Sleep apnea, just like any other chronic medical condition, has many different forms of treatment. In addition to how you choose to take care of your problem, you also have to integrate many other various methods as well, including a sensible diet and exercise regimen. Unfortunately, there’s no pill to solve this anatomic problem. 

I’m assuming that you’ve tried all the conservative options like losing weight or improving your nasal breathing. Once you and your doctor have decided that you need to move on to one of the more definitive treatment options, you have three to choose from: CPAP, oral appliances, or surgery.

If you’ve done your research (I’m assuming you have since you’re reading my blog),  you’ll see vastly differing opinions on success rates and patient experiences. Some discussions are very heated. Unfortunately, as expected, the internet forums are filled disproportionately unsatisfied patients that have tried each of the three treatment options. You won’t see a website called, "ILoveCPAP.com", or "IHadSuccessfulSleepApneaSurgery.com". Most people who are happy with their results go on to live normal and productive lives. The ones that are still searching for better answers tend to fill the blogs and forums with their individual experiences. 

In the medical world, we’re no better. Our research studies are full of conflicting data that the press ends up distorting in their quest to bring you the latest in breaking news. Even though a news story tries to present two sides to the coin, it can’t do it in 800 words. There are books on sleep apnea with over 100,000 words that don’t ever make strong conclusions that one is better than the other. Because science can only prove association between one variable and another (and never cause and effect), we’re only getting an overly simplified picture of peoples’ medical conditions.

In medical studies, we always try to exclude other variables besides what we’re studying. If one person doesn’t exercise whereas another does, then we have to "adjust" for this fact, so that it doesn’t skew our data for CPAP’s effects on blood sugar levels. 

This brings me to sleep apnea treatment options. Yes, we have hundreds, if not thousands of studies supporting various aspects of sleep apnea treatment. They all report their answers in averages, essentially negating a single individual’s experiences. If you’re an outlier, then you’re considered "deviated." You should be average, but for some reason, you’re an aberration because the dental device didn’t work for you.

If you look at the big picture, all three treatment options (CPAP, oral appliances and surgery) all work to similar degrees. In carefully controlled research studies, "success rates" are as high as 80 to 90% in some cases for all three options. However, in the real world, true success is probably way less than 50%. I’ll even hazard a guess at 10 to 20% long term (20 to 30 years). 

So what does success mean? For the sleep physician, it’s lowering your sleep apnea number no sleep study down below 10, or some variation. But what it your number goes from 35 to7, but you don’t feel any better? What if you start at 7 and go down to 4? We doctors just shrug our shoulders in this situation.

For the patient, success means different things for different people. As examples, for people who choose CPAP, it’s waking up in the morning completely refreshed and having the energy to perform during the day without feeling very tired or fatigued. For others, it’s being able to go to a movie with a loved one and not fall sleep. For oral appliance users, it’s getting to the point of not having to use CPAP or undergo surgery. For surgery patients, it’s getting to the point where you don’t have to use a device of any kind. Different people have different wants and needs from treatment, as well as different expectations. 

But just like you would never prescribe a pill for high blood pressure without stressing other issues such as proper diet, weight loss, adequate exercise and stress reduction, you can’t prescribe sleep apnea treatment without addressing all the other issues as well. Sometimes, these "other issues" can help more than the treatment itself in the long run. Occasionally significant weight loss can even "cure" someone with mild sleep apnea. 

We can leave the debate over the specific pros and cons of different sleep apnea treatments for another time. For now, what I want to stress is that it’s important to stress your ultimate goals before treatment, and have an integrated plan of action along with your sleep doctor. With sleep apnea, there’s no magic bullet.

What was your ultimate goal when you started sleep apnea treatment? Please write your comments below.

Every few days, I hear from a frustrated patient with sleep apnea how they’re at wit’s end with their CPAP machine. Either they just can’t seem to get used to it, or they’re using it faithfully, but find no improvement in their quality of sleep. Some are almost in tears, to the point of giving up. Many of these people have tried various masks, different machines, participated in online and live CPAP support groups, or had multiple interactions with their sleep medicine doctor and their DME vendor. All to no avail.

Granted, there are a number of reasons why you may not find CPAP helpful, but with good support and going through a standard checklist of issues, many of you can usually find a solution. You’re not the only one going through this process. Most people just starting out with CPAP fit into this category. 

However, there are others that have tried everything, and still don’t notice any improvement. Even the compliance data from the machine is saying that everything is good, with no leaks and a very low AHIs. What can be done for you at this point?

Unfortunately, many of you fall into the trap of feeling like it’s your fault, that there’s something wrong with you or that you’re doing something wrong. You may ask, many others are able to use CPAP just fine, so what’s wrong with me? 

This is a very common situation where typically, most sleep doctors just shrug their shoulders and offer a stimulant like Provigil to take during the day and sleeping pills at night. 

From my perspective, there are three issues/options to consider if you ever get to this point. The first is to make sure that you’re able to breathe well through your nose. If your nose is stuffy (and most sleep apnea patients have stuffy noses by definition due to their anatomy), then CPAP pressure have to be higher, and it can become more uncomfortable with more chance of leaks. Many of my patients are able to better tolerate and benefit from CPAP after treatment.

The second consideration is, do you have full compliance data? Most people are given bare-bones CPAP machines that only measure how long you’re using the machine for every night. There’s no information to tell you if there’s any leak within the system, or if you’re having significant apneas or hypopneas. Having a fully data capable model is important to get objective feedback on what’s going on. 

Third, at a certain point, after exhausting all the possibilities, you have to look at other options including oral appliances and even surgery. For a recording of an interview I did with a dentist about oral appliances, click here. For a free report called, "The Truth About Sleep Apnea Surgery," click here.

One last thing to consider is that your sleep apnea may be adequately treated (by whatever means), but you still feel lousy. Dr. Jacob Teitelbaum, a world renown expert in chronic fatigue syndrome, explains that due to the massive neurological and hormonal imbalances that occur in these situations, some people don’t feel better with CPAP, oral appliances, or even with surgery, despite optimal treatment based on sleep studies. Go to his website at vitality101.com to find out more information. He has a free online symptom analysis program that will guide you toward various treatment options.

Are you struggling with CPAP? If so, what steps have you taken with CPAP, and what other options have you tried so far?