The CPAP has been the most frequent form of treatment for obstructive sleep apnea for many years. Unfortunately, for a variety of reasons, the CPAP doesn’t work for many people. But researchers may have discovered an alternative involving electrical stimulation.

Transcutaneous electrical neurostimulators (or TENS machines) are devices that deliver low levels of electrical currents directly on the skin through adhesive patches. These electrical currents serve in place of neurological stimulation to keep muscles firing. While TENS machines have been used for years to treat pain and muscle spasms, researchers have begun to test the effectiveness of TENS machines to treat obstructive sleep apnea.

Sleep apnea is generally caused by obstructions in the airway due to the soft palate and other portions of the throat to obstruct air flow. Research believed that using electrical stimulation on the throat to target specific muscles might help keep the airway open during sleep. They found that patients who used TENS machines while sleeping experienced a significant reduction in their AHI (apnea-hypopnea index) decreased, which means they had fewer pauses in their breathing during sleep. The study also showed that patients who used the TENS machine had improvements in their sleepiness levels, meaning that they felt more awake and alert during the day.

This could be good news for patients who have trouble using the CPAP. The TENS unit only involves using adhesive patches applied in strategic locations on the neck, with no need for a mask. The TENS also doesn’t require a separate machine for cleaning like the CPAP.

It does have some drawbacks. The TENS machine did cause skin irritation and headaches with some patients, and like the CPAP, it also requires access to electricity, so it does carry some of the same limitations.

But overall, this new approach to treating OSA could end up being a promising development in the field of sleep medicine. It offers hope for those who struggle with traditional treatments and provides a potential option for managing OSA symptoms.

Sources:

• Noninvasive Nerve Stimulator May Ease Sleep Apnea (MedPageToday)
• Domiciliary transcutaneous electrical stimulation in patients with obstructive sleep apnoea and limited adherence to continuous positive airway pressure therapy: a single-centre, open-label, randomised, controlled phase III trial (eClinicalMedicine)

When a person is diagnosed with obstructive sleep apnea, the first approach to treatment is generally the continuous positive airway pressure device (CPAP). However, many people quickly find that the CPAP doesn’t work for them – in fact, it has happened enough that “CPAP intolerance” has become a generally accepted diagnosis. So why do so many people end up abandoning the CPAP?

Obstructive sleep apnea occurs when a person’s breathing is repeatedly interrupted during sleep due to the collapse of the airway. The CPAP works by delivering a constant flow of air into the person’s airway by way of a mask worn over the mouth and nose, thus preventing the interruptions in breathing that occur in OSA. Think of it like placing an electric fan in front of a doorway and setting it to run air fast enough that the door can’t close on its own.

CPAP intolerance can occur for various reasons. One of the most common reasons is the mask itself, which may cause skin irritation, pressure sores, or discomfort around the nose and eyes, making it difficult for some people to wear it for an extended period of time. Some users may feel claustrophobic or anxious while wearing the mask, which can further exacerbate the intolerance.

Another reason for CPAP intolerance is the sensation of the air pressure itself. While the CPAP is intended to help people breathe more easily during sleep, some users may find it difficult to adjust to the sensation of the air pressure, which can feel uncomfortable or overwhelming. CPAP machines can also be noisy, and some people may find it difficult to sleep with the sound of the machine in the background.

There are a number of other factors that can contribute to CPAP intolerance:

• Dry mouth or throat. Wearing a CPAP means a constant flow of pressure into the airway, which means it gets very dried out overnight.
• Air leaks. If the mask doesn’t fit adequately, the air won’t go into the airway, which defeats the purpose of the device.
• Some users may experience psychological barriers to CPAP therapy, such as a negative attitude towards the treatment, a lack of motivation to use it regularly, or difficulty adapting to the routine of using CPAP every night.

These are just some of the reasons that Dr. Krish doesn’t prescribe the CPAP for her patients. But the biggest one is quite straightforward: it treats the symptoms without actually providing a cure. A person suffering from sleep apnea can’t use the CPAP for a limited period of time and then find that their snoring stops. Even if the CPAP works for you, it’s your new normal forever.

Yes, the CPAP is a widely accepted treatment for sleep apnea, but it’s not a cure-all. For that matter, it’s not even a cure.