Sleep apnea has become one of the leading categories of disability handled by the Veterans Administration (VA). It’s even been shown that sleep apnea is causing these veterans to lose brain matter. But there are many challenges for trying to get help for veterans’ sleep apnea. Many of these veterans have PTSD (post-traumatic stress disorder), and veterans with PTSD have a hard time keeping to their CPAP treatment.
Now researchers are claiming that they’ve detected the reason for the problem, and that it can be solved with advanced forms of PAP. But looking at their results don’t inspire confidence. It may just be that CPAP alternatives like oral appliances may be more effective.
Trying to Explain the Compliance Problem
Many veterans report feeling smothered by CPAP, which is they they are less likely to use it. Researchers propose that the problem isn’t the CPAP mask. Instead, the problem is what they term expiratory pressure intolerance (EPI). Basically, when you try to breathe out, but the pressure from CPAP forces your breath back, you feel smothered.
They reasoned that EPI was the problem because in their experience, mask problems didn’t make people give up on CPAP–mask problems made them give up on their mask.
If EPI is the problem, they further reasoned, they should be able to get around it by using forms of positive airway pressure that let people exhale freely. The two options they employed for this study were auto-servo-ventilation (ASV) and auto-bilevel positive airway pressure (ABPAP). By automatically adjusting to users’ breathing, these devices help users avoid EPI.
They reviewed the cases of 147 patients who had trouble complying with CPAPand were tried with either ASV or ABPAP. Unfortunately, even with the advanced machines and the second trial period to allow for acclimation, only 58% of veterans were compliant with treatment.
That level of treatment cannot be considered success, not when these are our servicemen and women we are talking about. We need to do better.
CPAP Alternatives Might Do Better
The results of the trial cast doubt on whether EPI is the real reason why veterans have trouble complying with CPAP. But what is not in doubt is that veterans do have trouble with positive airway pressure for sleep apnea, and that advanced forms don’t seem to help much. We have to consider other alternatives.
One alternative that needs to be studied more is oral appliance therapy. For people in many situations, oral appliance therapy makes an excellent alternative to CPAP. With oral appliance therapy, it doesn’t matter whether the problem is the mask or EPI. The oral appliance causes neither problem.