cpap
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
Multiple research articles have shown that CPAP compliance can be as low as 50% because of discomfort and inconvenience. Obstructive sleep apnea 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
Still there is hope. Oral appliance therapy, provided by dentists specifically trained in the use of these devices, can be an effective alternative to CPAP. A recent parameters paper published in the journal Sleep 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
Although not as efficacious as CPAP, oral appliances are indicated for use in patients with mild-to-moderate obstructive sleep apnea who prefer oral appliances to CPAP, or who do not respond to CPAP, are not appropriate candidates for CPAP, or who fail treatment attempts with CPAP or treatment with behavioral measures such as weight loss or sleep-position change.
Oral appliances, which resemble sports mouthguards are associated with better compliance than CPAP systems for many patients. Oral appliances can also be used as first-line treatment for primary snoring that is not associated with obstructive sleep apnea.
These appliances should be fitted by dentists specifically trained in oral appliance therapy and those experienced in treatment of temporomandibular joint and dental occlusion. Treatment with oral appliances should be followed on a regular basis and have follow up polysomnography.
