Over the years, devices for snoring and sleep apnea have come a long way. Since the recognition of the condition of OSA, the invention of the CPAP by Prof. Colin Sullivan has made a huge difference to millions of lives. (Valuable thanks Professor for your pioneering and ongoing efforts). After the introduction of the CPAP a lot of research went into finding cheaper, more comfortable, portable devices and this led to a few reputable alternatives but also to a lot of rubbish which has flooded the market for years. It often seems to me that when looking what is on offer, it is more about selling a gadget than offering a proper treatment or giving general information about the condition. Suffering from OSA myself and trying to find a solution is probably the main reason why I started this series but I have limited the information to a few reputable machines and devices only. Obstructive Sleep Apnea Treatments
Velum/Palatal Devices or VPD's from now on, are the newest and most recent version of recognised approved devices that are in use for both snoring and OSA and have been around for 10 years or so. Let me explain how they work. Similar to the Mandibular Advancement Splint MAS (see Oral devices - Part 2) a VPD needs to be professionally fitted and is not available over the counter or internet. This of course increases the initial cost of the device and could be considered a drawback to some but gives a much better, more consistent and satisfying result. As I mentioned in part 2 of the series you are usually better off with a fitted device rather than an "off the shelf" version. The professional can, during the consultation, give you information as to how well the device will work for you. The initial cost outlay varies according to the type of device you choose, but is usually about $1500 for a permanent version (Pillar procedure) or $400 for the removable (Velumount) type.
The permanent VPD version stays in place until you have it professionally removed if desired. It doesn't need cleaning. That's it. The removable version however is only inserted prior to going to sleep and removed again upon waking. Like the mouthguards, the advantage here is that they are small, hardly noticeable when using and can be carried anywhere as no electricity is required. Certainly an advantage if you are considering being on the road a lot, love boating or camping out. VPD's are therefore preferred.
Because the removable VPD is worn in the mouth all night, it's lifespan is restricted somewhat as it needs to be cleaned following each use and is tossed out after a couple of months or so for hygienic reasons. However this probably makes it more hygienic than an MAS that is generally used until it breaks. The advantage of the removable, also disposable VPD is, that no further fitting is required when needing a new device as replacements are issued according to your original device size at less than $20 each; this makes them considerably cheaper than an MAS.
The velum/palatal device slips behind the uvula and keeps the excessive soft tissues in place, preventing them from vibrating if you snore or from collapsing altogether, if you have OSA. This sounds a bit frightening especially for the one which you have to self-fit, but is for most people easily accepted within minutes. VPD's are not fixed to your teeth and it doesn't matter if you wear dentures. Obstructive Sleep Apnea Treatments
VPD's work well for snoring and OSA which is caused by the soft palate. How would you know where your snoring occurs? There is much more to it, but to keep it simple if you do breathe through your nose during normal daily activity and your nasal passages are clear, you have a good chance for VPD's to work well. If however you breathe through your mouth constantly and suffer from narrow, stuffy or blocked nasal passages you may be better to stay away from these and try an MAS or revert back to the CPAP, especially if you are an OSA sufferer. Again I do stress, if you suffer from OSA do not leave it untreated otherwise your life may be in danger. Get a sleep test done. Also keep in mind snoring is not dangerous in itself but can lead to OSA.
Let's look at the success of VPD's. Early results for both the permanent Pillar and the removable Velumount version are very promising provided the problem is in the soft palate. Opposite to mouthguards, VPD's target the upper throat area. Clinical trials are ongoing but for the disposable device, tests show similar success to Uvulopharyngopalatoplasty (UPPP) or Somnoplasty (surgical removal of the uvula and stiffening of the soft palate by laser or radiotherapy). If you are not so familiar with the clinical jargon, it just means that they work similarly to surgery without having to go through surgery.
Having all this information, you may consider a VPD but before you do, you need to know more about the comfort level. Having described the possible discomforts of the CPAP and MAS, the VPD's too have to be scrutinised. Both device procedures, Pillar or Velumount, take about 20 minutes for the fitting of the device. While the Pillar version is performed under a local anaesthetic to overcome gagging reflexes, the Velumount version is "al a natural". Hence with the first one you will have to wait and see what the comfort or success level is once the anaesthetic wears off you and you go to sleep while with the second disposable option you will know immediately.
The same applies as with the MAS, you will have to get used to either method over a minimum 10 day period before feeling fully comfortable, but again this is individual. The only difference is that both the MAS and the removable VPD can be self-removed if it annoys you in any way and can be adjusted if need be.
It pays to go into forums or discussion groups to learn more about any or all of the devices covered in this series. Just remember, snoring or OSA is not an on/off switch. While in some cases it may completely disappear with treatment, in others it may be significantly reduced. For the long-term, a healthy lifestyle including good food, plenty of fresh water and regular exercise still seems to be a promising way of improving if not solving the problem. We could all probably lose 5-10kg or more to help eliminate snoring or OSA. In the short term, I hope I have helped you along the way with some advice regarding treating snoring or OSA immediately. Obstructive Sleep Apnea Treatments
