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Upper Airway Stimulation Therapy and Mandibular Advancement Devices: The New Alternatives for Sleep Apnea

Published February 24th, 2022 by Chris Riley
Fact Checked by
Jacqueline Hensler
Medically Reviewed:
Erik Rivera

If you are one of the millions of people who suffer from sleep apnea, you know how difficult it can be to get a night of quality sleep.

You may have tried the most common treatment option in positive airway pressure therapy, but found that you were intolerant to it, meaning it is difficult to tolerate wearing the mask while you sleep.

If so, you may be interested in new alternative therapies for sleep apnea.

Upper airway stimulation therapy is a new treatment that is showing great promise for treating sleep apnea and helps by stimulating the muscles that help you breathe. Mandibular advancement devices, or MADs, have also become increasingly more popular for sleep apnea treatment too.

We will go into detail about why you may be intolerant to positive airway pressure therapy and why upper airway stimulation or MADs could be great alternative treatments for sleep apnea.

What is sleep apnea?

Sleep apnea is a condition that affects how you breathe when you sleep. It can cause snoring, make it difficult to get restful sleep, and even cause health complications like heart attacks and strokes.

Sleep apnea is caused by an obstruction in the upper airway which can be due to a number of factors such as obesity, enlarged tonsils or adenoids, genetics, and aging among others.

With severe sleep apnea, you may experience over 30 instances of pauses in breathing, called apneas, per hour which lead to a number of symptoms that we will describe below.

Not all apneas are the same and there are three types of sleep apnea that you can experience. The first type, obstructive sleep apnea (OSA), is the most common and is caused when the airway becomes blocked.

Central sleep apnea (CSA) occurs when the brain fails to send signals to the muscles that control breathing leading to apnea events. Mixed apnea, also called complex sleep apnea, is a combination of obstructive sleep apnea and central sleep apnea and is the rarest form of sleep apnea.

new sleep apnea treatment

What are the symptoms of sleep apnea?

The most common sleep apnea symptoms are loud snoring and pauses in breathing during sleep.

Excessive daytime sleepiness (EDS) is also a common symptom that can lead to other problems such as difficulty concentrating, mood swings, irritability, and accidents while driving which can all diminish your quality of life.

Due to low blood oxygen levels, people with sleep apnea can experience morning headaches too.

You may also find that you have trouble staying asleep at night, which is also called insomnia. Other symptoms include a dry mouth or sore throat when you wake up.

When being diagnosed with sleep apnea, your doctor will often send you to a sleep specialist for an overnight sleep study. These take place in sleep centers or sleep labs that monitor different biometrics while you sleep.

The results will then be interpreted by the sleep specialist to determine if you have sleep apnea. At-home sleep tests are also available but are not as accurate.

What is positive airway pressure therapy for sleep apnea?

There are many different treatment options depending on the severity of your sleep apnea that range from sleep positional therapy to surgical procedures. However, if you have moderate to severe sleep apnea positive airway pressure therapy, or PAP therapy, is the most common treatment for sleep apnea.

It works by delivering pressurized air through a mask that you wear on your nose, mouth, or both while you sleep.

This pressure helps to keep your airway open and prevents pauses in breathing.

There are several different machines that use PAP including constant positive airway pressure (CPAP), automatic positive airway pressure (APAP), bilevel constant airway pressure (BiPAP), and adaptive servo-ventilation (ASV) machines.

All of these use PAP, with the main difference being if and when different pressures are used.

For example, CPAP machines have a constant pressure going into your mask while BiPAP machines use two different pressures, one when you breathe in and another when you breathe out.

While PAP therapy is very effective for many people, some are intolerant of the pressure and cannot use it.

Why are some people intolerant of positive airway pressure therapy?

There are a number of reasons why people can be intolerant to PAP therapy. One is that the mask may not fit well, which can cause leaks and make it difficult to get a good seal.

The pressure from the machine can also be uncomfortable or too strong for some people. Some people find the noise from the machines to be disruptive or find the machines to be difficult to use.

Lastly, some people find that PAP therapy does not help them sleep well or stops working over time.

What are the new alternatives to positive airway pressure therapy?

There are a couple of new therapies that have been developed as alternatives to PAP therapy for those who are intolerant of or unable to use it. Let's take a closer look at them below.

Upper airway stimulation

The first is called upper airway stimulation (UAS), or hypoglossal nerve stimulation therapy and involves the placement of a small device in the upper airway.

This device is then activated using a small magnet implanted in your chest similar to a pacemaker that sends electrical impulses to the muscles that control breathing.

These impulses help keep the airway open and prevent apnea events from happening. Upper airway stimulation therapy is new and is still being studied, but early results show that it is effective in reducing the number of apnea events people experience.

Oral appliance therapy

The other new alternative is oral appliance therapy (OAT). This involves the use of a custom-made mouthpiece that fits tightly against your teeth and helps to keep your jaw in a forward position which opens up your airway.

These oral appliances, also called oral devices or mandibular advancement devices (MADs), have been prescribed more frequently over the past decade and have shown they are effective in reducing the number of apnea events people experience.

Who should try these alternative treatment options?

Anyone who is intolerant of or unable to use positive airway pressure therapy should speak with their doctor about these new options.

Upper airway stimulation therapy and oral appliance therapy are new and not everyone will be a candidate for them, but they may be worth considering if you have difficulty using PAP therapy.

Your doctor can help you determine if one of these new therapies is right for you.

Summary

If you are intolerant of or unable to use positive airway pressure therapy, there are new alternatives available that may be a better fit for you.

Upper airway stimulation involves the placement of a small device in the upper airway that receives electrical impulses to the muscles that control breathing.

Oral appliance therapy involves the use of a custom-made mouthpiece that fits tightly against your teeth and helps keep your jaw in a forward position.

Both upper airway stimulation therapy and oral appliance therapy have been shown to be effective in reducing the number of apnea events people experience, so if you have trouble with PAP machines this could be the answer for you.

Please speak with your doctor or healthcare provider if you are interested in trying one of these new therapies.

References and Sources:

Mayo Clinic 

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