Alternatives for Treating Sleep Apnea

Dr. Tod Huntley, an expert on obstructive sleep apnea, clues you in on upcoming treatment alternatives to "the mask."

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If you don’t have it, you most likely know one of the millions of people with sleep apnea, the condition that disrupts breathing and most often occurs when something in the throat is “too big, too floppy, or relaxes too much” during sleep, says Dr. Tod Huntley, a surgeon and researcher with St. Vincent Health in Indiana. Mask therapy known as continuous positive airway pressure (CPAP) is indeed the gold standard for treating for sleep apnea. But new technology may be a real game-changer in coming years for the nearly 50 percent of patients who can’t—or won’t—wear the mask.

CPAP therapy “works wonderfully” to keep air flowing to the lungs, the expert continues. “But it’s no better than a coin toss as to whether someone will use it as recommended or end up with a very expensive paperweight. That’s why we are doing all this research: to find the best, safest, and least painful solutions.”

The research that Dr. Huntley is referring to currently centers on two new ways to keep the airway open: a pacemaker-like device called the hypoglossal nerve stimulator that moves the tongue slightly forward with each breath during sleep and is about “two years from primetime”, and robotic surgery to precisely shave away extra tissue that gained FDA approval in December 2010. Here’s more about promising therapies.

Implanted Pacing Device

“As a surgeon, I want to treat sleep apnea effectively and also compassionately,” says Dr. Huntley. “Hypoglossal nerve stimulation (HNS) is exciting to me because, unlike the surgeries we do now for sleep apnea, it’s potentially an outpatient procedure, it causes minimal pain, and it offers long-term effectiveness.”

Similar to the way cardiac pacemakers stimulate the heart muscle, HNS triggers tongue muscles to pull away from the back of the throat when the person inhales during sleep.

Here’s how: A pulse generator with two wires is implanted over the right chest. One wire goes over the ribcage to sense respirations. The other travels into the neck and fits around the hypoglossal nerve that controls tongue movement. When the system senses breathing, it stimulates the tongue to pull away.

“An intriguing finding is that hypoglossal nerve stimulation affects not only the tongue, but, in the best-treated patients, also seems to pull the soft palette forward and open up the rest of the throat, treating the problem on two fronts,” says Dr. Huntley.”

So what’s next? Two companies are conducting clinical trials on a nerve stimulator for sleep apnea: Inspire Medical Systems, Inc., and Apnex Medical, Inc., where Dr. Huntley is a medical advisor but not an investor. On August 2, Apnex received the go-ahead for its pivotal study at a dozen sites in the U.S., Europe, and Australia. If all goes as anticipated, their device will hit the market in fall or winter of 2013.

Click here for clinical trial updates, purpose, eligibility, locations, and contacts.

Robotic Surgery

Doctors are also treating sleep apnea by removing tonsils and excess tissue with a type of robotic surgery approved in December 2010 and typically used to remove cancerous growths at the back of the throat.

In robotic procedures, surgeons peer at high-definition images to remotely control instruments much smaller and more dexterous than human hands, notes Dr. Huntley. “It’s the best way we have to remove tissue precisely and less invasively and I believe there’s a definite place for it in the treatment sleep apnea. We’re just trying to figure out its role.

“Again, if we knew the hands-down best approach for treating sleep apnea, we wouldn’t be looking at all these approaches. Do we pull the jaw forward? Do we pull the tongue forward, move it, or hook up a nerve stimulator to it? Is some combination of the above? We just don’t have the full answer yet, but we’re definitely working on it.”

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  1. Bi-PAP user here, Quatro full face mask allows me about 4 hrs. Before I chuck it onto the floor in my sleep. I’ve had the greatest success so far with that. My 16 central apnic events per hour were not due to obstruction, but as a result of my brain “forgetting” that I should expel the air. I’m two years in, and still trying to discover what works best for me. I really appreciate the various comments and just knowing I’m not alone in my search for a good night’s sleep! Hang in there everybody!

  2. I work for a company that fits and dispenses sleep-apnea machines. Insurance companies will pay for new supplies, depending on type, every three months or less. It is important for patients to get new supplies at that rate because masks begin to leak, tubing gets “boggy,” filters get dirty, elastic breaks down that holds that mask on. There are many, many types of masks, and it can take some changes before someone finds the mask that works the best. As someone commented, there are also special pillows and hangers for the tubing. Using the faithfully that comes with the machine does help dry mouth. You WILL feel better if you take the time (several weeks or more) to adapt to your machine. It will completely change the quality of your life.

  3. Re:Fletcher C. Eberle’s comment Posted Oct 1, 2011
    I use a Resmed Quatro FX Full Face mask. For a month and a half I fought the
    problem of air leakage that would squeel and wake me up. The company that
    furnished the equipment had no answer. I went on line to, looked
    at what they had to offer.Some fellow came up with a brillant idea (I only wish
    I had invented it) It is called RemZzzs Full face & Nasel CPAP mask liners.
    They come 30 facial liners in a box, put it on the mask before applying it to the face.
    For more detailed info visit them on line at
    I now sleep 7 hours without being problems with air from a high pressure machine.
    Hopes this helps!

  4. I know it is hard to get use to wearing a mask. Both my husband and i wear a mask. We found a way to keep the hose from being tugged around. We got a plastic hook and put it on our bed post got a head band run the hose thru it and hooked the band on the plastic hook .We had to adjust it many times . That hook keeps all the extra hose in place and the mask did not slide around on our head when we turned around in bed.

  5. I have been trying for over a year to use my cpap as I have 49 episodes in a 4 hour period. Also night terrors. It’s very hard to have any comfortable position with any mask on and I’ve been through them all. It always ends up on the floor by the time I awake. I would be very interested in a different alternative.

  6. I was diagnosed with sleep apnea (30 episodes in 1 hour). I have had a bipap, with humidity chamber) for 14 months. I had about 7 different masks before I found one that reallly worked well for me. It is the Quatro FX. With the others I used a chin strap but that didn’t help. For the dry mouth I use Oral Balance or Biotene. They don’t releive all the dryness but they are a big help.

  7. I have just started using CPAC (3 months) – not a happy camper – Three different types of masks all with the same results (awful dry mouth – to the point of ripping it off after using it only two hours). All of the CPAPS have humidity, but that is not helping at all. Also tried a chin strap to keep my mouth closed – no help, About ready to give up on this therapy!!!!!!!!!!!!!

  8. Eight years ago I was diagnosed with cardiovascular disease, and was fitted with a defibrillator in case my heart stopped beating again, but it hasn’t. My heart has continued to strengthen, but two years ago my Cardiologist recommended I take a sleep apnea test as additional precaution. At that time I was diagnosed with Sleep Apnea, suffering 17 episodes of breath holding per hour, so doctor advised to start CPAP to reduce irreggular breathing during sleep, which causes extra stress on the heart. I started out with the CPAP mask, but that irritated the bridge of my nose, so I switched to the nazzle pilllow, which is much more comfortable and allows nore sleeping positions. I find it hard to sleep now without my CPAP nazzle pillow. It has become like a security blanket. Heart tests have now indicated my heart has strengthened to the point where doctor feels I no longer need the defibrellator. P.S. The implanted devise in your article does not sound inviting.

  9. I am excited that there may be help for sleep apnea. I do use the mask faithfuly because I feel so well when I arise in the morning. Of course it is a pain to care for it. This news is something to look forward to.

  10. I was diagnosed with Severe Obstructive Sleep Apnea approximately 8 years ago
    based on a Sleep Study and was fitted with a CPAP Machine which came with a
    very uncomfortable mask which was triangular in shape and covered both my nose
    and mouth. After some time using the mask my equipment supplier sent a “Swift Pillow Mask” which just filled into my nostrils. This seemed to work well. I ultimately
    went for a new sleep study and was fitted for a new RESMED CPAP with built-in
    humidifier. The mask initially provided with the new CPAP was a small mask which
    just covered my nose. This encouraged me to breath through my mouth which was
    not good. I now have a new mask which covers both my nose and down under my
    lower lip which is must better. The continuing problem overall is that the strap system provided to hold the mask(s) on has never been good. I spoke to the
    CEO at RESMED and told him they need to try to come up a better method
    to hold the mask on rather that just reinventing the mask over and over again.
    I would really appreciate your comments. Thank you for this opportunity to share.


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