Over the past few years, the number of adults living with obstructive sleep apnea (OSA) has steadily increased. If you’re not familiar, OSA is a sleep-related breathing disorder that impacts one’s ability to breathe during sleep. Across the world, it’s predicted that at least a billion people have this condition, with 25 million estimated to have OSA just in the United States alone [1],[2].

Alarmingly, it’s also predicted that 80 percent of all sleep apnea patients remain undiagnosed [3]. This statistic is disturbing, especially considering the consequences associated with this common condition. If left untreated, sleep apnea can lead to serious health conditions, including high blood pressure, type 2 diabetes, and stroke – and it some cases, it can even be fatal.

Why are there so many undiagnosed OSA patients?

The sleep community is worried that the number of undiagnosed OSA patients has consistently remained so high. It is especially concerning since sleep apnea is highly treatable. There are many options out there for patients to consider. When trying to wrap our heads around this health issue, it comes down to analyzing the circumstances that perpetuate a failure to diagnose.

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With sleep apnea specifically, one important obstacle for diagnosis is patient fear. Fear not just of the sleep apnea diagnosis itself, but of the treatment options available. Many people have seen or are aware of CPAP devices, the main way sleep apnea is treated, and have decided that it is not for them.

A new generation of therapy

Unfortunately, these fears are rooted in past misconceptions of sleep apnea. Because of this, many OSA patients are stopping their care journeys before they even begin. What many people don’t realize is that sleep apnea therapy options have come a long way over the past several decades. Now, there are multiple solutions that have been uniquely designed using a patient-centric approach.

Newer solutions offer improved comfort, ease of use and support increased mobility for sleep apnea patients – all to ensure that patients stay adherent to their treatment plans.  Instead of being afraid of treatment, patients need to give themselves a chance to find the best solution for their unique needs.

As with most chronic conditions, there are a million questions that go through a patient’s mind after an initial sleep apnea diagnosis. As sleep experts, it’s our job to work with OSA patients to determine the best treatment plan for both their specific condition and their lifestyle.

Even in patients who do seek a diagnosis, we can face barriers with treatment. Unfortunately, patients can struggle to adhere to some prescribed treatments. This is because some therapies are uncomfortable and interfere with sleep habits.

But sleep apnea therapy has changed.

Not your father’s CPAP

Traditionally, the gold standard for sleep apnea therapy has been Continuous Positive Airway Pressure (CPAP). CPAP machines work by sending a constant flow of air pressure to the patient’s throat during sleep. This keeps the airway open and thereby treats the pauses in breathing associated with sleep apnea. As an additional benefit, many patients stop snoring, breathe regularly, and get a restful night of sleep with CPAP therapy.

However, people can find it difficult to adjust to sleeping with their CPAP equipment. Patients will sometimes complain about difficulty moving around in their sleep. They struggle with the pressure in their nose and airway. Some even struggle to comfortably watch TV before bed because of their masks.

Thankfully, there are new advancements in sleep technology that are paving the way for new options for more comfortable yet equally reliable treatment. No longer the bulky machines of the past, modern CPAPs, and their accompanying masks are:

  •  smaller and quieter
  •  portable
  •  offer greater ease of movement during sleep
  •  provide precise pressure control at the lowest effective pressures

Newer CPAP mask designs even include cushion options for additional comfort. Some have open-face masks that allow for the ability to comfortably wear glasses, read and simply relax in bed. In addition, other options and alternatives continue to present themselves.

Related Content:  How Your Dentist Can Help with Sleep Apnea [Author’s note: click the link to learn more about Mandibular Advancing devices (MADs) which are effective therapeutic options for OSA.]

Positional therapy: non-invasive and just as effective

Even with these new innovations that offer more freedom and comfort for CPAP users, sometimes CPAP therapy just doesn’t just fit in with a patient’s lifestyle. For patients living with a certain subset of sleep apnea, there is another option for successful treatment: positional therapy.

Patients with positional OSA primarily experience disruptions in breathing when sleeping on their backs. In fact, it’s estimated that up to 47% of all sleep apnea cases are positional [4]. In the past, these patients have gone to extreme efforts to avoid sleeping on their back – with some resorting to sleeping with a tennis ball sewn into the backs of their pajamas to encourage sleeping on the side.

As an alternative method to CPAP therapy, positional therapy wearables like Philips NightBalance work by encouraging users to remain off their back with gentle vibrations. As one of the most non-invasive sleep apnea therapy methods, positional devices are lightweight, portable, and easy to use. Like CPAP, they have also been proven to reduce the snoring that is typically associated with sleep apnea.

As an additional perk, positional therapy devices have demonstrated high adherence rates. A recent study in the Journal of Clinical Sleep Medicine found that short-term adherence with positional sleep apnea devices jumped from 75 to 95% when compared with other sleep apnea therapy methods [5],[6]. A clinical trial also found that these positional devices are effective in reducing Apnea–Hypopnea Index (AHI), an indicator of the severity of a patient’s OSA [7], [8].

Surgery is for sleep apnea is an option 

Some patients seek a solution that will fix or cure their sleep apnea so that ongoing therapy is not required. One such option is surgery of the upper airway.

-Surgery to enlarge the airway

Most such procedures are aimed at enlarging the airway in the area behind the palate and tongue. This is generally accomplished by removing tissue or rearranging the tissue in such a way that the airway remains open during sleep when the pharyngeal muscles relax.

However, it must be realized that these procedures do not work in everyone and an examination of the airway under general anesthesia is often required to determine in whom such procedures will work and which procedure would be best for each patient.

-Hypoglossal nerve stimulation

A new approach to OSA therapy called hypoglossal nerve stimulation (HGNS) has emerged over the last 4-5 years. This therapy involves the placement of a nerve stimulator under the skin on the chest which is connected to the nerve that controls a muscle under the tongue which opens the airway.

This device is turned on at night and, in many patients, can effectively treat OSA [9]. However, it only works in patients with very specific characteristics such as only a moderately elevated body mass index (BMI) and those not collapsing at certain places in the airway. Because of this, as described above, an examination of the airway under general anesthesia is usually required.

Looking ahead

Solutions like positional therapy and HGNS give me a great sense of hope for the future of sleep apnea diagnosis and treatment. Through years of research, sleep therapy companies have begun to develop patient-centric therapies that are fundamentally changing the way patients live with sleep apnea.

Another hope for the future is drug therapies for OSA. Although there are currently no FDA-approved therapies to treat sleep apnea, studies suggest that this may well be possible. [10]

As a result of these advances, people suffering from this chronic condition no longer have to fear diagnosis or treatment plans. Instead, they can move forward on a path to living more healthy and restful lives.

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[1] Benjafield A, Ayas N, Eastwood P, et al. Estimation of the global prevalence and burden of obstructive sleep apnea: a literature-based analysis. Lancet Respir Med 2019, Aug 7(8):687-698.

[2] https://aasm.org/rising-prevalence-of-sleep-apnea-in-u-s-threatens-public-health/

[3] https://www.sleepapnea.org/learn/sleep-apnea-information-clinicians/

[4] Heinzer, R. et al, Prevalence and Characteristics of Positional Sleep Apnea in the HypnoLaus Population-based cohort, Sleep Medicine 2018; 48:157-162

[5] Long-term effectiveness and compliance of positional therapy with the Sleep Position Trainer in the treatment of positional obstructive sleep apnea syndrome. van Maanen JP, de Vries N. SLEEP 2014;37(7):1209-1215.

[6] Benoist, L., de Ruiter, M., de Lange, J., & De Vries, N. A randomized, controlled trial of positional therapy versus oral appliance therapy for position-dependent sleep apnea. Sleep medicine. 2017 34, 109-117

[7]  Berry R, Uhles M, Abaluck B, et al. NightBalance Sleep Position Treatment Device versus Auto-Adjusting Positive Airway Pressure for Treatment of Positional Obstructive Sleep Apnea. J. Clin Sleep Med. 2019 July 15:15(7):947-956.

[8]  Eijsvogel, M. M., Ubbink, R., Dekker, J., Oppersma, E., de Jongh, F. H., van der Palen, J., & Brusse-Keizer, M. G. (2015). Sleep position trainer versus tennis ball technique in positional obstructive sleep apnea syndrome. Journal of clinical sleep medicine, 11(02), 139-147.

[9] Strollo P, Soose R, Maurer J, et al; STAR Trial Group. Upper airway stimulation for obstructive sleep apnea. New Engl J Med. 2014 Jan 9;370(2):139-49.

[10] Taranto-Montemurro L, Messineo L, Sands S, et al. The Combination of Atomoxetine and Oxybutynin Greatly Reduces Obstructive Sleep Apnea Severity: A Randomized Placebo-controlled Double-Blind Crossover Trial. Am J Respir Crit Care Med. 2019 May 15;199(10):1267-1276.

Editor’s note: Although the author is employed by Philips Sleep and Respiratory Care and they could benefit from this article, we have accepted it for publication because it contains valuable information for our readers. This post has not been sponsored by Philips.

One of the leading causes of death in the United States, chronic obstructive pulmonary disease, or COPD, affects millions of Americans.

Known also as chronic bronchitis or emphysema, many mistake COPD’s slowly oncoming, but steadily-worsening signs and symptoms – shortness of breath, chronic coughing, and wheezing – as problems that naturally come with aging or being out of shape.

This can often lead to a delay in seeking medical treatment and therefore getting diagnosed. If left undetected, this devastating lung disease can greatly impact one’s quality of life and ability to complete everyday tasks.

Thankfully, the disease is treatable.

Misconceptions about COPD

COPD affects people across the country. However, there are misconceptions about,

  • how many people actually have the disease,
  • who is most at risk, and
  • where they live.

COPD is greatly underdiagnosed.

While about 16 million people have been diagnosed, we estimate that several million more have the disease without knowing it.

-COPD has been mislabeled as a “man’s disease.”

Yet 56 percent of patients with the disease are women.

-Misconceptions about where patients live

Data released in CDC’s Morbidity and Mortality Weekly Report (MMWR) show that the percentage of adults in rural areas who have been diagnosed with COPD is nearly double the percentage in large urban areas, according to 

Cigarette smoking is the main risk factor for COPD.

So, what’s behind these dire numbers? For the most part, it is cigarette smoking.

Smoking is the main risk factor for and cause of COPD. But the story is not as simple as that, as up to 25 percent of people with COPD have never smoked.

Long-term exposure to other lung irritants—such as air pollution, chemical fumes, or dusts—also may contribute to COPD. A rare genetic condition called alpha-1 anti-trypsin (AAT) deficiency can also cause the disease.

The cost of COPD 

Whatever the reason a person gets the disease, the impact on society is profound. And it continues to grow.

In 2010, Americans spent more than $32 billion on COPD-related patient care. Those costs are projected to increase to $49 billion by 2020. Most costs are associated with hospital care.

In the next five years, hospitalizations for COPD will exceed those for heart disease.  

Currently, heart disease is the number one reason people are hospitalized. Compounding the economic problem is COPD’s grave impact on work: more than half of COPD patients report that their disease hinders their ability to do their jobs.  

Communication Matters

Given the serious, often deadly, consequences of the disease, why do so many Americans go undiagnosed? Qualitative research points to a communications gap between patients and their health care providers.[1]

While one in 10 adults experience signs or symptoms of COPD, only seven in 10 of these adults report talking to their health care provider about their signs or symptoms. Primary care providers believe that a major barrier to diagnosis is patients not fully reporting their symptoms during visits.

This communications barrier on both sides of the patient and health care provider relationship remains a challenge for diagnosing and treating patients with COPD.

The most important way to get care to those who need it is to encourage patients and health care providers to speak frankly with each other. That way a patient’s history of exposure to lung irritants and his or her disease symptoms can come to light—and a plan of care prescribed.

How else can we help ease the burden of the disease?

Consider these three critical steps:

1. Prevent COPD before it starts.

The best way to do this is to avoid tobacco smoke or to quit smoking.

If you smoke, talk with your health care provider about what to do to help you quit. A variety of medications on the market can bolster your efforts. In addition, joining a support group can keep you motivated.

Also, try to avoid lung irritants that can contribute to COPD, such as air pollution, chemical fumes, dust, and secondhand smoke. Ask your family members and friends to support you in your efforts to be lung health conscious.

2. If you already have COPD, prevent complications and slow the progression 

Avoid exposure to the lung irritants mentioned above and follow the treatment plan your health care provider prescribes.

Providers can

  • help you breathe easier,
  • stay more active, and
  • avoid or manage exacerbations (a sudden worsening of symptoms).

Stay up-to-date on vaccinations. People at risk for or with COPD should do as much as they can to protect themselves against influenza (the flu) and pneumonia. These vaccines can lower the chances of getting these illnesses, which are major health risks for people who have COPD

3. Consider pulmonary rehabilitation if standard treatments are not enough.

Research data show positive outcomes from pulmonary rehabilitation, which may help certain people with COPD live and breathe better.

Also known as respiratory rehabilitation, pulmonary rehabilitation is an exercise and support program for people with a chronic respiratory disease who remain symptomatic or continue to have decreased function despite standard medical treatment.

An important part of the management of the disease, it is most effective when started in the moderate stage of COPD. But even people who have advanced stage lung disease can benefit as it helps reduce overall symptoms, increase physical activity, improve daily life function, and improves psychological health.

Related Article:  At Home Noninvasive Ventilation for COPD Saves Time & Money

These recommendations focus on what people living with and at risk for COPD can do to improve their health.   

We at the National Heart, Lung, and Blood Institute (NHLBI) are committed to helping everybody across the country understand COPD and become aware of what is at stake.

COPD National Action Plan

In 2017, we worked with federal and non-federal partners across the country to release the first COPD National Action Plan, which provides a framework for unified action by all Americans to reduce the burden of the disease.

The plan is built on five distinct goals that address the needs of the entire community including:

  • people at risk for COPD
  • people who live with the disease
  • caregivers
  • health care providers
  • advocacy groups
  • researchers
  • payers and health systems
  • policymakers

Want to join us in our efforts? Through the COPD Learn More Breathe Better® program, NHLBI offers a variety of educational resources to help increase awareness and understanding about COPD among patients, their families and caregivers, and health care providers.   

  Together, we can all work to help people
with COPD breathe better.



  1. COPD: Tracking Perceptions of the Individuals Affected and the Providers Who Treat Them2018 Report. National Heart, Lung, and Blood Institute. Available at: https://www.nhlbi.nih.gov/health-topics/education-and-awareness/copd-learn-more-breathe-better/data-perception-awareness

[Author]: Statements provided in this blog are for informational purposes only and do not constitute medical advice or recommendations.

Chronic respiratory diseases are among some of the most common and costly health problems, affecting millions of people all over the world. One respiratory condition in particular that remains a growing concern for the healthcare industry is chronic obstructive pulmonary disease (COPD).

COPD is one of the leading causes of death, third in the U.S. and estimated third worldwide by 2030. In addition to the millions of patients already diagnosed, COPD is commonly misdiagnosed and underdiagnosed, with a predicted 12 million Americans to have the disease without even knowing it. Not only is COPD among the most common and most debilitating to patients, but it also places an economic burden on the healthcare industry. The disease is a reason for substantial increases in costs, due to the result of inpatient readmission rates, with associated costs estimated to be $50 billion by 2020.

Despite the number of affected people and costs associated with COPD, the conversations continue to be limited around awareness, diagnosis, and treatment options. While there is no cure for the disease, there are a range of treatment options that physicians can provide their patients, whether they are newly diagnosed or late-stage that can help to improve their quality of life.


It all starts with a proper diagnosis

COPD can be easily misdiagnosed as it has similar symptoms to many other lung conditions. Early COPD symptoms can include shortness of breath, a chronic cough, and body fatigue that might be misinterpreted by patients, as signs of the normal aging process. Patients should be encouraged to come forward with these symptoms, especially if they are a current or past smoker. Doing so allows physicians to provide reliable lung assessments such as spirometry, which can help detect COPD earlier before major lung damage develops. Physicians can then assist patients with a personalized treatment plan that will enable them to live a better, fulfilled life.


Coming to terms with your diagnosis

Receiving a COPD diagnosis is life changing for a patient and frequently is followed by the question “now what?” A diagnosis requires patients to change their current lifestyle and regular routine. Education is key, as many COPD patients don’t know what it means to have COPD, how it will impact their current lifestyle, habits, and relationships, and the available treatment options that can help manage their condition.

While COPD is a chronic condition, it doesn’t need to be a debilitating disease. There are steps patients can take such as creating an action plan for future exacerbations, exercise to strengthen lung function, attend pulmonary rehabilitation, and, of course, quit smoking. The most critical component to understanding COPD is making patients aware of available treatment options that can drastically change their lives for the better. Patients must have a more educated conversation with their physician about care management programs and the available care therapies.


Leveraging existing treatment options for improved care

An ongoing challenge for the healthcare industry is finding the right therapy for COPD patients. Each patient is at a different stage of the disease with different symptoms, and there is no “one size fits all” approach for COPD.

Advances in scientific knowledge have led to better therapies for COPD. Positive airway pressure (PAP) therapy, specifically noninvasive ventilation (NIV) therapy, is a treatment used to reduce blood CO2 levels in COPD patients. NIV therapy tailors ventilation pressure to match the patient’s breathing patterns in order to maximize oxygen and has shown to alleviate symptoms of respiratory discomfort. It has also been shown to reduce readmissions and save money.

In addition to PAP therapy, other novel treatment options are nebulizers, designed to provide fast and efficient aerosol drug delivery with shorter treatment times and portable oxygen concentrators that help to provide patients’ with the freedom to live a full life.


Study: Advanced NIV saves reduces hospitalizations and saves money

A Philips-funded study demonstrated that both hospitals and payers can benefit from significant reductions in hospitalizations, readmissions, and healthcare costs by providing patients with NIV therapy at home in the context of a multifaceted program that includes oxygen therapy, respiratory therapist-led care, patients education, and medication reconciliation.

The study, titled, “Cost Savings from Reduced Hospitalizations with Use of Home Noninvasive Ventilation for COPD,” compared savings associated with the use of advanced NIV, less advanced NIV (a respiratory assist device with bilevel pressure capacity), or no NIV. Savings were calculated at 30 and 90 days for 250 patients with severe COPD in a single hospital study and 3 years cumulative for 100,000 patients in a payer database.

The advanced NIV used in the study was the Philips Trilogy 100 with AVAPS-AE mode. The Trilogy is a portable ventilator designed for use outside of the hospital. AVAPS-AE is an auto-titration mode of NIV with multiple algorithms that work simultaneously to meet the changing needs of individual patients. It’s three main components are:

  • AVAPS – automatically adjusts to a patients breathing
  • Auto-EPAP – proactively adjusts peak air pressure to the lowest effective level for patient comfort
  • Auto-backup – reduces air trapping by delaying a machine breath until the patient has exhaled

Key findings of the study were the following:

  • A reduction in hospitalizations led to cumulative savings of $402,981 over 30 days and $449,101 over 90 days with a multifaceted therapy approach using Philips Trilogy in-home advanced NIV therapy versus no NIV treatment or less advanced NIV therapy devices.
  • Payers studying admissions of 100,000 severe COPD patients had cumulative 3-year savings of $326 million when using home NIV in comparison to no NIV treatment.


Providing improved COPD care through

With the industry shifting toward a value-based care model, physicians are looking for innovative, patient-centered care through proven, multifaceted treatment options that provide both better patient care and lower healthcare costs associated with that care. As the number of COPD patients continue to rise and technology continues to improve delivery of effective therapy, we have a vast opportunity to achieve both goals.