Alternatives to CPAP Clinic

An innovative and unique Alternatives to CPAP Clinic has operated since 1998 to streamline evaluation of patients with obstructive sleep apnea who do not tolerate treatment with continuous positive airway pressure (CPAP). This multidisciplinary clinic offers several appointments with different specialists during a single afternoon visit.

A visit to the Alternatives to CPAP Clinic includes an evaluation with a sleep medicine specialist, an otolaryngologist, an oral and maxillofacial surgeon, and sometimes a dentist who specializes in prosthodontics. The program is designed for patients who are considering surgery or an oral appliance as a treatment for obstructive sleep apnea.

At the Alternatives to CPAP Clinic, the following evaluations will usually be performed. A faculty sleep disorders specialist, usually working with a fellow who is training in sleep medicine, will review the history of your sleep problem, perform an examination, and explore strategies that might allow you to use CPAP. Sometimes no such strategies can be found, but if so, this information is important in deciding whether surgery is appropriate.

An otolaryngologist will see you to determine whether you might be a candidate for surgery that would remove the uvula and part of the soft palate at the back of your throat. Sometimes nasal surgery also may be appropriate. Procedures sometimes can be done by laser or other means on an outpatient basis. The otolaryngologist also will perform video pharyngoscopy, in which a thin tube is used to obtain detailed images of the throat.

An oral and maxillofacial surgeon will evaluate whether you might benefit from surgery to advance the upper and lower jaw, thereby pulling the tongue away from the back of the throat and enlarging the airway. Special x-rays are used to measure airway size and positions of bony structures that affect it.

A dentist may see you if an oral appliance is likely to be an option for treatment of your obstructive sleep apnea. An oral appliance fits within the mouth and holds the lower jaw forward while you sleep, pulling the tongue away from the back of the throat and enlarging the airway.