CPAP (continuous positive airway pressure) is a promising sleep apnea treatment in theory, being nearly 100% effective. However, in practice, the effectiveness is significantly lower, quite likely 50% effective or less because that’s how many people use it according to recommendations over the long term. This drives a continual search for CPAP alternatives.
One alternative researchers have explored is positional therapy. In positional therapy, a person sleeps in a specific position. This is different from simply choosing a particular sleeping position (such as back sleeping vs. side sleeping), and usually relies on specialized sleep devices to achieve an elevated sleep position with the upper body at a 45° angle.
Although researchers showed this can be effective for specialized groups, it does not seem to be a good treatment option for the general population. Here are some of the people who might benefit from positional therapy for sleep apnea.
Positional Therapy After Pregnancy
In general, women are at a lower risk for sleep apnea. However, women’s risk of sleep apnea increases significantly during and after pregnancy (as well as at menopause). Since pregnancy-related sleep apnea is expected to improve with time, positional therapy has promise as a short-term treatment that helps women sleep better after delivering their babies until pregnancy-related apnea resolves.
In this study, researchers identified 55 women who had postpartum sleep apnea. Polysomnograms were performed within 48 hours of giving birth, and for 30 women they were performed in both the flat and the elevated position. One in five women tested positive for moderate sleep apnea. In the elevated position, sleep apnea severity decreased from an apnea-hypopnea index (AHI) of 7.7 to 4.5. For half of the women with sleep apnea, the condition dropped to levels below clinical concern.
Researchers also measured women’s airways in both the flat and elevated positions and found that the changes in AHI were correlated with the relative size of the airway in the two positions.
Importantly, the polysomnograms showed that women were able to sleep comfortably in both positions. As a result, researchers say that this simple nonsurgical intervention is a good way to reduce women’s risk of postpartum complications.
Helping Patients after Upper Airway Surgery
In general, surgery is not recommended as a frontline sleep apnea treatment. In addition to the risk of surgical complications in people with obstructive sleep apnea, many people still have significant sleep apnea. The most common surgery for Sleep Apnea only eliminates sleep apnea for one in four patients. The rest have sleep apnea that needs additional treatment.
Understandably, people may resist additional treatment with CPAP after airway surgery. In fact, many people get upper airway surgery specifically to avoid CPAP. Positional therapy seems an appealing complementary treatment for people who still have sleep apnea after surgery.
Studies show that positional therapy can help, although many people still don’t adequately overcome sleep apnea with both surgery and positional therapy.
In a 2016 study, researchers looked at positional therapy for 33 patients who had a median AHI of 18.3 after upper airway surgery. These patients saw their median AHI drop to 12.5, which is still mild sleep apnea. Only 31.3% of these patients saw their sleep apnea successfully resolve with positional therapy.
Positional Therapy Benefits Limited
Cochrane Library reviews are among the most respected indicators of the effectiveness of a clinical treatment. That’s because Cochrane reviews carefully examine not just the findings of studies, but how well the studies are set up to produce reliable results. Cochrane reviews scrutinize studies carefully for bias and reject low-quality and biased studies, including only the best studies in their review.
In 2019, the Cochrane Library published a review of positional therapy for sleep apnea. Only eight studies met criteria for inclusion. The good news is that, in many ways, positional therapy matched CPAP when comparing treatments head-to-head. As usual, CPAP did a better job of controlling apnea by reducing AHI. However, people complied with positional therapy better. In the end, for results like quality of life, quality of sleep, and cognitive improvement, the two treatments achieved similar impact.
Other studies showed that using positional therapy could reduce AHI by an average of 7.38. This could be enough to help a person with mild sleep apnea achieve relief. However, it is not enough to be a reliable stand-alone treatment for sleep apnea.
In addition, the studies were too short for their findings to be reliable.
Looking for Effective Sleep Apnea Treatment in Omaha?
Overall, we understand why people are looking for more effective sleep apnea treatments. When a doctor only offers CPAP, you might look around for better options. At the Advanced Dental Sleep Treatment Center, our focus is helping everyone find effective sleep apnea treatment. We can help you understand all your options, including oral appliance therapy. We will discuss the benefits and limitations of each. Then we can help you decide on the best treatment or treatments that will give you the best results.
To learn more, please call (402) 493-4175 or use our online contact form to schedule an appointment at the Advanced Dental Sleep Treatment Center in Omaha.
