Want to try Provent Sleep Apnea Therapy? Learn about one of the most popular CPAP alternatives with our comprehensive guide.
Introduction to Provent sleep apnea treatment: Is it right for you?
Have you been diagnosed with obstructive sleep apnea (OSA) and CPAP was recommended, but the thought of sleeping with a mask on your face makes you cringe? Perhaps you've been ducking your doctor because you know she's going to try to twist your arm into getting a machine, but you're quite certain that there's no possible way you could tolerate it. You do some research online and the health consequences of untreated sleep apnea alarm you: heart attack (myocardial infarction), TIA (ministroke), stroke, arrhythmias, sudden death, high blood pressure (hypertension), dyslipidemia (high cholesterol), type 2 diabetes, acid reflux (GERD)...the list goes on and on. Now you're motivated to do what you can do treat this medical problem. While researching CPAP alternatives you come across an article (maybe the one in the New York Times) about something called Provent Sleep Apnea Therapy. Hmmm...looks interesting. No machine? No mask? "But how do I know this is right for me?" you wonder. At Singular Sleep, we've encountered many patients like you. Here is a primer on the Provent apnea breathing device to help you decide whether it's right for you or not. Will Provent prevent apnea or will it be just as bad as a CPAP sleep apnea machine?
What is Provent?
Provent is considered one of the CPAP alternatives. It was approved by the FDA for obstructive sleep apnea (OSA) and was brought to market by Ventus Medical, Inc. in 2009. The Provent technology is now owned by Provent Sleep Therapy, LLC.
Provent uses resistors embedded in adhesive patches that fit over the patient's nostrils to generate nasal expiratory positive airway pressure (EPAP or nEPAP). During inhalation, air flows through the nasal devices but during exhalation, air is sent backward, resulting in pneumatic splinting of the posterior upper airway. This is effective because repetitive collapse of the posterior upper airway is the physiological mechanism behind OSA.
Each Provent package contains two Provent EPAP patches, and each patch is comprised of a nasal insert with resistors and adhesive. At bedtime, the Provent device is attached to the nose, fitting over the nostril.
The Two Types of Provent
- two nights of light resistance
- two nights of medium resistance
- 26 nights of standard resistance (SR)
2) Provent Sleep Apnea Therapy 30-Night Standard Pack - also known as Provent Standard Resistance (SR)
Provent's manufacturer advises that it may take a week or more to get used to Provent. They recommend initiating therapy with the starter kit as this has been shown to improve long-term tolerance of the nasal device. Patients that have used Theravent prior to Provent might consider jumping right into the standard resistance.
How does one get Provent?
To be a candidate for Provent sleep apnea treatment, you will first need to undergo a sleep study. Formerly, this required spending a night in a sleep lab to have a full polysomnogram, but now a home sleep apnea test is sufficient for establishing the diagnosis. Your degree and type of sleep apnea will determine if you're a candidate for Provent (see discussion below). Provent is considered a legend medical device, meaning that a prescription is required for a durable medical equipment company to dispense it, so you will need to obtain the Rx from your doctor. The majority of primary care physicians, and even your sleep doctor, may be reluctant to prescribe you Provent. These doctors may be unfamiliar with using Provent to treat sleep apnea and probably have not read the research studies proving Provent's effectiveness in treating OSA. You will need to find a sleep apnea doctor who is familiar with prescribing Provent. Some suppliers may provide you a Provent trial pack should you request one.
Who is not a good Provent candidate?
If your sleep apnea is severe - an apnea-hypopnea index (AHI) >30 - most sleep doctors would not recommend Provent for sleep apnea as a first-line treatment. In my opinion, the best research study to be mindful of when considering Provent treatment was a trial that found an approximately 50% reduction in the AHI with use of the device. As sleep doctors, our goal is generally to try to get the patient's AHI <5, but we acknowledge that a perfect result is not always possible. Based on this study, Provent is a good choice for patients with mild-moderate sleep apnea. It is a reasonable second-line treatment for severe sleep apnea if you cannot tolerate CPAP or BiPAP. Also, some CPAP and BiPAP users develop central sleep apnea with the use of those machines - called "complex sleep apnea" - and Provent therapy is useful in this situation.
According to the Provent instructions from the manufacturer's guide, here is the complete list of contraindications for Provent for sleep apnea:
- severe breathing disorders including:
- hypercapnic respiratory failure: research has shown that Provent results in a moderate but stable increase in blood carbon dioxide in some patients
- respiratory muscle weakness
- bullous lung disease - as seen in some types of emphysema
- bypassed upper airway, e.g, tracheostomy
- severe heart disease - including heart failure
- pathologically low blood pressure
- an acute upper respiratory inflammation or infection, e.g., acute sinusitis, otitis media, upper respiratory tract infection (URI)
- perforated eardrum
To expand on these restrictions, patients with more complicated sleep breathing problems beyond obstructive sleep apnea are not good candidates for Provent treatment. Patients with sleep related hypoxemia (decreased blood oxygen) or hypercapnea (elevated blood carbon dioxide) due to medical conditions like COPD, heart failure, restrictive lung disease, and neuromuscular disease (including obesity hypoventilation disorder) are not good candidates for Provent. Provent might be beneficial in treating the obstructive component of the sleep related breathing disorder but not the "gas-exchange" problem, i.e., the abnormality in blood O2 and/or CO2 levels. More advanced forms of BiPAP such as BiPAP ST and ASV are needed for these conditions.
Also, patients with central sleep apnea syndromes, including Cheyne Stokes respirations and central sleep apnea due to neurological disorders and medications, are not good candidates for Provent. In terms of medication-related central sleep apnea, you might be at risk if you take opiate medications like Norco, Dilaudid, Percocet, morphine, Fentanyl, and Oxycontin. Even Suboxone, which is used for opiate withdrawal, has been implicated in central sleep apnea.
Due to the mechanism of Provent EPAP, mouth breathers may not be good candidates for the device. The resistance in the Provent nasal valves may promote mouth breathing. We have had some patients try using a CPAP chin strap in conjunction with Provent nasal EPAP with mixed results. Longer term strategies to ameliorate nasal congestion or chronic sinusitis, such as dual nasal saline sinus rinse and topical nasal steroid therapy, may improve nasal stuffiness and promote success with Provent therapy for sleep apnea. Typically, daily treatment with this regimen will be needed for weeks to several months to promote better cilia (the hair-like projections on the cells that line the upper respiratory tract and whisk away mucous) function in the upper respiratory tract and decrease nasal congestion and sleep-related mouth breathing. Antihistamines may be of some benefit in chronic sinusitis treatment if there is a known allergic component.
Provent for Sleep Apnea Reviews:
Generally, patients love Provent. Now, take this with a grain of salt because there is likely a selection bias at play here. Patients that are completely opposed to CPAP tend to gravitate towards Provent and feel relieved that there is a non-mask, non-machine sleep apnea solution. Some patients use both CPAP and Provent (but not at the same time), typically switching to Provent when they're traveling due to its convenience and portability, especially when electricity is unavailable or unreliable. In our experience, the most consistent complaint that arises with Provent sleep apnea reviews, is the Provent price: Provent is rarely, if ever, covered by health care insurers. However, patients can use their HSA or FSA to pay for it and it will count toward their deductibles as a qualified medical expense. Patients frequently notice minor skin irritation from the adhesive but this is usually not severe enough to cause them to discontinue use of the treatment
When you compare Provent vs CPAP in patient reviews, Provent typically tops CPAP in terms of patient preference.
Provent vs CPAP
I like to tell patients that when it comes to Provent vs CPAP, a treatment that is 85% effective that you're going to use 100% of the time is better than a treatment that is 100% effective but that you're going to use 0% of the time. If there's a high probability that a CPAP machine is going to end up gathering dust in your closet, then Provent is a great option.
In reality, Provent will not be as effective as CPAP for most users, but if you'll use it and you know you won't ever use CPAP, the math works out in your favor. I do recommend that, if patients choose Provent, we follow up to evaluate Provent effectiveness, both subjectively and objectively. Subjectively, I want to get feedback from the patient as to whether the quality of their sleep has improved: Are they waking up less during the night? Feeling more rested upon waking? Any change in daytime fatigue and sleepiness levels on our standardized questionnaires? Also, have the snoring and other breathing symptoms, i.e. witnessed apneas, nocturnal snorting, choking and gasping, been resolved? Objectively, a repeat limited sleep study while using Provent is the best course of action. I say "limited sleep study" because the Provent nasal strips will prevent effective signal acquisition from the nasal pressure sensor, i.e. the nasal cannula, used to measure airflow. However, valuable information can be gleaned from the effort belt recording (the strap that goes across the chest in a home sleep study) in conjunction with the pulse oximeter (the sensor that measures blood oxygen levels). If a limited sleep apnea study is not possible, nocturnal pulse oximetry to ensure that there is no residual hypoxemia (drops in oxygen saturation below 90%) while using Provent is advisable.
Provent vs Theravent
Theravent is a non-prescription product marketed to help stop snoring. Theravent was launched in 2012 as a Provent spinoff. As of 2016, Theravent is available at CVS, Walgreens, other pharmacies and on Amazon. Provent is not available through these channels. Some of our patients have used Theravent first as a snoring aid and found it to be helpful but have subsequently been diagnosed with sleep apnea and switched to Provent due to its proven track record in treating OSA. Customer reviews of Theravent have generally been positive when compared to other snoring remedies such as nasal sinus rinse, Breathe Right strips, intra-nasal stents, and anti-snore pillows. As with Breathe Right strips, the device's adhesive may irritate the skin. Theravent comes in three different strengths. The one that's closet to Provent is likely Theravent Max.
Where to buy Provent
If you have a Provent prescription, you can purchase it at a durable medical equipment store, either online or at a brick-and-mortar location.
Provent for sleep apnea cost
Generally, the market rate for a 30-day supply of Provent is about $65.
Joseph Krainin, M.D., FAASM is the founder of Singular Sleep, the world's first online sleep center. He is a Fellow of the American Academy of Sleep Medicine and board certified in both sleep medicine and neurology. He has been practicing medicine for over 10 years.
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