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However, a Main Line Health sleep expert says there are new options available, with even more on the horizon.
For Cas Wolanin of Newtown Square, Pennsylvania, it was a moment of reckoning.
"Ten years ago, my wife sat down and talked with me, and said: 'Cas, in the middle of the night, you stopped breathing'," he recalled.
A sleep study confirmed he has sleep apnea. Wolanin realized it was the cause of his afternoon sleepiness.
"You wake up in the morning, you're feeling good. But then about noon, you're like real tired, drowsy, you have to take a nap," he said.
Dr. Rochelle Goldberg, a Main Line Health sleep specialist, says untreated sleep apnea carries big risks.
"Hypertension, diabetes, heart disease in a number of directions, which includes heart attack risk, heart failure," said Dr. Goldberg. "The sleep can't do its job because you're always waking up to fix your breath."
A sleep lab study is the most reliable method for detection. Home sleep tests can give vague results or even false negatives for some people, such as those with insomnia or chronic pain.
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For severe apnea, CPAP is still the first choice and new ones are even easier to use.
"The masks have gotten lighter weight, more comfortable," said Dr. Goldberg.
She also uses a remote fitting app called MaskFit AR that only needs a cellphone image to find the best-fitting masks.
Dr. Goldberg says there's other technology, such as Inspire, which is an implanted device to keep airways open during sleep. But she says to remember it is a surgical procedure.
"I say, okay, this is a surgical procedure. And that stops a good percentage of people in their tracks," she said.
Oral appliances are another option that's grown over the years. They have a 60% success rate, compared to 99% for CPAP.
"The best candidate is typically one who has more mild or mild to moderate sleep apnea," said Dr. Goldberg.
She notes that over-the-counter devices to stop snoring only solve that, not sleep apnea. There's also the unusual-looking Excite, which works on a simple theory.
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"By stimulating the tongue to strengthen the muscle. If you strengthen the muscle, it's less likely to flop back and contribute to that airway narrowing," said Dr. Goldberg.
It's used for about 15 minutes and takes a daily commitment.
"This is something that the person has to do daily for six weeks to see if they get the full response from it," she said.
Dr. Goldberg said Excite is also a prescription device and rather expensive, so it's not generally covered by insurance, though it may qualify for some HSA or FSA accounts.
She says there is also a sleep apnea pill in tests, and it could be approved in the next year or so.
A team at Brigham and Women's Hospital in Boston says in a study, scientists found that a combination of atomoxetine and oxybutynin, taken as two pills at bedtime, reduced patients' frequency of airway obstruction from a median of 28.5 hourly obstructions on placebo to 7.5 on the pills.
There was a median reduction of 74% in patients with the highest rate of interruptions, and every patient had at least a 50% reduction.
Click here for the latest on the clinical trials of the experimental medication.
Wolanin says anyone getting a CPAP recommendation should try out different masks or nasal devices to find one they are comfortable with, He admits the CPAP his doctor prescribed took getting used to.
"But now I'm used to it. I can't sleep without it," he said.