Talk with your sleep medicine provider about which alternatives are the best ones for you.
The milder your apnea is, the more likely these treatments will be effective. Combining two or three treatments may be helpful. A Mandibular Advancement Device, significant weight loss, and perhaps a tongue bulb are the best non CPAP options for severe apnea. Stopping alcohol or narcotic pain medication can also reduce sleep apnea. There is some evidence that eliminating smoking will improve airway function during sleep.
WEIGHT LOSS: An estimated 40-80% of sleep apnea is due to excess weight, and weight loss can improve, and sometimes eliminate sleep apnea. Depending on the person, weight loss of 20-30 lbs. is usually needed to make a significant difference in the severity of sleep apnea. A Body Mass Index (BMI) of 28 or less is ideal.
MANDIBULAR ADVANCEMENT DEVICE (dental device): This is a good treatment option for mild to moderate sleep apnea. It’s not a bite guard to prevent tooth grinding and isn’t available in pharmacies. It’s a bit like a football mouth guard, except that the lower jaw is pulled forward to open the airway. The device can cause TMJ (jaw) problems and soreness, some will notice a change in their bite with long-term use. It cannot be used by denture wearers or people with missing or unstable teeth. Online versions, such as SnoreRx, can be found for $60-$120. You can buy a PureSleep device at our sleep clinic offices for the manufacturer’s price of $25 (one-time purchase only). Dentists can provide an individually fitted device for $400-$2000. Dr. Brian Summers (541-926-3689) is a local specialist in sleep dentistry.
BongoRX: This soft silicone device fits inside your nostrils. Small valves open to let in the air during inhalation but slow down airflow while exhaling, which helps keep the airway from closing. It’s best for mild apnea. BongoRX requires a prescription. It costs about $200.
SIDE SLEEPING (lateral positional therapy): This is best for those persons who only have sleep apnea while sleeping on their back. It’s rare to stay on one’s side all night, so a positioning device should be used. A positioning device prevents turning on to the back. Slumberbump is a comfortable belt worn around the lower chest with an inflatable cushion that prevents sleeping on the back. $80. A fanny pack stuffed with firm foam (cut-up pool noodles) is an alternative. Some products start to vibrate gently when one is turned on the back. The vibrations increase gradually until the person turns to the side. The Night Shift Sleep Positioner fits loosely around the neck; it can also monitor sleep parameters. $350 The NightBalance Lunoa device fits on the chest and vibrates if you are out of position; $750.
OROPHARYNGEAL EXERCISES / MYOFUNCTIONAL THERAPY (throat exercises): These exercises strengthen airway muscles making them less collapsible. We have a handout describing these and examples of throat exercises for sleep apnea are easy to find on YouTube.
SLEEPING UPRIGHT: Sleeping as upright as is comfortable helps counteract the effect of gravity and lessens apnea. Wedges are preferred since pillows can bend the neck and close the airway. Basic wedges are inexpensive and adjustable/convertible wedge systems such as Lunix or Costway cost between $50-$200. Some wedges have space for arms and allow side sleeping, such as MedCline Reflux Relief system $200. Adjustable beds and recliners work well, too.
TONGUE BULB: The tongue is sucked into the bulb, which pulls it forward and stabilizes it outside the mouth, making more room in the airway. They are cheap, portable, effective, and can be used by people with dentures. They can take some getting used to. On the Amazon for $20.
SNORE DETECTORS: Some wristbands will detect snoring and vibrate; prices vary but can cost less than $25. Smart Nora Snoring Solution detects snores, then auto-inflates the pillow slightly to change head position. $350. These devices are only indicated for snoring and may interrupt some sleepers.
INTRAORAL ELECTRIC TONGUE STIMULATORS (ExCITEosa): This device uses a small amount of electrical energy to stimulate tongue and airway muscles. It is used during the daytime to build up muscle tone, much like oropharyngeal exercises. $800.
SURGERY: Older surgeries for sleep apnea, such as UPPP, were painful, mutilating, and not always helpful. Newer surgeries such as Expansion Sphincter Palatoplasty (ESP) are more likely to be at least partially effective and cause less pain. Surgery can be helpful, usually for slim persons with milder apnea, but rarely eliminates apnea completely.
HYPOGLOSSAL NERVE STIMULATION (Inspire Device): It is a device implanted like a pacemaker, with lead wires to the rib muscles and the hypoglossal nerve. When the device senses a breath is beginning, it stimulates the tongue pushing forward, which opens the airway. It reduces apnea by about 70%. This device is indicated for moderate to severe apnea only in cases where CPAP therapy is not tolerated. It is not used for patients with a BMI of 33 or greater. Cost is $35,000. Insurance coverage varies. Not available in Corvallis.
DNA APPLIANCE/BIOBLOC: An orthodontic approach that expands with width and space of the oral cavity. Not a typical approach, efficacy varies for adults, although in children, a similar technique called Rapid Palatal Expansion is common and effective. Not covered by insurance. Not available in Corvallis.
