Get Some Sleep: Apnea beyond the CPAP
January 25th, 2011
02:08 PM ET

Get Some Sleep: Apnea beyond the CPAP

Lisa Shives, M.D., is the founder of Northshore Sleep Medicine in Evanston, Illinois. She blogs on Tuesdays on The Chart. Read more from her at Dr. Lisa Shives’ Sleep Better Blog.

Last week, I talked about CPAP (continuous positive airway pressure), which is the gold standard therapy for obstructive sleep apnea. As promised, this week I will discuss the other treatments.

Although not all patients with OSA are overweight, we think that about 80% are overweight or obese. For these patients, weight loss would almost always improve and sometimes eliminate their OSA. There is research that shows that even a 10% loss of total body mass can reduce the number of apneas per hour by 50%.

The Catch 22 is that having OSA makes losing weight difficult. In fact, there are studies that indicate that OSA may be one of the causes of weight gain. I think that it is unrealistic to think that weight loss is an appropriate first line approach for treating OSA in overweight patients because the untreated sleep apnea is most likely sabotaging their efforts at weight loss. My approach is to treat the sleep apnea and then work on weight loss with the carrot always being that one day patients may be truly cured of their sleep apnea.

Most patients have worse OSA when they sleep on their backs; a few have it only when they are on their backs. A sleep study in a sleep center (as opposed to at home) will break down how many apneas occur while the patients sleep on their sides and on their stomach versus on their back. The sleep physician can also see if the oxygen drops in all positions or only when the patients sleep supine (on the back).

If a people have sleep apnea only when they sleep on their back, then they have “positional sleep apnea” and we can treat them with positional therapy. This usually involves a T shirt with pockets sewn into the back into which are placed tennis balls, Styrofoam cubes or small beach balls. There are also belts with Velcro in the front and some ball or cube in a pocket in the back. The whole objective is to make the patients instinctively roll back onto their sides if they try to go onto their backs while they are sleeping. While it is rare for this to completely treat OSA, it can be used as an adjunct therapy. Sometimes, if patients can’t tolerate other therapies but will do this one, then I think it’s better than nothing.

Because obstructive sleep apnea is an anatomical disorder, there has always been great hope that there could be a surgical cure. Unfortunately, it hasn’t panned out yet. There are at least five surgical approaches so I cannot discuss them all here in detail, but I could do another column if there is interest.

The most commonly performed surgeries are ones aimed at reducing pharyngeal tissue, the classic one being the UPPP (uvulopalatopharyngealplasty). The American Academy of Sleep Medicine recently sponsored a study of surgical therapies for OSA. The researchers found that pharyngeal surgeries have a low success rate and high complication rate, including risk of death, and these surgeries are not recommended as standard treatment.

There is a simple office procedure whereby the otolaryngologist implants small filaments to stiffen the pharynx, the medical name for the throat. This is considered appropriate for people who have only snoring and no OSA on their sleep study.

The most successful OSA surgery, and the one with the lowest complication rate, is called maxillo-mandibular advancement. It is however considered invasive, technically challenging and has a long recovery period. It involves bisecting the upper and lower jaw and extending them forward with titanium plates.
There is a new therapy called Provent whose effectiveness rates are low, but it is relatively non-invasive and less cumbersome at first glance. It consists of small plastic valves that fit into the nostrils which are held in place by an adhesive flap over the outside of the nostril. Even the manufacturer admits that this should not be considered a first line therapy. At best, it can lower the number of apneas per hour by 50%. It works via a valve system. The valve opens when the patients breathe in and closes when they breathe out thereby creating resistance that in turn creates a back pressure in the throat that can serve to prop it open. Many patients find it so difficult to exhale that they cannot tolerate the therapy. Others think that it works well for them, but when we do a sleep test with them wearing the Provent, we find that they are sleeping all night with their mouths open which defeats the treatment mechanism. Still, this treatment is worth a try for mild to moderate OSA or people who cannot tolerate CPAP or the oral appliance. This is a prescription item and presently is not covered by insurance, but it is fairly affordable.

The final treatment I will discuss is the oral appliance, also known as a mandibular advancing device, because this is really the true alternative to CPAP. The oral appliance is considered, by the American Academy of Sleep Medicine, to be an appropriate first-line therapy for mild to moderate OSA and an appropriate second-line therapy for patients with severe OSA if they cannot tolerate CPAP. I call this a rich man’s bite guard.

There are many manufacturers, but basically it does look like a bite guard with the exception that the lower jaw is moved forward relative to the upper jaw, which opens the airway and can put tension on the pharyngeal tissues as well as encourage the tongue to stay forward. It is less reliably effective than the CPAP and it is hard to predict which patients are the best candidates so for now we use the severity level as a guide.

However, I have seen patients with severe OSA who are treated remarkably well with the oral appliance and others with milder sleep apnea not helped at all. I used to discuss this as a treatment option only with patients who had mild or moderate OSA but now I discuss it with all patients even those who are severe because the oral appliance is being advertised so heavily by dentists that I know my patients will read about it and wonder why this is not a good option for them.

The oral appliance looks so much less cumbersome than the CPAP that readers might be surprised to learn that it is not without its own discomfort and side effects. Well known side effects are: excessive salivation, jaw pain, teeth shift and/or change in bite. Again, this is quite different from a bite guard in that it pulls the lower jaw forward and places it in quite an unnatural position for eight hours. And this is a new enough therapy that we are only now having thousands of patients who have used it for many years and so we are now starting to see some long-term consequences.

Ideally, the diagnosis of OSA should be done by a sleep physician as should the discussion of the long-term health consequences as well as all the treatment options. A comprehensive sleep center will do the type of thorough testing required to know if your sleep apnea might respond well to treatments other than CPAP. They will have the knowledge of the latest therapies.

They will also know how to combine therapies and sometimes avoid CPAP. For example, I have a patient with severe OSA who is well-treated using the oral appliance, positional therapy and the Provent. She is thrilled and so am I. I have many other patients who combine two therapies and are adequately treated and can feel the difference in their energy and alertness. Although, the CPAP is the best choice for many people, a sleep physician can take a creative approach and use the latest research to help many patients treat their OSA without using a machine.

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  1. sftommy

    Medical science has a long way to go before an effective treatment for sleep apnea can be said to be had.
    My one night with CPAP turned into a Korean War torture scenario (tech spoke no English only Mandarin), the sleep doctor never read my write up of the experience but just had his receptionist leave me a gleeful message saying I'd been approved for the thing, that doctor is a CPAP pusher nothing more. The other options here presented by Dr. Shives shows the shortcomings inherent in the alternatives.
    A treatment plan that slowly enlarges the relevant part of the back of the throat needs to be developed and these treatments need to be introduced while likely candidates are young and their muscles and skeletons can be more easily promoted to develop without this condition. Adult treatment plans should also be developed along this line of thought.
    Like millions of Americans my sleep apnea is untreated given the treatment options medicine currently offers.

    January 25, 2011 at 16:59 | Report abuse | Reply
    • Tom

      Please try another sleep study facility. While the study is uncomfortable the end result is fantastic. I have had my CPAP for 10 years and it makes a world of difference.

      January 25, 2011 at 18:27 | Report abuse |
    • Amanda

      Please don't wait for a better option! Sometimes it can take weeks to get used to CPAP. If you can manage to wear it for only a few hours a night at first, it's worth it. Ask for a Ramp feature, that allows you to fall asleep at a lower pressure. Or, ask for BiPap if your pressure is too high to tolerate. Consult with a different sleep lab if you are unhappy with the service you received. I've been in this field for over a decade, and if people with sleep apnea really understand what is happening to their bodies during the night, they would be frightened. There is plenty of thought and research put into finding a different solution to this problem, but without a lot of luck, We should be happy, however, that we have the CPAP option. Before that, the only really effective treatment was, I believe, a tracheotomy.

      January 25, 2011 at 18:32 | Report abuse |
    • David

      I tried a CPAP machine, my OSA was rated off-the-charts/rattling-the-windows bad.
      The first time I tried it was in the second sleep study. I slept all the way through
      the night, had to be shaken awake, the first time for that in 10 years. Really good.
      It is not as good now as it used to be, maybe I need to adjust something, but I still
      really like the thing. Your guy may have been a CPAP pusher, but that doesn't mean
      the thing doesn't still help people. Really, give it a chance.

      January 26, 2011 at 03:17 | Report abuse |
  2. JohnCRoberts

    have had to use CPAP since 1991, Sleep apnea was diagnosed as a young Underweight skinny kid, who was an athlete for 20 more years after high school. But was not known how to solve until I had a sleep study in 1991 showed hundreds of waking periods from Sleep Apnea. Went to CPAP and stopped having recurring dream of holding breath while swimming for the surface. Have not had that dream since 1991. That ALONE was worth having CPAP. Nose mask seemed to work better than nasal tube but that was my experience. Weight and blood pressure had gone up, are now controlled, no change in Apnea. CPAP still required.

    January 25, 2011 at 18:16 | Report abuse | Reply
    • Arlene Collins

      You are the first person I have heard about having a recurring dream due to having Sleep Apnea....I also had this going on for years which stopped upon use of my CPAP....I would dream about swimming up to the surface and just stay below the waterlline trying to break out to the surface so I could breath. I don't miss my dreams either! Thank God for my CPAP.

      September 27, 2011 at 15:17 | Report abuse |
  3. Pete

    I was diagnosed with sleep apnea about a year ago and I have been using a CPAP since my diagnosis with great success. I am 24 years old and while I find that CPAP is effective and had improved the quality of my sleep immensely, I agree with Clark1b about its impact on intimacy. It’s a pain to have to bring it to and from my girlfriend’s house and she says when I wear it I often push her away in my sleep. As I am only 24 the doctor who diagnosed me and set me up with CPAP recommended that I look into the jaw extension surgery after seeing how I liked the CPAP. I would like to learn more about it and hopefully get to a point where I don’t need a CPAP so Dr. Shives, I would appreciate if you wrote something about the maxilla-mandibular advancement.

    January 25, 2011 at 18:38 | Report abuse | Reply
  4. Maggie

    So the bottom line is, lose weight. Our population is so obese that we are literally suffocating our fat selves to death. Stop eating so much. Do you think they are wearing CPAP machines to force air into their fat chests in Nigeria? How much is all of this costing the nation? Now kids are on CPAP. Sad.

    January 25, 2011 at 18:52 | Report abuse | Reply
    • Dan

      Wow! So the part about sleep apnea being a cause of obesity went completely over your head?

      January 25, 2011 at 19:24 | Report abuse |
    • Michelle

      It seems illiteracy is a bigger problem because you clearly weren't able to read or understand the article. It said that sleep apnea CAUSES obesity. Do you understand what that means?

      January 26, 2011 at 00:01 | Report abuse |
    • skinnier than you

      Don't assume all sleep apnea sufferers are obese!!! You need to look up Marfan Syndrome and related connective tissue disorders. The phenotype is tall, thin, with long arms, legs, neck, fingers, face. We have difficulty GAINING weight, not losing it. So that is not going to solve my sleep apnea problem. When the back of your throat collapses while you are asleep and cuts off your air supply, it is horrible. This happens over and over and over again to many of us every single night, regardless of our slim builds. So your uncaring post is way off-base.

      January 26, 2011 at 07:48 | Report abuse |
    • RobertV

      Maggie, It is just not true that obesity causes many cases of sleep apnea. Also, contrary to what you read in the media, it is rare for an individual to be cured of sleep apnea by losing weight. The root cause of obstructive sleep apnea is most commonly narrow, underdeveloped jaws which result in small airways easily subject to collapse when the muscles relax normally during sleep. Why are underdeveloped jaws predominant in our society? It is the modern diet. We do not breastfeed for lenghty periods and we eat a diet that requires very little chewing. No exercise of the jaw during our developing years and the jaw skeleton will not develop fully.

      January 26, 2011 at 12:18 | Report abuse |
    • sounding

      Maggie, The article was clear that obesity is a symptom of sleep apnea, not the cause. What the article didn't state is why it is a symptom. When your body senses something is wrong (stress on the body, whether caused by emotional or physical force) it will take any food (even healthy food) and store it as fat until the 'perceived' emergency is over. When it senses that the emergency is past, it will then allow you to lose the weight. Keep in mind also that some people starve their body and when it doesn't have the food intake, the body starts feeding on itself leading to muscle and boneloss. I don't know if one can recover from muscle and boneloss (meaning rebuild muscle and bone).

      Again, obesity is mostly a symptom, not a cause; but it can certainly increase the problems with sleep apnea.

      January 27, 2011 at 10:59 | Report abuse |
    • Ann

      Maggie, apparently you failed to read the entire article, but also, do you really think that fat people WANT to be fat? It is very easy for some of us to gain weight and very hard to lose it. Obviously if it were an easy thing to do, we would all just do it! I am sure you have never been overweight or you wouldn't be insensitive enough to have made that offensive comment! Until you have walked a mile in another person's shoes, keep you opinions about that person to yourself. The reason that people in the third world countries "don't have sleep apnea" is most likely because they don't have access to the medical care that could diagnose the condition. It doesn't mean that no one there has the problem.

      January 29, 2011 at 22:56 | Report abuse |
    • Willow

      I suggest checking the BMI to see where you fall on it. Unless you're a starving refugee, you're probably technically overweight or obese too. Most people are. Clean up your own house before telling others to clean theirs.

      February 2, 2011 at 07:49 | Report abuse |
  5. Bob

    My son had sleep apnea and was cured by having is tonsils and adenoids removed. It was a miracle cure. He went from snoring, mouth open, gasping for air and waking every 2-3 breaths, to sleeping without a sound and breathing through his nose all night.

    January 25, 2011 at 19:02 | Report abuse | Reply
  6. Jack

    That's fine, but careful not to make generalizations. My AHI is 40 per hour - severe, to say the least. In my doc's opinion, it's entirely due to the geometry of my skull, jaw and airways. I'm 5'7", 160 pounds, and extremely athletic (when I wasn't falling asleep). CPAP undoubtedly saved my life.

    Oh! And wanna talk about doctors pushing unnecessary treatments on their patients? Mine told me for years that I suffered from depression, fibromyalgia, and ADHD - becuase I complained about low energy, bad mood, trouble concentrating, and widespread joint pain. Guess what!?? Three months of CPAP and all of the above disappeared! Never occurred to any of them to see if I had a sleeping disorder. That's a much better example of failed medicine, and waste/abuse in the managed care system than the one you mentioned, I think.

    January 25, 2011 at 20:59 | Report abuse | Reply
  7. JayDee

    I was diagnosed with moderate sleep apnea a year ago. I refuse to use the CPAP machine. To me, it seems like a relic from a century ago. I am not motivated to use it because I do not have bad enough symptoms like daytime sleepiness. I realize I am at greater risk for heart disease and stroke because I do not use it, but I just cannot commit to that torture device. So I am doing nothing....but this article has persuaded me to perhaps look into an oral appliance.

    January 25, 2011 at 21:06 | Report abuse | Reply
    • Daniela Sever

      I am a dentist who is specially trained to provide Oral Appliance therapy and I can tell you that it is a very
      effective option to CPAP, and that it helps most patients. I can refer you to someone in your city/state who
      is specially trained to treat sleep disorders such as apnea to see if you are a candidate.
      Just email me. You can check out http://www.stopsnoringboston.com also.

      January 28, 2011 at 16:52 | Report abuse |
    • Daniel

      I too was diagnosed with a mild case, and I hate the cpap machine, I told the therapist that I do not want the cpap when I got one, but told her I would give it a try. I end up taking it off while I sleep, It takes me a while to go to sleep because it is very uncomfortable having that device strapped to my head, it absolutely hate it. The company I worked for kept tabs on me for compliance which I take it off when I sleep so I was not compliant and they took me out of work, I asked about getting the oral device but was told it was frowned upon because they can not tell if I was using it. I feel that is wrong because if I can not use the cpap and I have this so called apnea then let me get something I may be able to use instead of trying to force this stupid cpap machine that I do not want. It does blow off dust pretty good, the only real use I have for it.

      January 14, 2014 at 23:23 | Report abuse |
  8. Bariatric Surgeon

    It is interesting that an article by a sleep study expert mentions a number of surgeries that are aimed at improving OSA but fails to mention bariatric surgery. OSA is significantly improved or eliminated in the majority of patients undergoing Roux en Y gastric bypass


    January 25, 2011 at 21:41 | Report abuse | Reply
    • sounding

      I don't think there is ENOUGH research looking into the long-term affects of bariatric surgery. Generally I believe that surgeons are too eager to start cutting up and removing body parts. I believe that the human body isn't designed for this type of drastic surgery. Bypassing a vital organ (stomach) is not an intelligent step. But what alarms me the most about this type of surgery is that it is done like passing out candy. No one really does a psychiatric study on the patient to see if the obesity is emotionally based. No one really studies the patients eating habits to see if they're on a healthy diet or not. I KNOW one patient that has a steady diet of chocolate and wine and supplements it with a little protien (like beans).

      After this type of surgery, you also need to be able to afford cosmetic surgery to remove the excessively hanging flesh all over their bodies.

      How about treating the cause of the problem instead of treating the symptoms. Most Bariatric surgeries should be crimes and the doctors put in prision for frivilously pushing patients into it. Although, truthfully I understand that you are pushing the patient, the patient eagerly wants to lose the weight – but you are too eager to give them the surgery instead of truly helping them with the true issue.

      January 27, 2011 at 11:09 | Report abuse |
  9. Thomas

    Rather than simply treating the symptoms of sleep apnea, why not cure it with a DNA appliance developed by Dr. Dave Singh of Portland, OR? Using the concept of Epigenetic Orthodontics, the DNA appliance can actually stimulate the growth of new bone and promote craniofacial development. No surgery, no pain, no medications, no lenghty treatment protocols. Sound fantastic? Google "DNA Appliance" and see for yourself.

    January 25, 2011 at 21:43 | Report abuse | Reply
  10. Jay

    There is no problem in individuals becoming aware of potential causes of negative symptoms they may be experiencing. Jack's reply is a great example of this. Albeit, you raise an important point: most people suffering from obstructive sleep apnea syndrome (OSAS) could stand to lose some weight to improve the severity of their OSAS. That said, before making generalizations, we must acknowledge that the onset of this disease are multifactorial and include, but are not limited to genetic history, facial geometry (perhaps due to other underlying disease), and body mass index/waist-hip ratio.

    Although I don't agree with Dr. Shives regarding not using lifestyle changes as an initial approach to treatment for OSAS, I do want to point out to you an interesting comment she made: "there are studies that indicate that OSA may be one of the causes of weight gain". This suggests a potential positive feedback system between body weight gain and OSAS, and thus a more complicated issue of "lose the weight, fatty", in particular, the fact that the disease will get worse.

    Additionally, these factors can precipitate other disease states such as insulin resistance, reduced kidney function, hypertension and other cardiovascular insults over the long-term course of having a chronic metabolic disease such as OSAS. As such, your statement regarding the "serious, life-threatening" cases of OSAS clearly applies to anyone that has this disease. In fact, in a study by Yaggi et al of Yale Medical School published in the New England Journal of Medicine in 2005, subjects with OSAS were significantly more likely to die than age and weight-matched controls without OSAS, even after accounting for factors such as the presence of hypertension.

    Clearly, individuals presenting with any severity of OSAS should be concerned with treating their disease in a serious manner. We should not be undermining their ability or motivation to do that, regardless of what the insurance industry tells us.

    January 25, 2011 at 21:53 | Report abuse | Reply
  11. Michelle

    I disagree with the Dr. that surgery is not effective. 13 years ago (I was 24 years old) I had a uvulectomy & a corrected deviated septum in the same surgery for my sleep apnea. It was a 2 week recovery. I want to also mention that my tonsils & adnoids were removed as a teenager. I have lived at a healthy weight have not had any trouble in all of these years with sleep apnea subsequent to these procedures! I would highly recommend this alternative to living with a CPAP for the rest of your life!!! Please do not rule this out as an option & ask your ENT doc about this surgery.

    January 25, 2011 at 22:24 | Report abuse | Reply
  12. deb

    I have severe sleep apnea and MDs recommended a tracheostomy which I declined. Tried Bipap machine which has the ramp feature. This triggered my cluastrophobia so tried the appliance that fits into the nostrils instead of the mask and I would lay awake waiting for it to ramp up and never slept. So gave that up and I now use oxygen at 6 liters and sleep practically in an upright position. I no longer wake up gasping for breath and no longer have periods of falling asleep without meaning to. Is this a cure? no. but it is an assistance that helps me.

    January 25, 2011 at 22:58 | Report abuse | Reply
    • Sherri

      My father, now dead, had sleep apnea for years and years. Would not use the machine. Then while in the hospital for other things, his doctor intimidated my parents, threatened them that if my dad would not do a tracheotomy, he would not be his doctor. My father was 78 years old. So, he did it. It apparently did something to his brain (my dad's) because he was like a child after that. He lived 5 days in a nursing home, my heart breaking every day. There was no reason to do this surgery on a man this old. Yes, my dad was stubborn, but he had lived with this for 60 years. There was no reason to cut open his throat.
      On another side of this – I put a tennis ball in the pocket of a Tshirt. I started waking up with terrible headaches. Apparently at some point during the night I must have been laying on the ball. As soon as I stopped wearing the T shirt to bed, the headaches stopped.

      January 26, 2011 at 00:20 | Report abuse |
  13. dejah_thoris

    I snored even as a skinny kid, and eventually about 10 years ago (in middle age) the OSAs were so bad that I kept waking up many times per night. Went for a sleep study and was fitted with a CPAP. Been sleeping much better with it. I can see where OSA would not be useful if one were overweight - before I was fitted I was very tired, slept a lot, low metabolism. It could have led to a huge weight gain.

    For those who come on here and snark about fat people, etc., you tell us more about yourself than you know. Your ignorance and hatefulness really show through. You're not people I'd want to know, and I'm glad I don't. People with health problems don't need to have ignorant s**theads on their cases, too. So, snarkie ones: get a life and butt out.

    January 25, 2011 at 23:50 | Report abuse | Reply
  14. bisnono

    My husband has snored since he was a child and a skinny beanpole, and was finally diagnosed with severe obstructive sleep apnea last year. His adenoids are huge, as are his tonsils. NO amount of weight loss is going to make his adenoids or tonsils get smaller, nor will weight loss fix his deviated septum. Telling someone with obstructive sleep apnea that all they need to do is lose weight is like telling someone with big feet that all they need to do to wear smaller shoes is to lose weight. It's idiotic.

    January 26, 2011 at 00:00 | Report abuse | Reply
  15. Chrysta E. Banks

    I have been headache called (mirgina) from stayed late night and none ate for breakfast and Lunch so I ate for dinner. I am deaf senior citizen and I am 64 now. I am careful with my health important life. I did not get headache from stay late night but only none eat make headache simply. Thanks

    January 26, 2011 at 01:45 | Report abuse | Reply
    • ddd

      what are you talking about?

      February 15, 2011 at 12:06 | Report abuse |
  16. chuck

    I tryed a cpap for about 4 mos. and could not stand it. I thought that was weird since i frequently used a resporator at work for many years.I switched to a oral appliance [tap] system $2000.00 and have had much better results. It is much more comfortable, quieter and effective for me. Yes you can have jaw pain if you advance it to fast, but if you take your time that should not be a problem.It also helps with intimacy since there is no hose,mask or air compressor making a bunch of noise. I use another appliance in the morning for 10 mins. to make sure my bite stays correct. I also use breathe right strips. My wife is happy and so am I.

    January 26, 2011 at 01:47 | Report abuse | Reply
  17. Blima

    I have been using a C-pap for about 6 years now. In the beginning the mask was difficult to tolerate but I persisted and I was glad because I slept better. the mask improved to a nasal canula, now it is really comfortable and is called a cradle. although i am more comfortable when i sleep i am not really well rested and feel tired all day. my sleep study shows that i do not go into deep sleep anymore. i lost 45 pounds but my sleep apnea actually worsened. I wish there was some help for me to be more rested

    January 26, 2011 at 04:42 | Report abuse | Reply
  18. Johnson

    I am concerned that not enough research is being done regarding sleep apnea. I was diagnosed with sleep apnea 7 years ago and was upset that the sleep center was pushing the cpap machine. I tried the machine and felt I was being buried alive. It was an extremely uncomfortable experience. The machine is expensive and my insurance didn't pay for it. I believe the makers of the cpap don't want alternative cures to sleep apnea because they would experience a loss of business.( I am not overwight, run 3 times a week, and swim.)

    January 26, 2011 at 07:37 | Report abuse | Reply
    • Kimberly

      You are perfect example of the point I was trying to make, as was the other poster who discussed other medications being the culprit. Some folks really have TERRIBLE apneas and need CPAP; others do not.

      I agree 100% with the bariatric surgeon. If a morbidly obese patient has sleep apnea, a lap band (less invasive than a bypass) could help the person lose enough weight to reduce/eliminate the need for CPAP, lower blood pressure, return sugars to normal...

      January 26, 2011 at 10:38 | Report abuse |
  19. Dasha18

    For mild apnea that left me exhausted, I elevate the head of my bed, use a heavy pillow to keep me on my side, use a sinus rinse and breathe right strips. My BMI is under 25, so weight may not be the cause.

    January 26, 2011 at 07:58 | Report abuse | Reply
  20. Gary

    I've used a CPAP for 2 yrs and tolerate it well although it took so time to adapt and to find the right mask. I'm surprised at the Doctor's remarks about positional therapy. I believe that it could be useful for many, perhaps even me, but a sleep study in my experience can't determine positional therapy applicability due to the patient's inability to sleep in any position but on their back during the study. The wires and sensors used in the study certainly prevented me from turning over to sleep in my favorite position, the swimmers position.

    I recommend avoiding the so-called sleep study centers unless they are recommended by a reliable neurologist. Many neurologists have a sleep disorder practice within their main practice and they should be consulted first. My first study was performed by a study center and it was a terrible experience. They had only 1 type of mask for me to try and forced me to sleep on my back until 5 am at which time they kicked me out even though I hadn't slept well at all and had been in bed only since 11:30 because it took them so long to set everything up. The seemed interested only in getting paid.

    January 26, 2011 at 11:39 | Report abuse | Reply
  21. AE

    My husband had the UPPP (uvulopalatopharyngealplasty) surgery because he did not want to use a CPAP. While the surgery helped alleviate his snoring, after reading Dr. Shives article, I now wonder if we have a false sense of security and my husband should have a second sleep test to check for OSAS. I'll start the process of "negotiating" with my husband to convince him that he needs to have a follow-up. Thank you, Dr. Shives. I very much appreciate your article.

    January 26, 2011 at 16:18 | Report abuse | Reply
  22. Ann

    My husband has a CPAP and although it took him some time to get used to it, it's really helped. He's been trying to convince me to go for a sleep study myself – apparently I snore like a freight train. I resisted the idea for ages, because I'm too vain to have a doctor tell me i have a problem being caused by being fat! I thought, well, I'm trying to lose weight anyway, so give me until summer and if I can't solve the problem, then I'll go for the study.

    Well, I finally realized I was being stupid. I'm so tired all the time from not sleeping properly that I can't even function half the time, much less start an exercise program to drop the weight. (By the way, I'm overweight, but not huge – I probably need to lose around 35-40 lbs but I'm far from the Biggest Loser crowd). I'm a firm believer that the sleep problem is making it much harder to lose weight, even if it's not the reason I gained it. So, off to the sleep study I go (tomorrow). Ugh. I hope it helps.

    January 31, 2011 at 12:43 | Report abuse | Reply
    • sounding

      Good for you! I'm really glad that you're taking a step forward and seeking a diagnosis. Regardless if it turns out to be sleep apnea, or something else entirely, snoring is a signal that you're not getting enough oxygen.

      Also, when your body 'perceives' an emergency (emotional, physical, etc) then it will take ANY food and store it away until the 'perceived' emergency is over. All this to say, don't worry about the weight right now (that just adds stress), but find out what the 'perceived' emergency is first. It also sounds like your spouse is supportive – that is truly a blessing to hold on to.

      January 31, 2011 at 14:32 | Report abuse |
  23. Dyanisme

    Along with all the good advise here, also get your thyroid and adrenal functions tested. I went to a doctor because, among other symptomes, I had no energy and work up frequently during the night. The doctor immediately saw that I was overweight and sent me to a sleep specialist. Instead, I sought a second option and found out that I have Hashimoto's (a autoimmune disease that was destroying my thyroid), adrneal fatigue and dangerously low vitamin D levels. As soon as we treated my real problems, the sleep issues resolved themselves.

    Be your own advocate and don't assume that the doctors automatically know best.

    January 31, 2011 at 15:03 | Report abuse | Reply
    • Margaret

      Hi Dyanisme, can you recommend a good doctor? I believe you are correct.

      November 19, 2015 at 15:15 | Report abuse |
  24. doofus

    You-all write too much. Has any one tried singing. When I sing I can feel the throat muscles being fatigued.

    February 3, 2011 at 17:00 | Report abuse | Reply
  25. Donna - Missouri

    My CPAP saved my life and my sanity. Buy a neck pillow (travel type for planes and cars) and put it on top of your regular pillow. Sleep on your side with your head cradled in the neck pillow. Takes the face mask off of the regular pillow and makes it way more comfortable.

    I have a sister and two brothers who also have sleep apnea. Doctors tell us it is the structure of our throats. We all have the same short wide necks and slightly receeding chins. My sister has so many episodes that her doctor told her she should not even take a short nap without her CPAP because she could easily get low enough on oxygen to die.

    Even if you do not die in your sleep from the condition, it will eventually cause you to have heart attacks or strokes. Or you will fall aslleep behind the wheel and maybe kill other people. So CPAP or surgery or appliance, for goodness sakes, do something to treat this.

    February 6, 2011 at 10:23 | Report abuse | Reply
  26. Jeff

    I was diagnosed with OSA while serving as an active duty military member. In the military, if your SDI is high enough to recommend CPAP treatment, you are identified as CPAP dependent, and your military career can be ended over that dependence. The military offered me a UPPP as an elective (but covered) proceudre to see if I would be fortunate enough to reduce my SDI enough to evade identification as CPAP dependent, adn thus the evaluation of whether to allow me to remain in uniform or not.

    In discussion of the procedure there was no mention that a UPPP was any more life threatening than any other ENT surgery, and I was quite surprised to see death listed in the article as a primary complication of this procedure.

    I had a fairy-tale perfect UPPP, BTW. My SDI was cut in half. I experienced some post-surgical discomfort, but I was eating the next morning. I can still properly close my soft palate. The SDI reduction was enough, in my case, to justify NOT marking ym records as CPAP dependent, and I was able to continue wearing the uniform for nearly an additional decade.

    BTW, I assume a great deal of genetic pre-disposition in my case, as my mother has been using a CPAP for thrity or more years at this point.

    February 7, 2011 at 15:36 | Report abuse | Reply
  27. Jim Caudill

    I a Registered Polysomnographer, employed in an excellent, hospital-based sleep clinic. Something for all of us to consider is, there is no "one-fits-all" cure for OSA. Different people require different approaches. A multifaceted approach would be ideal, not one of promoting a particular mode of treatment. Most OSA sufferers need to lose weight, though obviously not all. Mandibular surgery works for some, as does the rather unpleasant UP3 procedure. Doctors need to treat people as human beings, not dollar signs. Many people also suffer from Central Sleep Apnea, another beast altogether.

    February 18, 2011 at 11:54 | Report abuse | Reply
  28. Jason

    Hello, I ask for input, at the moment I have not read much about your blogs or anything else and I hope I am at the correct place. I am 30 and I live with My mother and Grand mother at the moment, (Only pointing this out to say that I have witnessed a lot but know little in regards to some things) ~ My Grandmother is in her 80's, she has snored and had a sleep issue, of some form, my entire life, (They say over 40 years). She will get up over and over through out the night, as she has always had these issues for my entire life...k well she has FINALLY been given Some attention in regards to her sleep, However, it is not the right attention and I apologize for my frustration as I Love my grandmother very much and see people only labeling her as someone that does not care, instead of helping her. k here is the story from my take on it (I don't know a lot from a docs stand point and want claim to, tell ya what I do know about though, people labeling other people and not seeing them as a person.) She has had a in home sleep study in 9~2010 and she went and had one at the docs office back in 11~2010, They found that she has OSA, k now here is the part that is really starting to tick me off...They gave her some really, really complicated mask, k and from my understanding they did not measure her noise (for that first mask she used about a month), or pay much attention to making sure she would remember how to use it after leaving there office (No dvds, asking my ma if we even have a dvd player, hardly any information in a freak-en packet of info with hardly any pics) ~ While at the same time saying that if she does not care to master it within 3 months, that medicare will not pay for it and she will have to return it. K so time passes, she never once gets a Full night sleep with it, in fact hardly even doses off with it, 2 weeks have passed and I am starting to catch on to what is happening... I look up her mask on the internet and find, hey what do you know they have some videos. well I try to show her how to use it, to no avail, its one of the most complicated mask there is, the fact it works for 95% of people that use it should say that. 10 or so settings just on the forehead setting, which I think was at a different setting when she would try to use it half the nights. She would go to bed at night and simple things I would find like the straps would be not on right, or she would have heck taking it off due to the poor design (for her) of the fact that the color of the straps that go over the head are the same color (same darkness, Navy Blue straps, Hunter Green Clips) of the clip on's to attach to the mask itself, (She could not locate them to take it off, would get disoriented by it, also it had a type of Braille on those really small latches, for tactile, but she hardly recognized it was there to use it as a guide of sorts to guide her hand to take it off) ~ I would also notice that her face mask straps would get inter twined (all messed up, gave her nothing but hell just to wear). She would try to master this complicated piece of plastic, with hardly any guidance (and little professional) nearly alone, Night after night, Day after day, I saw her determination, she has had this sleep problem longer then I have been alive, I know my grand ma, and I know she cares, the fact that for 3 months she tried and is still willing to try again says that. K well some time or another, through much complaining from me, my ma calls them up and a nurse that knows how to work the device comes out and shows her how to use it, k so my mom and her are in another room and I hear this nurse say some comment about the fact that some times older people do not care and they have to, if they want the help, she even said some comment like " You can lead a horse to water, but you can't make it drink " ~ K so more time passed and that night was no different, my grand ma still tried and still could not master the device, with nothing to go by as far as guidance she would try and try and try, while being told that if she did not do the impossible and master this mask while having no info to do that, that they would have to take the device back if she had not proven she would use it in 3 months. k so at this time its been about a month, I keep complaining to my mom about how this is not right and they give her another mask, which is no better then the first and it itself came with a postcard type shape of a packet of directions, with few pictorials of info on how to use and most of the info in it was a freak-en registry card for the mask itself. K same deal month later, now its been 2 months, They give her a 3rd mask...They did not bother to recognize that she has Sinus ideas, she wore the 3rd mask for a little bit and from the get go it started to make sores on her noise, on the 2nd or 3rd night I went up to say good night to her and I noticed it was inflating her noise, (sorry no better term), within using the new mask for no more then a week her head started to hurt and she had to stop using the mask, she in time had to go to a Medical doc, get a shot for a sinus infection and is on an antibiotic now (that medical doc told her that she should of never been put on that mask as well, The medical doc is not even a sleep specialist and he knows that) ~ Well, its been about a week since she went to that doc and she is still walking Way off balance, Way, she is all the time trying to regain her balance, not very oriented when walking and carry's a lot (to her) UP the stairs, mean while, now to the next part of the story...They want to give her another sleep study and are yet again acting as if they can see her as something other then a label of someone that does not care...I tell her & my ma that I want to see her get help with her sleep apnea of course, however are you sure this is the right sleep "specialist" to go to? I tell them that rather this doc and his crew knows everything about sleep apnea or not, that they do not know jack when it comes to seeing people as people and not a label. They say something like the fact that they want to try a different device all together, and some how need another test to do that, Which might be true if it is a different test I have no idea, however if they had made a 'Real' attempt to see her as a person to begin with, then the very first mask would of been better, less complicated and they would of made sure she knew how to use it, and the 3rd one would of never been an option as she has Sinus Ideas and all it did was make a bad situation hell.

    K she is scheduled to go see these people sometime at the end of this month and although I want to see her get help with her sleep I do not want to see her wasting any more time with these people. No offense to my mom but she does not really care or help matters by even looking up other sleep specialist in this area. I would not know where to start, I tell her the facts that she does need to try for help if it can help her and that is what she decides to do, however I also try to tell her that there are other people she can go to, to get that help, I'm not sure what she is going to do, she says she wants to go and I respect that, however, I wish I could help her somehow, but I wouldn't even know how to go about that, We Live in North Georgia and I do not know of how to go about finding a good sleep doc for her in this area or if she would listen to me to go anyway.

    So, How the heck does someone handle this? When the very people that are suppose to help her are only making it worse, She has had more hell sleeping since trying to get help with her sleep then she did waking up 40, 11 times before even going. The Thing is it makes logical since that the device might just work if it can help her breath right when she is a sleep, however she will never know that if they can not give her the right mask / device AND make sure she knows how to use it, to begin with.

    I welcome any input,

    Thank you,


    February 18, 2011 at 22:50 | Report abuse | Reply
  29. pamelaklopfenstein

    My son is not overweight. He has over a hundred episodes a night where he suffers from apnea events. He's tired all the time, blood pressure and heart rate are elevated. And he has underdeveloped jaws, or should say he did have. I will clarify. Three years ago they took out his tonsil etc, then an ENT tied his tongue at the base. A plastic surgeon said he'd take him to surgery, break both jaws, realign them and my son would be okay. So we proceeded. In ICU, I noticed the doctor did not go through the old scar on top of my son's head like he said he would do, instead he made slits under both eyes, Then he cut from the outer orbit of the right eye, across the bridge of the nose, to the outer orbit of the left eye. This is called midface breakage, LeFort III. And he didn't break the lower jaw. I did say anything, just proceeded thinking maybe there was a reason. In ICU I tell them I'm turning the distractor screws the wrong way. They didn't listen. I unscrewed his face. A week later he had another five hour surgery for this reason. Then he had to have 3 lower jaw surgeries. Why they had to keep being repeated, I'm still not clear on this issue. Then another surgery to fix his eye that wouldn't close after the first surgery. Then they took a piece of his rib to build up his nose. I think after ten surgeries, Matt was okay for about ten months or so, or so I thought until he collapsed on me in the kitchen. He spent time in the hospital with high heart rate and blood pressure and high hemoblobin levels related to sleep apena. He flunked another study. After much frustration, I took him to California since no doctor in Ohio would see him, since he's a reopearte, and we found out the airway was never ADDRESSED at all. In fact, the only thing that was addressed was my son's appearance. And we found out he will never get the feeling back in his chin or lower lip cause his facial nerve was cut. We were also told many surgeons will tell you they know what they are doing, but some are just guessing, as evidenced by my son's outcome. Basically, the doctor said, the other doctor just cut him, advanced his jaws, bolted him into place and hoped for the best. We are saving our money to go to Dr. Arnett in California. He is the best. He does one surgery and fixes everything at once. His success rate for curing apnea is 98 percent. And after interviewing this doctor, I can honestly say, I wouldn't trust anyone else to operate on my son again. I hate it he has to go through more, but CPAP and BiPap don't work for him. He's too young for a trachea. Just keep us in your prayers. And if anyone is considering surgery, please check out the doctor and their references. And go to an actual jaw surgeon,not plastic surgery.

    May 16, 2011 at 17:19 | Report abuse | Reply
  30. SleepDeprived

    Well, I'm just ready to curl up and die,I tell you. I've done many sleep studies over the past 5 years, and my AHI and AI's are getting worse (and I'm 38). I'm not even close to being obese and unless I physically sleep with my head upright (just as if I'm awake and standing up), I'll get apneas either sleeping on the side or even on my stomach. What's even more disturbing is that I have a BiPAP and it's supposed to adjust in case my apneas get worse and even though there's more air pressure gradually increasing, I still end up with an AHI of 5.5 and AH of 1 after 8 hours and I feel like CRAP!!! If those numbers drop to AHI of 3.0 and AI of .5 or 0, I'm good. I'm very sensitive to any type of apnea...I'm just not used to it (started in 2008).
    What I did find as a cure on a daily basis: Singing! I sing like crazy every evening before bed for an hour. If I sing for about an hour, my apneas with my machine drop considerably, in any position. Also, purposefully sucking out a straw for 30 minutes using water (taking in water, then expelling it) strengthens my throat muscles considerably. But you have to do this every day. I also have discovered playing the didgeridoo has helped alot. But singing has the most effect. This might not work for an obese person, but if you're like me that has this abnormality, it should work.

    September 6, 2011 at 15:11 | Report abuse | Reply
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  32. Billy

    Check out Respiratory Solutions, They always helped me out with my cpap supplies.


    February 27, 2012 at 16:51 | Report abuse | Reply
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  38. CPAP failure

    I just returned my CPAP. It was horrible, for me. Everyone just kept saying, "Keep trying. You'll get used to it." After 3 months of hell, I finally got to where I could wear it for almost 4 hours before I ripped the thing off my head. I sleep on my side, but switch from side to side during the night. The damn hose would get in the way and wake me up. Also, I am claustrophobic and felt trapped. I was much more tired and miserable than without it, so I just stopped using it. It may be ok for back sleepers or people that only sleep in one position all night, but I don't see how you can use it otherwise.

    I lost 40 lbs and use Breath Right strips. (I know apnea is not in the nose, but the strips help me stop breathing through my mouth.) The loss of weight was easier for me than wearing the CPAP. I now sleep like a baby.

    August 6, 2012 at 16:27 | Report abuse | Reply
    • Andrew

      I heard in saying many people that they get difficulty to use of CPAP machine. People are not aware of the right use even leave the diagnosis; it is not the best option to go with. But a proper prescribe and consultation through doctor it can be trouble-free an effected in results; everything takes time to make it place. Your trouble might be a reason of style or not a fit size of mask, and not being able to tolerate the high pressure. It is overcome by using a ramp feature. I suffer from this since two years and then my friend refers the CPAPFreeShipping platform where i got the proper consultation for therapy and also arranged a prescription in choosing the right machine to comfortable heal.

      November 18, 2013 at 22:15 | Report abuse |
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  47. Regina

    I came here because I have been diagnosed with severe OSA and I am waiting on my insurance approval process to approve my prescribed CPAP machine. Why is it that the comments go from very helpful to downright crazy at the bottom???

    March 16, 2015 at 14:48 | Report abuse | Reply
  48. Angela Downer

    I find it really interesting that some people can actually only have sleep apnea while sleeping on their back, and therefore you can train their body to not sleep in that position. Like you said, this just sounds like a quick fix, and not a permanent solution to the problem. If I had positional sleep apnea, this technique wouldn't work on me because I can sleep on anything without waking up.

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    March 31, 2015 at 10:29 | Report abuse | Reply
  49. Mark

    I have been diagnosed with hypopnea and central apneas. CPAP, no way, I felt worse than with nothing at all. I am currently trying a BIPAP. I can tolerate it a little better, but I either wake up with my tongue stuck to the roof of my mouth or take the mask off during the night.

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