These are interesting and trying times across the globe. Novel Coronavirus (COVID-19) is spreading and the world is grappling with new realities and possibilities. In this time of stress and worry there is a high probability that you may not be getting much sleep. Worst of all, the sleep you get may lack quality restoration. A far greater concern is that you are going to bed with a device over your face looking like a villain from a DCTM Batman comic.
Ah, the continuous positive airway pressure machine we so lovingly shorten to CPAP, as a pleasantry. The sun sets and the dark night rises to reunite you with modern medicine’s most unattractive accessory. (Pun intended, we gotta laugh to make it through 😄 otherwise we would cry.)
All jokes aside. It becomes almost demoralizing to require this machine every night. For many, tolerating the machine, in and of itself, is the biggest hurdle to overcome. Rightfully so, if we weigh the pros and cons. CPAP is the leading treatment in obstructive sleep apnea, but if your apnea gets you more “sleep” than the frustration of sustaining the mask all night. You may understand how 46% of patients fall into a similar problem. One study summarized it well, “[A]lthough many patients with OSA (obstructive sleep apnea) derive subjective benefit from, and adhere to treatment with CPAP, a significant proportion of those so diagnosed either do not initiate or eventually abandon therapy.”
What are the alternatives to CPAP?
As the standard of care, CPAP, sits tall and strong, but not alone. Many try alternative measures ranging from dental appliances to reconstructive surgery to find resolve. Such as nasal strips, holistic medicines, cognitive behavioral therapy, bulky silicone appliances, aromatherapy, nasal dilators, orthodontics, and mandibular advancement surgery, among many other possibilities. None of aforementioned nonsurgical options are permanent solutions, very few resolve the source of problem, and minimal are comfortable.
With a prevalence almost equalvent to type 2 diabetes, what are the approximately 18 million Americans to do after fielding through numerous alternatives?
- Resort to cosplay every night with a loud machine over their heads. Struggling with either keeping it on or ripping it off and annoying their partner with loud snoring and startling gasps.
- Decide to do nothing and ultimately increase their risk of heart disease, high blood pressure, impotence, diabetes, and memory loss.
Well, when all the options are not acceptable we don’t throw in the towel. We are resilient and resourceful! Even with the current crisis occurring we work towards solutions. Social distancing has introduced Zoom parties to bring together families for birthdays and weddings, neighborhood driveway happy hour, and social media live DJ performances that bring together celebrities and the general public.
At the moment when frustration and resourceful converge, people come across the specialty service that provides much needed relief to those who have run out of options.
Myofunctional therapy. A conscious program of exercise and re-training of the muscles of the orofacial complex. Strengthening the muscles that are often culpable in collapsing he upper respiratory tract causing the obstruction that leads to an apnea. This century old field of specialty has been studied and shown to improve CPAP tolerance, decrease obstructive sleep apnea symptoms and in some instances eliminate the need for the CPAP. A 2018 comprehensive review of 11 separate studies concluded: OMT [orofacial myofunctional therapy] is effective for the treatment of adults in reducing the severity of OSA and snoring, and improving the quality of life. OMT is also successful for the treatment of children with residual apnea. In addition, OMT favors the adherence to continuous positive airway pressure.“
How do you know if myofunctional therapy is the right solution?
There are a few key requirements to be a good candidate for myofunctional therapy
- Sleep study results–
It is most effective for adults and children with mild to moderate obstructive sleep apnea. Sleep apnea can be obstructive, central or mixed. Obstructive sleep apnea involves a narrowing or blockage of the upper respiratory passage during sleep. This creates an abrupt stop in breathing that results in choking or gasping for air. Central sleep apnea involves a disruption in breathing caused by failed signaling of the brain to respiratory muscles. Mixed sleep apnea is a combination of both. Myofunctional therapy works best in obstructive sleep apnea, rarely in mixed and not at all in central. A sleep study will allow your physician to accurately diagnosis the type and degree of sleep disorder present.
- Mouth breathing–
Mouth breathing is an inefficient method of respiration and should be used only as a last resort during nasal congestion or obstruction. When done during sleep it leaves the upper respiratory tract even more susceptible to collapse as the tongue and pharyngeal muscles relax back. If you find that during the day your lips stay open (even slightly) and you have difficulty breathing through your nose, you may be a good candidate for myofunctional therapy.
- Dental or ENT (otolarygologist or ear, nose, throat) evaluation
Even those with both mouth breathing habits and diagnosed sleep apnea may be beyond the capabilities of myofunctional therapy. Physical or anatomical barriers may inhibit nasal breathing and progression in orofacial neuromuscular strength. Enlarged tonsils, adenoids, deviated septum, and enlarged turbinates, to name a few, may need medical intervention prior to seeing benefits from any sleep apnea treatments. A thorough evaluation from a sleep dentist and/or and ENT will guarantee concrete answers as to whether you can do alternative treatments or if you need surgical interventions.
How to improve sleep during the coronavirus crisis
While you may be awaiting the return of non-emergent health services to see a sleep physician or ENT, here are a few tips to help you improve your sleep in the interim.
- Those who are at home are in a great position to take time to invest in themselves during this time. Self-care is key to achieving a better mindset and decreasing the stress load. Do add in a new self-care aspect into your routine, one that is easy to maintain post quarantine. Something as simple as learning a new hobby or journaling. Winding down the mind as much as possible before bed, preps the body for the initial stages of sleep where brain activity will slow naturally.
- Be consistent with your night time routine. Do not make drastic changes in your routine due to being at home. This will result in altering your biological clock and make the transition back to a regular schedule more difficult.
- Consider doing a daily nasal hygiene routine. I highly recommend Pronto Sleep, a nasal dilator with built in aromatherapy. Aromatherapy has been known to aid in nasal decongestion and patency. The dilator holds open the nostrils to allow for better air flow and decreases the soft tissue narrowing that would cause snoring.
- Finally, myofunctional therapy, even in the interim of the quarantine can improve sleep dramatically by engaging in better breathing practices to allow for deeper sleep as the brain will have optimum oxygenation during REM restoration. Teletherapy options are readily available.
The struggle for a good alternative for sleep apnea treatment does not have to result in joining a local villain league or doing nothing. A long term, non invasive treatment exists that will improve your sleep while putting your fears to rest. The best candidates for myofunctional therapy have had a sleep study and a diagnosis by their medical provider of mild or moderate sleep apnea. However, you can make simple changes while you await those screenings. If you already fit the criteria for myofunctional therapy, schedule an appointment today for a FREE virtual consultation.