CPAP – The “Gold Standard”
While CPAP (continuous positive air pressure applied through a nasal mask) is considered the “gold standard” for treatment of obstructive sleep apnea (OSA), it is not without its problems. CPAP, when used, will control obstructive sleep apnea 100% of the time but there is a problem with patient compliance. Compliance simply means that a patient is following their doctor’s orders to keep their disease problem under control. In the case of sleep apnea, it means that the patient is using the CPAP machine every night as recommended life-long.
CPAP Compliance
But multiple research articles have shown that CPAP compliance can be as low as 50% because of discomfort and inconvenience. OSA sufferers who do not wear their CPAP machines increase their risk of heart failure, high blood pressure and stroke and are drowsy during the day and fall asleep while driving. OSA sufferers who stop wearing CPAP often snore, gasp and choke loudly disturbing their bed partners placing a strain on relationships and marriages.
Some of the common problems that people experience with CPAP are:
- The mask is uncomfortable.
The mask is taken off at night without knowing it
- The mask is taken off at night to use the bathroom and it’s too much bother to put it back on
- The mask irritates the skin and the nose
- Air in the stomach or sinuses
- The mask leaks air
- The pressure of the CPAP is bothersome
- The CPAP machine is too noisy to allow sleep
- The tubing gets in the way
- You just can’t get used to the mask
- The mask gives you a feeling of claustrophobia
- Your nose can be stuffy because of a cold or allergies
- The air is too hot, too cold or too dry
Whatever the reason, some people just cannot tolerate CPAP.
The Alternative – Oral Appliances
An oral appliance is an orthotic device custom made to fit over your teeth. It is worn only at night while you sleep. It is small, discreet, portable and holds your jaw and/or tongue in the correct position to optimize your airway. A major cause of OSA is the tongue falling back when asleep and partially or completely blocking the airway.Oral appliances are associated with better compliance than CPAP systems for many patients. Treatment with oral appliances should be followed on a regular basis and have follow up polysomnography (PSG). Oral appliances can also be used as first-line treatment for primary snoring that is not associated with obstructive sleep apnea.
Oral Appliance Therapy
Oral appliance therapy, provided by dentists specifically trained in the use of these devices, can be an effective alternative to CPAP. A Practice Parameters report published February 1, 2006 in the journal Sleep volume 29, Number 2 by the American Academy of Sleep Medicine stated that oral appliances can be used as first-line therapy in some patients for treating mild-to-moderate obstructive sleep apnea. The guidelines state:
"Oral appliances (OAs) are indicated for use in patients with mild to moderate
OSA who prefer them to continuous positive airway pressure (CPAP) therapy, or
who do not respond to, are not appropriate candidates for, or who fail
treatment attempts with CPAP. Until there is higher quality evidence to
suggest efficacy, CPAP is indicated whenever possible for patients with
severe OSA before considering OAs. Oral appliances should be fitted by
qualified dental personnel who are trained and experienced in the overall
care of oral health, the temporomandibular joint, dental occlusion and
associated oral structures."
Advantages of oral appliance therapy
Oral appliance therapy has several advantages over other forms of therapy:
Oral appliances are comfortable and easy to wear. Most people find that it only takes a couple of weeks to become acclimated to wearing the appliance.
Oral appliances are small and convenient making them easy to carry when traveling.
Treatment with oral appliances is reversible and non-invasive.
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