Treating sleep apnea by treating the tongue

In Belgium, the number of people needing a ventilator (CPAP) to sleep has risen by 30% in five years: there are more than 170,000 people, according to Enami figures. But 20 to 30% of patients do not tolerate the CPAP machine well in our country (45% in France). Why ? “In one out of every three cases, the cause is psychological“, says Professor Moenj. There are often problems with their relationship, their self-image, or even claustrophobia…”

But a CPAP machine isn't the only way to treat sleep apnea. While a mandibular advancement brace moves the jaw forward to open the airway, other methods focus more on the tongue area.

Testimony of Matteo, who suffers from excessive sleepiness

1. Linguistic rehabilitation

Physiotherapists and speech therapists practice tongue rehabilitation. The difference between the two: Speech therapy sessions must take place as part of orthodontic treatment to be compensated, while physical therapy sequences are prescribed by a doctor.

“Physical therapy is intended for mild to moderate apnea“, explains Alison Ankert, physiotherapist at Greater Charleroi Hospital. Through daily exercises, we strengthen all the muscles that are part of the breathing tube. But these are exercises that must be maintained over the long term, at least five days a week.“.

“This effect of bodybuilding was demonstrated by a study conducted by Guy Mares among football players. Didgeridoo, Dr. Mueng said. Regarding several elements, including their weight, research showed that sleep apnea was less significant in these musicians than in the general population. But the sleep scientist adds: “I've had patients who did exercises. Once they were stopped, polysomnograms showed worsening apnea, as if the super-trained tongue had fatty infiltration, after it was released.“

But bodybuilding is not the only component of rehabilitation, whether physical therapy or speech therapy. “I work a lot on nose breathing as well as ventilating the abdomen and relaxing the diaphragm.“, says Marine Lebastard, A specialized speech therapist, so that the patient can breathe properly. Often, these patients have a very tense diaphragm, which leads to successive obstructions at the laryngeal level. We also work on relaxing the floor of the mouth“.

2. Stimulate the hypoglossal nerve

Since April 2023, Enami has also reimbursed the costs of an innovative treatment: hypoglossal nerve stimulation. Currently, only two centers perform the procedure: UZA Antwerp and Saint-Luc University Clinics. This should happen soon in Wallonia.

This technique consists of placing implants around the tongue nerve, the hypoglossal nerve, which controls tongue contraction (the tongue is made up of eight pairs of muscles). This treatment has been paid for since 2023 because it has proven its effectiveness: “A 65% reduction in the apnea and hypopnea index, i.e. the number of times the apnea stops per hour“.

For whom is this ? The first criterion: The apnea must be moderate, i.e. less than 65 apnea per hour. “The second criterion is more difficult to meet: that the collapse – that is, the closure of the airways – must not be complete.Therefore, the otolaryngologist must ensure closure, by passing an endoscopic camera through the nose of the sleeping patient, under anesthesia. “This second factor is very limited, He meets Professor Mueng. toOverall, only one in ten patients qualifies for neurostimulation“.

For patients who do not want a CPAP machine and are eligible, the procedure is performed in a day hospital. Then, instead of traveling with the air-blowing machine, they would just have a small device, an implant that could be reminiscent of a pacemaker, with a remote control that could be placed on the chest to recharge the device's battery by induction.