New Device Offers Hope for Sleep Apnea Patients Frustrated With CPAP

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Obstructive sleep apnea (OSA), the most common type of sleep-related breathing disorder that affects about a quarter of American adults, doesn’t just affect how well you sleep. Repeated lapses in breathing during sleep can have serious consequences for your health, such as increasing the risk of diabetes and heart disease. While continuous positive airway pressure (CPAP) devices are the go-to treatment, many find the cumbersome devices expensive and uncomfortable to use.

Young female sleeping with cpap machine for sleep apnea.Independence_Project/Shutterstock

A first-of-its-kind clinical trial from Kings College London finds that a small, battery-operated device that can sit on your night table may be an effective and safe alternative as it gently stimulates key muscles to keep airways open.

Trial Finds Electrical Stimulation Safely Treats Sleep Apnea

The device is called the transcutaneous electrical stimulation in sleep apnea (TESLA) and was found to be effective and safe, according to a clinical trial from Kings College London, published in The Lancet’s eClinicalMedicine.

To test TESLA’s effectiveness, participants used a transcutaneous electrical neurostimulator (TENS) machine, usually used for pain relief, to relieve symptoms of OSA.

The randomized, controlled phase 3 trial included 56 participants with poor CPAP adherence. They were assigned to CPAP (27 patients) or TENS (29 patients) and were observed for three months. Obese patients and those with more severe OSA were excluded.

The TENS unit used a device that transmitted current to electrodes, stimulating the genioglossus muscle, a fan-like muscle essential for preserving the openness of the upper airway, to reduce breathing difficulties. The TENS group used their device four and a half hours per night, four nights weekly.

Results suggest the stimulation maintained an open airway during sleep. TENS also improved sleepiness and fragmented sleep, which the authors considered clinically meaningful.

Minor skin irritation and one headache were the only TENS side effects.

Sleep Apnea Patients Don’t Like Cumbersome CPAP

The TENS group used their device four and a half hours per night, four nights weekly, while the CPAP group averaged zero hours of use.

“Our results confirm that it remains challenging to motivate patients to use CPAP therapy once they have failed to adhere to this first-line therapy of OSA,” the study authors wrote. Patients are willing to try emerging, non-CPAP therapies that may provide benefits, they added.

The main disadvantage to CPAP is that it can be cumbersome to use, Dr. Thomas Kilkenny, director of the Institute for Sleep Medicine at Northwell Staten Island University Hospital in New York, told The Epoch Times. “It feels abnormal to have air pressure applied to the airway through a mask,” he said. “It definitely takes getting used to.”

Poor adherence to CPAP therapy exposes OSA patients to an increased risk for complications such as concurrent health conditions, cognitive deterioration, and a diminished standard of living.

Just 75 percent of people stick with CPAP treatment after three months, and that rate drops to only 25 percent after five years, the TESLA study authors point out.

A 2017 study observing nearly 700 recently diagnosed OSA patients for three years found that, on average, just over 77 percent stick to using CPAP—and even less if the symptoms were mild.

Another study found that 20 percent of OSA patients stopped their CPAP treatment due to a lack of perceived benefit, discomfort, or claustrophobia with the mask.

CPAP alternatives include more invasive options, including mandibular advancement devices that widen the airway and prevent closure and surgical choices like hypoglossal nerve stimulation involving an implanted device.

Non-Device Options for Treating Sleep Apnea

Routine upper airway care should be standard for all OSA patients, according to Dr. Kilkenny. “This would include, especially, dealing with nasal allergies and sinus conditions,” he added. Consulting a doctor can help determine appropriate care.

Weight loss is also key, as OSA is common in overweight patients. Even modest weight reduction can dramatically improve OSA, Dr. Kilkenny noted. “Some patients consider weight loss surgery, which can be very effective in obese patients,” he added. “Avoiding alcohol and sedating medications will also improve the OSA.”

Orofacial myofunctional therapy has been shown to reduce OSA severity and snoring. “These oropharyngeal exercises are derived from speech–language pathology and include soft palate, tongue, and facial muscle exercises,” Dr. Kilkenny said.

Interestingly, playing the Australian didgeridoo may also lessen mild to moderate OSA by training upper airway muscles controlling dilation and stiffness, according to some research.

“Regular didgeridoo playing has been shown to be an effective treatment alternative well-accepted by patients with moderate obstructive sleep apnea syndrome or less,” Dr. Kilkenny said.