With So Many Sleep Apnea Treatment Options, What’s a Patient (or Doctor) to Do?

As I walked down the cereal aisle of my local supermarket the other day, I was amazed at how may options I had. I saw endless rows of cereal boxes, each claiming to be superior and more nutritious than others. In the same way, available treatment options for obstructive sleep apnea are exploding, and patients and health care professionals are now more confused than ever. You would think that having more options to choose from is a good thing, whether it’s about cereal, CPAP machines, dental appliances, or sleep apnea surgery. But patients as well as physicians are now even more confused and paralyzed with indecision. If you add the internet to this information overload, things get even more out of control.

In a recent Fiscal Times article, the sleep industry is projected to be a $32 billion industry this year. For the past few years, it’s been increasing about 8-9% per year. This includes not only medical products, services and devices, but also over-the-counter, consumer-based products. Bed Bath & Beyond has over 600 products in the sleep category. Resmed, one of the major CPAP manufacturers, had total revenues of $1.2 billion in 2011.

As we become inundated with options for better sleep, what can we do as patients and as professionals? Here are 5 suggestions for patients/consumers and 3 tips for health care professionals:

For patients and consumers:

  1. Take all product claims with a grain of salt. There’s no doubt that many of the touted success rates and claims on packaging labels my be true to a certain extent. However, marketers have a very low threshold for product claims. They just have to show that it’s true, whether or not it actually works for everyone. For example, if a nasal dilator strip company says, “Relieves nasal congestion and snoring,” they can say this even if only 1/10 people find any benefit. There’s no doubt that some people will experience significant benefits, but in my experience, most people have only slight improvement in symptoms. Objectively, it’s hard to quantify subjective improvement.
  2. Overcome paralysis by analysis. Having too many nasal dilator strip options can be frustrating. Choosing between CPAP and oral appliances can also be a challenge. Whenever faced with these issues, just pick one and give it a try. Usually, there’s one option that’s relatively easier to get (whether financially or logistically). Worse case scenario, it the first option doesn’t work, you can always go to the next option. Ideally, if possible you should try both options, since you won’t know what will work better. Some people end up using both CPAP and an oral appliance with better results.
  3. Don’t be afraid to try new things. If it works, keep using it. If you have the times and the resources, give both a try. Sometimes, a very good treatment option for sleep apnea won’t be covered by insurance. For example, a dental appliance for snoring or myofunctional therapy can help significantly, but you’ll have to pay out of pocket. Insurance will usually cover only the bare essentials for options that have a proven track record over many years. New and innovative options, no matter how good, usually won’t be covered.
  4. Trust your doctors, but take control and responsibility for your own care. Doctors are humans too, so despite years of training and education, they are prone to be biased. They are well-meaning, but they are not all-knowing. Use physicians as trusted advisors, rather than the old paternalistic way when you did everything your doctor recommended. 
  5. Don’t give up. Time and time again, more people who are persistent end up reaching their sleep goals compared to those that either give up trying or try only a few things. In addition, don’t be afraid to fail. Nothing is guaranteed to work. Choose options that are most likely to work, but if it doesn’t work, go on to try another option.

For medical professionals:

  1. Take all research-based studies and results with a grain of salt. The fundamental concept of good research design looking at one variable while controlling for other confounding variables is something that scientists strive to achieve. The problem is that disease in humans is not due to a single variable, but a combination of millions if not billions of variables. This is why in many cases, if you apply research findings by the book to a patient, results are not always satisfying. 
  2. Customize treatment recommendations to patients, and avoid template-driven medicine. If everyone followed to the letter practice guideline and recommendations, then we don’t need physicians. These recommendations are designed to be applied to the typical, routine, run-of -the-mill patient with classic conditions or symptoms. However, individuals are not statistical averages, and treatment options must be custom tailored to the patient’s unique life situations. For example, someone that travels frequently may be more inclined to use a mandibular advancement device over CPAP, despite the fact that overall effectiveness may not be as good.
  3. When things don’t make sense, trust your patients. This is the hardest lesson I had to learn, and it took me over 15 years to learn this. After years of training and practicing medicine and surgery, I thought that if I applied everything I learned from textbooks, journals and conferences, that’s practicing good medicine. Oftentimes, no matter how crazy I thought a patient’s explanation was, in the end, they were usually right. For example, one patient kept saying that it was his tongue that was obstructing his breathing. I didn’t see anything in the office. Sure enough, he had major tongue collapse that was seen under sleep endoscopy.

In the end, after going through dozens of different cereals in my lifetime, I’ve found one that I’m happy with (Honey Bunches of Oats). Similarly, if you keep an open mind about sleep apnea treatment options and are willing to try new things, then you’ll have a much higher chance of finding a solution to your sleep apnea problem.

What kind of frustrating experiences have you experienced as a patient or practitioner when faced with too many choices for sleep apnea care?

Please note: I reserve the right to delete comments that are offensive or off-topic.

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5 thoughts on “With So Many Sleep Apnea Treatment Options, What’s a Patient (or Doctor) to Do?

  1. The choice was really easy for me. CPAP is the gold standard and I have been using it for nearly nine years. CPAP has made a huge improvement in my life.

    Being able to afford it, this year I bought a custom-fitted oral appliance from a local dentist for $1600. Even extended to the maximum, my jaw could withstand for short naps, the device does not control my sleep apnea.

    Plan B was to use the device along with CPAP in hopes of lowering my CPAP pressure. I set the device to a very short jaw extension and tried it a dozen nights with CPAP. Wearing both the device and CPAP was overly complicated and uncomfortable.

    I am back to strictly relying on CPAP and life is good.

  2. It took me 2 years to be compliant with the CPAP after trying many masks. I think the most crucial change needed is the DME office need to create a space that allow you lay on a bed with pillow in order to know if the mask is going to work. Sitting in an office chair is not telling me much and it is a headache to try it at home, then to keep going back to DME office to try other masks.

  3. Dr Park. Fantastic. Thank you, for frankly telling the truth offering good advice to patients. People need to know to both take responsibility for their own health and to treat with caution the claims made by companies trying to encourage self-diagnosis and self-treatment. The old saying: “There can be no treatment without diagnosis” has never been more true!

  4. it was not the number of methods available that was frustrating, it was the fact that NONE of them worked. so I ended up having jaw surgery. the jaw surgery cured my intracranial hypertension, which is why sleep apnea made me so ill and why I could not tolerate CPAP. it actually did not cure my OSA, although the OSA is much better.

    I think what OSA patients need to realize, is that this human jaw issue is extremely problematic, and no solution is going to be perfect. there are pluses and drawbacks to all of it and you have to just go through the trial and error of giving each option a fair shot. you have to be persistent. again, you have to be persistent. it can be very disheartening, and it takes a long time. It took me about 2.5 years to find relief of my suffering once I realized that OSA was the cause, and this was with working on the problem full time, and after I had already suffered for over a year not knowing what was wrong. I am not sure I would have ever figured it out if not for Dr. Park and his website. I tried every single option and then added my own crazy ideas on top of those, trying things this way and that. I had surgery 3 times, before I got it right. know that you may fail and have to pull yourself back up many many times, and keep going. and if that doesn’t happen, if CPAP works for you right away, be eternally grateful and use it happily!

  5. For me, the oral appliance worked well, that is, I tested well with it on overnight sleep study. Through time though, my jaw expanded/stretchedto capacity and the appliance couldn’t be extended anymore . Switched to Cpap but couldnt keep my mouth closed while sleeping. Cpap(Apap actually) and chin-strap to keep mouth closed is the best combination treatment for me. Wouldn’t “dream”of not wearing combo. Pun intended