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How to treat sleep apnea without CPAP or surgery?

Ear, Nose & Throat

My mother is 63 and has dementia. She is unable to tolerate the CPAP mask, and we also do not want her to undergo surgery as I understand that anaesthesia will worsen her cognitive decline. What non-invasive, non-CPAP treatments are available to treat sleep apnea?

DOCTOR’S ANSWER (3)

Non-invasive, non-CPAP treatments are only considered for occasional or mild OSA, and if these are relevant:

  • Your mom should avoid alcohol and smoking if there is the off chance she is on them.
  • Your mom can try a change of sleep position to sleep on her side instead of on her back if there is no discomfort.
  • If she is overweight, losing help can help. If there is a nose block from allergy or infection, medications, nasal rinses and allergen control may help.

The European patent office lists more than 2000 devices which the public is tempted often to use to self-manage.

However, it is better to seek an ENT, sleep physician or neurologist’s consult first. For example, many of my patients try to use nasal splints or external nasal stickers to widen the nasal passages.

However, the level of block in their nose may not be at the nose, and those extra cost and discomfort would then not be helpful.

Mandibular Advancement Splints (MAS) worn at night may help advance the lower jaw in sleep. They are better prescribed by sleep dental specialists, as there can be discomfort in the temporomandibular joints and dentition otherwise.

There are tongue retainers which are used, but few patients have tolerated those well long term.

Unfortunately, continued sleep apnea will worsen dementia and cognitive decline, so treatment for your mom’s sleep apnea is very important. Anaesthesia comparatively, when expertly done, will not worsen her cognitive decline.

It is important to work with your vendor and doctor to see why the CPAP tolerance is low, as there is likely a simple solution to increase the CPAP tolerance.

891 views 19 Aug 2018

I have a few patients who are caught in a similar situation like yours where they are either unfit for surgery or just can’t tolerate wearing a CPAP mask.

When you say that your mum can’t tolerate wearing a CPAP mask, I hope she has had the experience of already trying different types of CPAP masks because they come in all shapes and sizes, not just full facial masks which many patients find difficult to tolerate for the whole night. CPAP masks also come in the form of small neat-looking nasal masks and even nasal specs/tiny tubes sitting just at the nostril area.

Other options of treating obstructive sleep apnea   also include wearing a specially fitted dental appliance in the mouth, called a Mandibular Advancement Device (MAD), which looks very much like a retainer people wear when they have braces fitted. This device may be customised to the shape and size of your teeth by a specially-trained Dentist. I think you can also purchase a similar device online eg Somnoguard AP which costs approximately $300. The aim of wearing a MAD is to push the tongue and jaw forward to open up the airway space behind the tongue base to prevent the tongue from falling backwards.

Simple strategies like getting your mum to sleep on her side, rather than flat on her back, can also help to relieve the airway collapse suffered during sleep apnea. There are also specially-designed wedge pillows to reduce snoring like from Intevision. Try to choose the foam wedge type instead of something too soft.

There are newer but more controversial devices on the market like Snore stoppers which are bluetooth headset earphones claiming to “cancel” out snoring. I think the jury is still out on these but by all means, feel free to try them and let us know what your feedback is.

Other products I’ve noticed on the market include so-called anti-snoring tapes and chin guards as well as Breathe Easi nasal splints which you are supposed to wear on the bridge of your nose to clear your nasal passages to breathe more easily. If your mum suffers from a blocked or stuffy nose, then I suppose a nasal decongestant spray might help. However, in the vast majority of snorers and sleep apnea sufferers, having a blocked nose is usually not the only reason for having obstructive sleep apnea. 

I would just like to add that I am in no way affiliated with nor sponsored by any of the companies mentioned above. I always try my best to give a balanced objective perspective and I hope you find the above info helpful, A.

958 views 15 Aug 2018

Obstructive sleep apnoea (OSA) is a medical condition in which a person "stops breathing" repeatedly for a short period of time during sleep. The classic symptoms are loud snoring, excessive daytime somnolence and feeling unrefreshed in the morning. At risk individuals include those who are overweight or obese, has a small/receded chin, have significant nasal blockage or large tonsils/adenoids.

Elderly patients may also be at risk of OSA because the soft tissues around the airway may be more lax with age. This may predispose one to sleep apnoea too. Untreated OSA (esp moderate or severe OSA) risk potential complications in the heart (e.g high blood pressure, irregular heartbeats, heart failure etc), brain (e.g stroke, poor concentration and memory) and metabolic system (e.g. diabetes)

I agree with Dr Leong that dental devices (e.g. mandibular advancement device) and lifestyle modications are alternative treatment options for your mother. Do note however that dental devices works best if your mother has mild or moderate sleep apnoea (but not as well for severe sleep apnoea).

CPAP (continuous positive airway pressure) therapy is the gold standard in the treatment of OSA because it works almost 100% if one uses it regularly and  properly. You may also want to bring your mother to the Sleep Technologist or ENT Specialist to troubelshoot the reason why your mother was not able to tolerate the CPAP mask. Many potential rectifiable issues with CPAP masks include  a pressure that is too high pressure from the machine (making it uncomfortable), incorrect mask fitting or size or concurrent blocked nose during sleep (which your ENT Specialist should be able to help).

As the management of OSA is often a muti-modality approach and is complex, I would suggest that you bring your mother to a doctor trained in managing sleep apnoea (all ENT Specialist in Singapore or some Neurologist or Respiratory Physician with an interest in Sleep Medicine) for an assessment. For more information on snoring & OSA, do check out my article on DxD

Hope this helps and all the best!

934 views 16 Aug 2018
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