. Because of this, it can be easy to overlook alternatives to CPAP like oral devices or therapy. Before prescribing a CPAP machine right away, weigh the pros and cons, and consider prescribing other devices or treatment methods to your patients.

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