People with obstructive sleep apnea have mainly three choices:
- CPAP – A mask with positive pressure
- A mandibular advancement device, usually made by a dentist
- Surgical intervention
CPAP has proven to be effective in 80% of the cases where advancement mandibular device less than 50%, and surgery less than 33%.
A major problem with CPAP is that there is a low compliance, often 70% or greater, of people despite having the equipment do not use it or use it inadequately.
Because it has been shown that if a patient is not compliant within the first week, there is a high likelihood they will not continue using it. The consequences, of course, are severe, a twelvefold increase in Alzheimer’s, hypertension and cardiovascular disease, plus obesity, personality changes and anxiety, panic attacks, and depression are just a few of the ramifications for those with Obstructive Sleep Apnea who do not use or utilize their CPAP correctly.
Compliance can often be helped with close follow up by the physician and a referral to centers or companies that supply the CPAP equipment and will work with the patient in order to find the right fit for them.
Armodafinil 150 to 250mg per day has also been shown to improve wakefulness and vigilance and episodic memory difficulties. If the CPAP cannot be tolerated, then a mandibular device might be tried, though only 52% of the patients will get satisfactory results, despite a 77% compliance rate. Palate surgery should be a last resort since it is the least likely to be successful compared to CPAP.
A new drug in phase 3 clinical trials called Almorexant may be a new strategy in the treatment of Alzheimer’s disease as it has been found that obstructive sleep apnea stimulates orexant by the hyperthalamus releasing abeta amyloid. This blocks orexant receptors and inhibits the abeta plaque accumulation.
In conclusion, compliance for those with obstructive sleep apnea is mandatory or the consequences including Alzheimer’s disease is too much of a price to pay. It is, therefore, important for everyone who has been told they have obstructive sleep apnea to return to their physician and have someone come to their home or you go to their office to find the best fir for your CPAP. I can be done. It must be done.