Advancement of Treatment Options for Sleep Apnea
January 29, 2018

By Alan J. Kanouff, D.O.
If you have tried CPAP (Continuous Positive Airway Pressure) in the past for sleep apnea and failed, it is worth trying again. I have been seeing multiple patients that were intolerant to CPAP in the past and are now able to use it. I believe the reason for this change is comfort. The two main reasons for not tolerating CPAP are high pressure and an uncomfortable mask. As with all technology, multiple advances have been made in how positive pressure devices provide air, making it more comfortable. Dr. Kanouff shows how a CPAP mask fitsIf unable to tolerate CPAP, one option is to try BiPAP (Bilevel Positive Airway Pressure). BiPAP is one pressure when breathing in and less pressure when breathing out. CPAP delivers the same pressure at all times. This is beneficial for patients that have trouble exhaling with CPAP or have issues with excess gas in the GI tract from their CPAP. The latest change with CPAP is how pressure is delivered to the patient. Flex is the name given for what is called expiratory pressure relief. The machine is able to monitor the patient’s airflow during expiration and reduces the pressure in response to the patient’s needs. Toward the end of the expiration, the pressure is increased again to prevent airway collapse. This has made a difference in compliance with CPAP and BiPAP. The pressure delivered is more tailored to the individual patient and therefore, more comfortable.

The masks have also changed with advancements in technology making them more comfortable. 3D printing has allowed for more contoured molds to better simulate a person’s facial structure and newer masks are the result of these changes. The silicone used in masks is very soft and more appealing. They are also getting smaller and lighter with smaller headgear.

Advances in alternative treatment have continued to improve and new treatment options are available. One of the alternative treatments is a dental appliance. This is not new, but advancements have been made in the development to make it more comfortable and affordable. Dental appliances are typically more comfortable than CPAP and are very small, requiring no power to use. They are not as effective in severe sleep apnea, but we have used them in patients that are unable to tolerate CPAP. Insurances are starting to help pay for these appliances especially for patients that fail CPAP. We are working well with local dentists who make the molds in their office so that they are designed specifically for you. The newest device for OSA is a hypoglossal nerve stimulator. It is FDA approved and is implanted in the chest with a wire that is positioned next to the hypoglossal nerve. This stimulates the nerve to help keep the upper airway muscles and tongue tense during sleep. Initial studies were mainly done in patients with a body mass index of less than 32, but did reveal significant improvement. Ongoing studies are being done to further evaluate this option.

The monitoring of CPAP in the past was typically to measure compliance with treatment. Now, we use this monitoring to evaluate how well a patient is doing on their current settings. We call this smart CPAP just like smart TV’s and smart Blu-ray players. They can monitor the patient through the night and tell us if it is working properly. This is something that can be monitored by the patient as well with their smartphones. These new advancements are just the beginning for patients with this disease and we will continue to stay updated to provide the best services for you.

Lung Disease Center of Central Pennsylvania
"The Official Sponsor of Peace of Mind"


The Buzz by Dr. Z

George M. Zlupko, MD, FCCP

Timothy A. Lucas, MD, FCCP

Alan J. Kanouff, DO, FCCP

Dr. Michael C. Zlupko, MD

800 Chestnut Ave
Altoona, PA 16601




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