From high to low tech, the apnea remedy rundown

From high to low tech, the apnea remedy rundown

Continuous positive airway pressure (CPAP)

Considered the "gold-standard" in treating obstructive sleep apnea, CPAP uses pressurized air sent through a mask to keep the air passages open. But about 40 percent of users can't tolerate the device. The face mask can leak and the pads can irritate the face. Some who quit say it's like sleeping with a vacuum cleaner. The device is about $700 and is covered by Medicare and most private insurers.

Oral appliance

A mouthpiece called a mandibular advancement device (MAD) pushes the lower jaw forward to open the airway at the back of the throat. Available with a prescription from qualified dentists, a custom-fit MAD can cost $1,500 to $3,000. Cheaper boil-and-bite devices are not considered effective, doctors said.

Hypoglossal nerve stimulation (Inspire device)

Approved by the FDA in 2014, the Inspire device - similar to a pacemaker - is surgically implanted near the collarbone. Two leads run from the device. One monitors breathing, another runs up through the neck to the muscle behind the tongue. When it senses a halt in breathing, it sends a mild electrical pulse to the tongue, causing it to move forward and opening the airway. Sleep specialists say it's very effective but costly. It's sometimes covered by Medicare and the VA but often resisted by private insurers.

Oral pressure therapy (Winx)

Winx, a bedside device, uses a principle similar to CPAP. A mouthpiece attached to a machine generates a slight vacuum and pulls the soft palate forward. Richard Schwab of the Penn Sleep Center said the $700 device has worked only about 30 percent of the time; the manufacturer says 50 percent. Some insurers cover the cost.

Maxillomandibular Advancement (MMA) surgery

The most extreme surgical treatment for moderate to severe obstructive sleep apnea requires breaking the upper and lower jaw and repositioning them to open the airway. It's very effective, said Karl Doghramji of the Jefferson Sleep Disorders Center, but it's also expensive, running up to $270,000. Some private insurers cover the cost.

Uvulopalatopharyngoplasty (UPPP)

Surgery to remove tissue from the throat to treat sleep apnea has fallen out of favor. Most often, doctors detached the uvula. Other procedures involved removing the tonsils, sections of the soft palate, and even parts of the tongue. Private insurance often covers the cost if the patient can't tolerate CPAP.

Pillarplasty

An outpatient procedure, pillarplasty stiffens the palate by inserting tiny woven implants. Schwab is not a fan. "There's insufficient evidence to show Pillar works long term or short term," he said. "In addition, the implants can extrude to outside the soft tissue. I advise people to stay away." Usually not covered by private insurance.

EPAP (Provent device)

A low-tech approach to treating sleep apnea uses two single-use disposable devices that stick to the nostrils like Band-Aids. EPAP (short for "expiratory positive airway pressure") allows air to enter the nose through a tiny valve. When a patient breathes out, the device slows the air as it leaves the nostrils, theoretically holding the airway at the back of the throat open. Schwab said his patients have found EPAP "very difficult to tolerate." Monthly cost runs $69 to $99 and is not covered by insurance.

Night Shift device

A "sleep positioner," the Night Shift device is a collar that buzzes when it senses a patient is sleeping on his or her back. A prescription is required for the $350 device. "If you want to go that route, it's just as easy to use tennis balls sewn into a night shirt," Schwab said. "You don't have to spend a lot of money." - Sam Wood