Sleep Apnea Treatments and Prevention Without Masks

It has been estimated that almost 30 million Americans have some form of sleep apnea, which causes people to repeatedly wake at night, alarming stoppages in the breathing during the night, often causing loud snoring and gasping for air. For decades, the standard treatment has been 'Continuous Positive Airway Pressure.' (CPAP) device and mask that maintains a mild air pressure in the airways to keep them open during sleep at night.

In obstructive sleep apnea, the airways collapse when people are lying down or become blocked during sleep. When people try to breathe, any air that squeezes past the blockage can cause loud snoring. This snoring and gasping for breath may wake partners or other people in the house. Many people afflicted with sleep apnea may cease breathing more than 50 times an hour. This is dangerous and can cause brain damage and poor sleep.

A mask over the mouth and nose must be worn at night. It is connected to an air pressure machine that gently forces air into the nose and mouth providing easier breathing.

The CPAP device is effective in reducing and in some cases completely preventing risky bouts of obstructive sleep apnea at night.

The sleep apnea cycle
The sleep apnea cycle. See the details here. Source: Public Domain
What is sleep apnea
What is sleep apnea. Source: Public Domain

Problems with Masks

However the mask is large, bulky, uncomfortable, obtrusive and the wearer has to drag the hose with them when they turn over. Many patients abandon the mask after a few nights as it disturbs their sleep. For others the mask comes off or they rip it off when asleep. Various research studies have shown that about 50% of all people who start using CPAP machines cease using them after 1-3 weeks. The CPAP devices are very effective with patients in the sleep lab, but when people go home with the device, about 50% of people don't continue to use the CPAP machines and masks.

Now an alternative form of CPAP for obtrusive sleep apnea is gaining popularity: Provent. This consists of two small disposable patches that are fitted over both nostrils and sealed using sticky bandage tape. Inside each patch is a tiny valve that creates just enough air pressure when the person exhales, to keep the airways open and unobstructed at night. (see the images describing how it is fitted). It is far less intrusive and bulky than the conventional CPAP machine with its large mask and hose. Provent is expensive as the units are disposable and are only used once, and it doesn’t work for every patient.

Provent was approved by the US Food and Drug Administration in 2008. It has become very popular with the manufacturer shipping over 1,000,000 of the devices in the last 12 months, and more than 500,000 in the two years previous years. Doctors and their patients have been provided with a new weapon for the treatment of obstructive sleep apnea, and many patients have found it a godsend, after they had struggled with the standard CPAP devices.

Provent works like a standard CPAP machine, by maintaining positive pressure in the airways but the units are only a fraction of the size. When people afflicted with apnea go to sleep, their throat muscles can collapse downwards, and partially block the airway.This causes the body to fight for air and triggers a response to get the breathing going again. This awakens the patient and disturbs their sleep. CPAP machines use a small positive air pressure to keep the airway from becoming blocked and keeping it open (see images opposite).

Provent works in a different way to keep the airways from becoming blocked. The Provent devices contain two tiny valves with one valve fitted over each nostril. The valves allow air to enter easily during inhalation. Most people breathe via their nostrils when sleeping and so the valves do not impede the air during inhalation. However the valves create a slight resistance as the user exhales. This resistance creates a back-pressure in the airways, unblocking the obstruction caused by muscles and other tissues collapsing down during the night. This dilation keeps the airways open for the next inhalation. The tape attached to the valve is used to seal the nostril. In the morning, the patch is removed; a new one is used every night.

A recent research study of 250 apnea sufferers, published in the medical journal 'Sleep' and subsidized by the company Ventus, evaluated the effectiveness of Provent. The study found that the devices reduced the apnoea–hypopnoea index (AHI), which is used to determine the severity of sleep apnea. In the study AHI was reduced by about 53 % in the when Provent was used compared to a 7 % reduction in the group given a fake device. Using Provent Therapy also boosted alertness, and reduced sleepiness. Significantly, patients accepted and continued to use of the device at a high rate with patients using them for 90% of the nights during in the study.

CPAP remains the accepted and proven standard treatment but Provent provides a promising alternative. Preliminary studies have suggested that a third of patients who try Provent do not end up using it continuously. Some people only use them when they are away from home on holidays or business trips. It works very well in some people but not in others. Many people breathe through their mouths at night, not their nostrils and so the device does not work. Nor will it work when the nasal passages are blocked at night. For example people with allergies may regularly have blocked noses at night. The patches can be expensive costing about $80 for a 30-day supply. Many patients typically start with a 10-day trial pack that costs about $25. Although widely prescribed the costs is a factor in explaining why people stop using the device. The CPAP devices are more expensive at the start but there is no ongoing outlay.

There are several other similar devices on the market.

Patient sleeping with Provent fitted
Patient sleeping with Provent fitted. Source: Public Domain
Standard CPAP Mask that fits over mouth and nose
Standard CPAP Mask that fits over mouth and nose. Source: Public Domain
Airways blocked when patient falls asleep
Airways blocked when patient falls asleep. Source: Public Domain
Positive Pressure Reopens the Blocked Airways
Positive Pressure Reopens the Blocked Airways. Source: Public Domain
Airway remains open when patient exhales as the positive pressure is maintained.
Airway remains open when patient exhales as the positive pressure is maintained.. Source: Public Domain
Unpacking the Provent valves
Unpacking the Provent valves. Source: Public Domain
Provent fitted to both nostrils and seals checked.
Provent fitted to both nostrils and seals checked. Source: Public Domain