Features March 2016 Issue

CPAP Often Only Treatment Offered Sleep Apnea Patients

Study shows that more than half of patients diagnosed with the sleep-disordered breathing problem stick with CPAP therapy.

The primary treatment for obstructive sleep apnea remains continuous positive airway pressure (CPAP) therapy. But a recent Cleveland Clinic study found that less than half of the people prescribed CPAP therapy actually followed through with the treatment. And only a third of the people who weren’t on CPAP therapy were referred to a sleep specialist for other treatment options. The study was published in the journal Otolaryngology — Head and Neck Surgery.

“The most striking thing about our study is that this is the first study to look at how many patients are using CPAP after a diagnosis of obstructive sleep apnea,” says study author and surgeon Alan Kominsky, MD, with the Cleveland Clinic Head and Neck Institute. “The surprising finding was just how few patients were referred to other providers once CPAP failed,” he says.

CPAP machine


A CPAP machine, mask, and adjustable headgear.

Understanding Sleep Apnea

Obstructive sleep apnea is a condition in which a sleeping person stops breathing temporarily many times throughout the night. The problem develops when soft tissue in the back of the throat relaxes while sleeping. This partially blocks the airway, leading to pauses in breathing, snoring and gasping for air. Often this occurs without the individual with sleep apnea even being aware of it.

But sleep apnea can lead to many problems, ranging from sleepiness during the day (caused by poor sleep quality at night) to high blood pressure and other cardiovascular complications. People with untreated sleep apnea face a higher risk of stroke, too.

CPAP involves a small bedside machine that pumps air through a tube and into a mask worn over the nose and mouth. For many individuals, CPAP is a life-saving treatment that presents no side effects or problems. For some, however, the device is too loud or cumbersome or is otherwise not a treatment that they will use consistently.

Exploring Alternatives

While CPAP remains the gold standard of sleep apnea treatment, there are other options. Certain oral appliances that adjust jaw position have been shown to be effective. These are often custom made to fit comfortably in the person’s mouth.

If large tonsils are the problem, a tonsilectomy may be the solution. Weight loss, if neck circumference is the issue, may also help. Dr. Kominsky says the key is to consult with a sleep specialist and be willing to try a variety of treatments.

“Sometimes the problem is reluctance, and a visit with a surgeon to explore the other options will convince the patient to get over their initial refusal to use CPAP,” he says.

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