Patient Uses Wesper to Evaluate Multiple Therapies for Sleep Apnea
Chelsie Rohrscheib, Ph.D. Neuroscientist and Head Sleep Expert, Wesper
Background
We present a 55-year-old man with a BMI of 26 and a history of moderate obstructive sleep apnea that is consistently affected by supine (back sleep). He was previously diagnosed with a home sleep tests and prescribed CPAP. His sleep physician would not consider alternative therapies such as a mandibular advancement device until he tried CPAP.
Between his initial diagnosis and testing with Wesper, he lost a significant amount of weight, which resulted in a BMI reduction from 28 to 26. He expressed that he “feels like my sleep has somewhat improved since the weight loss, but I’m still having some problems”.
The user is an engineer and described himself as “extremely data driven”. He was excited by Wesper’s ease of use and ability to collect detailed, longitudinal data. His primary use for Wesper was to track his sleep apnea after his weight loss and test several over the counter sleep apnea treatments before settling on CPAP therapy.
Explanation of metrics:
- Apnea/Hypopnea Index (AHI) - the combined average number of apneas and hypopneas that occur per hour of sleep
- Respiratory Event Index (REI) - the total number o3. Oxygen Desaturation Index (ODI) - the number of times per hour of sleep that the blood oxygen level drops by ≥ 4% from baseline
Findings
The Wesper user completed 6 tests using 4 different over the counter therapies that he purchased online. These therapies include an over the counter mandibular advancement device, a positional therapy device, a tongue retention device, and a wedge pillow. After each test, he tracked his data in an Excel spreadsheet to compare results.
His first test was a baseline assessment of his sleep without the use of a therapy. His AHI was 10.8 and his supine AHI was 27, ODI was 20.3 and supine ODI was 34.6. Average SPO2 was 91%. His baseline result suggests that weight loss may have reduced his overall AHI from moderate to mild, however, he was still having significant breathing irregularities while in supine position.
Next, he tested while using a positional therapy device with the goal of preventing supine sleep. Wesper showed that the positional device was not successful at keeping him off his back, and that he spent 80 minutes sleeping in supine position. His AHI was 13.7 and supine AHI was 23.3, ODI was 15.5 and supine ODI 31. His mean SPO2 was 92%.
His third night of testing evaluated the over the counter mandibular advancement device, a boil, and bit appliance that can be adjusted to keep the lower jaw in a forward position. His AHI was 6.6 and supine AHI was 15, ODI was 8.8 and supine ODI was 15. His mean SPO2 was 92%.
His fourth night of testing evaluated a tongue retention device, which used suction to hold the tongue in place at night. His AHI was 13.4 and supine AHI was 23, ODI was 16 and supine ODI was 24.5. His mean SPO2 was 91%.
His fifth night of testing reevaluated the mandibular advancement device. He described that he adjusted the device to the furthest setting and felt his teeth were not seated properly in the appliance. His AHI was 11.8 and his supine AHI was 8.3, ODI was 13.8 and supine ODI was 8.3. His mean SPO2 was 92%.
His final night of testing evaluated a wedge pillow that allowed him to sleep in supine but elevated his neck and head. His AHI was 9 and his supine AHI was 10.4, ODI was 11.4 and supine ODI was 15. His mean SPO2 was 91%.
On consultation with the Wesper sleep expert, it was determined that the mandibular advancement device is offering the most improvement, however the sleep expert recommended that he continue testing to confirm his results. Because the wedge pillow also showed promising results, it was suggested that the user might try using the wedge pillow in combination with his oral appliance.
Due to a large increase in AHI in supine, it was recommended that he continue to focus on eliminating supine sleep if possible with better positioning devices. The user plans to continue testing nightly in hopes of finding a CPAP alternative solution to his sleep apnea.
Conclusion
The patient completed 6 Wesper tests in a 6-day period, 1 baseline test and 5 tests while using various therapies. His tests determined that his weight loss may have improved his sleep apnea severity, however his AHI was still elevated in supine position. Further, the data showed that the oral appliance offered the most immediate improvement and that using it in combination with positional therapy or head elevation may result in additional improvement.
Wesper’s ease of use and detailed reports result in a quick turnaround for testing therapies and eliminates the guesswork by providing objective clinical data. While the user admits that he may not find an over the counter therapy that effectively treats his sleep apnea, he will continue to use Wesper if he goes on CPAP or a prescription oral appliance to track their effectiveness.
Clinical studies have shown that patients have better long-term health outcomes when they are highly involved in their own health care, and decision-making [1]. The user admits that being able to track his sleep apnea and see that over the counter treatments aren’t as effective as prescription therapies make him more willing to try CPAP. Continuing to track his progress with CPAP, will likely improve long term adherence to treatment.