Beyond CPAP: Why Sleep Apnea Patients Need More Treatment Choices

About half of patients abandon CPAP therapy. It’s time to embrace a patient-centered approach with a wider range of treatment options, says sleep consultant Lori Schulman, who has more than 25 successful years building early sleep tech, health tech, and digital health companies. She also serves as the ASAP board’s secretary.

by Lori Schulman

Navigating the world of sleep apnea can be a frustrating and confusing journey for many patients. The current standard of care often centers on continuous positive airway pressure (CPAP) therapy, a proven and effective treatment. While CPAP is highly effective for some and is widely covered by insurance, it's not a one-size-fits-all solution.

The reality is that a significant number of patients—approximately 50%—discontinue use, leaving them without a viable treatment for a serious health condition. This highlights a critical problem in the sleep industry: an over-reliance on a single therapy and a failure to provide patients with the full spectrum of available options.

The Problem With a One-Size-Fits-All Approach

For decades, CPAP has been the go-to treatment for obstructive sleep apnea (OSA). Its effectiveness in managing symptoms and improving health outcomes is well documented. However, the high dropout rate reveals a fundamental flaw in its widespread application. For many, the device is uncomfortable, cumbersome, or claustrophobic, or it doesn’t fit into their lifestyle, which can lead to non-adherence.

This isn't a problem of patient laziness or lack of willpower; it's a problem of patient-treatment mismatch. When patients feel they have no other choice, they may abandon treatment altogether, putting their health at risk.

This is why innovation becomes so necessary. Patients want options, and clinicians have a responsibility to present all of them up front. Rather than treating CPAP or perhaps oral appliances as the only options, we should introduce a variety of solutions at the very beginning of the patient's journey. This is not about replacing standard care, but rather about enhancing it with a broader, more patient-centric approach.

A Patient-Centered Approach: Choices and Combinations

The future of sleep apnea treatment lies in a patient-centered model, where evidence and patient preference guide the best course of action. This means having an open and honest conversation with patients about their lifestyle, personal preferences, and the different treatment options available. These options extend beyond CPAP and mask interfaces to include:

●      Oral appliances: Custom-fit devices that move the jaw forward to keep the airway open.

●      Negative Pressure devices: Therapy that gently brings the tongue and soft tissues forward, creating more space in the airway during sleep (i.e., iNAP)

●      Positional therapy: Products that encourage patients to sleep on their side, reducing or eliminating apnea events. These include earbuds that emit sounds to train the patient, as well as pillows designed to prevent the patient from sleeping supine.

●      Hypoglossal nerve stimulation: Implanted devices that stimulate the nerves of the tongue to keep the airway open during sleep (such as Inspire, Nyxoah, and others).

●      Medications: GLP-1s are having a positive impact on OSA. New drugs in clinical trials, such as Apnimed’s AD109, are oral pills with the potential to reshape the OSA treatment landscape.

●      Physical therapy: A language pathologist can help strengthen the tongue and throat muscles using myofunctional therapy. Playing wind instruments or using specific drinking straws may also help strengthen these muscles.

In many cases, the best solution might be a combination of therapies. For example, a patient might use an oral appliance for travel and a CPAP machine at home or combine positional therapy with a low-pressure CPAP setting. By considering combinations, clinicians can tailor a treatment plan to a patient's specific needs, leading to greater comfort and, most importantly, better adherence.

Moving Beyond the "Tried and True" Mentality

One of the biggest obstacles to progress is the mindset that "tried and true" is synonymous with "best." While CPAP has a long history of success, this doesn't mean it's the optimal solution for every patient. The sleep industry must embrace a culture of continuous improvement and innovation. We must challenge the status quo and recognize that what worked for patients 20 years ago may not be the best option for patients today.

This shift in mindset is about offering better care—sooner. Instead of waiting for a patient to fail CPAP therapy before exploring alternatives, clinicians should be educating them on all options from the outset. This empowers patients to make informed decisions and increases the likelihood that they will find a treatment they can stick with long-term. Newer, less invasive emerging technologies will offer more alternatives to traditional devices.

Ultimately, the goal is to improve patient outcomes and quality of life. By moving away from a single-solution mindset and embracing a world of choice, we can ensure that more patients are successfully treated, leading to a healthier and more rested society.