Sleep Apnea, Alternative Medicine and Other Info

There is not an abundance of information about alternative medicine and sleep apnea. I have seen some on acupuncture and sleep apnea, but most is very short and limited like this by the Mayo Clinic. There is also dental (oral) appliances for sleep apnea which I wrote about in September 2010.

Oral appliances are available and some dentists have been through the sleep specialist training to qualify to fit oral appliances for sleep apnea. If you are a person that sleeps on you stomach and tosses and turns a lot in your sleep, these may not be for you and they can do damage to your teeth. This information was received from a dentist that fits oral appliances for sleep apnea. More dentists now are qualified to handle mild to severe obstructive sleep apnea. I have written about oral appliances here. The national group for oral appliance part of dentistry is here.

Most of the discussion to this point has been about patients with sleep apnea that have been overweight. However, people with normal weight can develop sleep apnea as they age. So if you happen to be in this group, be careful as well. Also if you were an overweight person with sleep apnea and have lost weight, this does not mean that you have cured your sleep apnea problem. A friend of mine stopped using his CPAP when his weight was at his normal or ideal weight. Two months later, he complained about being so tired he could not stay awake.

After several days of discussion, he said it was six years since he received his CPAP machine and Medicare would maybe consider another sleep study and definitely a new machine. After talking to his sleep doctor, it was determined this would be best. After the sleep lab, it was determined that he still had sleep apnea and averaged about 50 apneas during the lab. Now he is waiting for the new APAP machine. He told me that in most of his reading they have said losing weight normally took care of the sleep apnea problems. He now knows better.

Two of the organizations for sleep apnea are:

http://www.sleepapnea.org/support/here-to-help/all-about-a.w.a.k.e.html

http://sleepfoundation.org/sleep-disorders-problems/sleep-apnea

http://www.ninds.nih.gov/disorders/sleep_apnea/org_sleep_apnea.htm

This one also lists the previous two organizations.

I have written about surgery for sleep apnea and from my reading would discourage considering this. Two blogs are here:

http://bobsdiabetes.blogspot.com/2011/02/obstructive-sleep-apnea-surgery.html

http://bobsdiabetes.blogspot.com/2010/10/sleep-apnea-surgery-options.html

Some other blogs that may be of interest are:

http://bobsdiabetes.blogspot.com/2013/04/sleep-apnea-are-you-prepared-patient.html

http://bobsdiabetes.blogspot.com/2012/03/avoiding-cpap-problems.html

http://bobsdiabetes.blogspot.com/2012/02/children-with-osa-benefit-from-cpap.html

This article from CardioSource is very informative and contains some straight forward information about CPAP use and the effects on lipids, hypertension, and diabetes.

Even with firm evidence that lack of sleep has a proven effect of making diabetes more difficult to manage, CPAP has mixed results on improving insulin resistance.

This concludes this series on sleep apnea.  I have come across more information and will have a few blogs in the near future.  

Sleep Apnea Surgical Treatments

Even though many articles mention treatment and drugs for sleep apnea, as of yet there are only devices that FDA approved and no drugs. Some drugs are approved for other sleep disorders, but they are ineffective for sleep apnea.

I should say for the next part of this that I have a strong bias and dislike for even bringing this up. That would be surgical procedures for the treatment of sleep apnea. I now know two people that have had surgery and regret every day that they had the surgery. It did not end their sleep apnea and both had several months of pain and discomfort. One has had trouble swallowing food every since his operation and the other has more trouble sleeping even using a BiPAP machine. The best warning I can give you is that surgery is not for everyone. Keep reading for those that it may be appropriate.

Surgery should be the option of last resort when other treatments have failed. Normally, it will depend on the doctor, but most doctors do not recommend surgery until they find something requiring surgery.

Jaw repositioning. In this procedure, your jaw is moved forward from the remainder of your face bones. This enlarges the space behind the tongue and soft palate, making obstruction less likely. This procedure, which is known as maxillomandibular advancement, may require the cooperation of an oral surgeon and an orthodontist, and at times may be combined with another procedure to improve the likelihood of success. This surgery is not done that often, but for some people is recommended and is one of the more successful is x-rays indicate a need.

Implants. This is probably the most reasonable and least problematic. Plastic rods are surgically implanted into the soft palate while you're under local anesthetic. This procedure may be an option for those with snoring or milder sleep apnea who can't tolerate CPAP.

Creating a new air passageway (tracheostomy). You may need this form of surgery if other treatments have failed and you have severe, life-threatening sleep apnea. In this procedure, your surgeon makes an opening in your neck and inserts a metal or plastic tube through which you breathe. You keep the opening covered during the day. But at night you uncover it to allow air to pass in and out of your lungs, bypassing the blocked air passage in your throat. We have all seen these in people that have had throat cancer.

Tissue removal. During this procedure, which is called uvulopalatopharyngoplasty (UPPP), your doctor removes tissue from the rear of your mouth and top of your throat. Your tonsils and adenoids usually are removed as well. This type of surgery may be successful in stopping throat structures from vibrating and causing snoring. However, it may be less successful in treating sleep apnea because tissue farther down your throat may still block your air passage. UPPP usually is performed in a hospital and requires a general anesthetic.

Removing tissues in the back of your throat with a laser (laser-assisted uvulopalatoplasty) isn't a recommended treatment for sleep apnea. Radiofrequency energy (radiofrequency ablation) may be an option for people who can't tolerate CPAP or oral appliances.

This procedure has the least success and seldom stops sleep apnea. Other types of surgery may help reduce snoring and contribute to the treatment of sleep apnea by clearing or enlarging air passages:

1. Nasal surgery to remove polyps or straighten a crooked partition between your nostrils (deviated nasal septum). This is often successful if needed.
2. Surgery to remove enlarged tonsils or adenoids

Treatments for central and complex sleep apnea may include: (These types of sleep apnea can be a dangerous as obstructive sleep apnea.)

Treatment for associated medical problems. Possible causes of central sleep apnea include heart or neuromuscular disorders, and treating those conditions may help. For example, optimizing therapy for heart failure may eliminate central sleep apnea.

Supplemental oxygen. Using supplemental oxygen while you sleep may help if you have central sleep apnea. Various forms of oxygen are available as well as different devices to deliver oxygen to your lungs.

Continuous positive airway pressure (CPAP). This method, also used in obstructive sleep apnea, involves wearing a pressurized mask over your nose while you sleep. The mask is attached to a small pump that forces air through your airway to keep it from collapsing. CPAP may eliminate snoring and prevent sleep apnea. As with obstructive sleep apnea, it's important that you use the device as directed. If your mask is uncomfortable or the pressure feels too strong, talk with your doctor so that adjustments can be made. All the different types of CPAP machines may be used with success.

Along with these treatments, you may read or hear about different treatments for sleep apnea, such as implants. Although a number of medical devices and procedures have received Food and Drug Administration clearance, there's limited published research regarding how useful they are, and they aren't generally recommended as sole therapies.

Obstructive Sleep Apnea Surgery

I don't know what it is lately, but apparently surgeons are trying to build their retirement fund before the Affordable Care Act gets before the Supreme Court. I am reading more and more about surgery being the solution for more and more health problems. That in itself sets off alarms about what is happening in healthcare that has surgeons operating everywhere they can.

Some surgeries are for the best and are unavoidable, but for obstructive sleep apnea, I have a real problem with this as even the American Sleep Apnea Association (ASAA) is very cautious about recommending surgery. Most surgeries cannot be reversed and can leave worse problems than using other options.

Apparently the surgeons at Henry Ford Hospital in Detroit have determined that it is acceptable and are trying to convince other surgeons that surgery is best. Since I don't have access to the full study, I can only assume that they did not compare results of the Epworth Sleepiness Score (ESS) questionnaire for those that have success with CPAP Equipment. I know that after being on the CPAP machine for three months that my score would have been 0.5 compared to the maximum score before the sleep study and use of the CPAP machine.

I can understand why the study only selected obstructive sleep apnea patients that were not successful with the CPAP equipment as this group would show an advantage for the surgery. They also don't state the sex of the participants to determine whether there were problems other than just the equipment that may have caused these patients to have problems with CPAP.

Before you let this study influence you, I would suggest reading what the ASAA has to say about surgery and then read my blog about surgery here. Please read what patients on site 5 have to say about surgery.  I know that I would not want surgery that is often less than successful and cannot be reversed. I have and use a CPAP (actually VPAP) and use nasal mask liners to keep air from escaping around the mask. Yes, I do get marks from the straps holding the mask, but within a short time after taking the mask off, they are unnoticeable.

I would encourage anyone to give the CPAP equipment a chance to work or if needed an oral appliance, before you even consider surgery.