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Treat Sleep Apnea With CPAP or Oral Appliance?

There is mounting evidence that regardless of the way you decide to treat sleep apnea may not be as important as treating it all night and every night. Some patients are even using both CPAP and an oral appliance in order to get a full night of treatment.sunrise-795299_1280

CPAP VS Oral Appliance to treat Sleep Apnea: What’s in it for me? A longer, healthier life!

The reasons are as varied as people, why compliance to CPAP is so low. Oral appliance compliance is better than CPAP but generally falls off after a year or two. However, oral appliance use still remains higher than CPAP over time. The type of oral appliance weighs in on compliance as well as the side effects of a change in the patient’s “bite”. Light sleepers, finicky sleepers, etc. may not tolerate CPAP, or those who have to get up during the night frequently due to other health conditions. The constant re-adjusting of the mask after getting up can contribute to the patient’s not putting it back on after having to get up a time or two.

Spouses often complain of the noise a CPAP makes, sometimes as disturbing as the snoring of the untreated apnea patient. However, newer CPAP machines are very quiet and have helped partners’ get a good night of rest too.

CPAP non-compliance varies between 29%-83% when “compliance” is measured by the current definition > 4 hrs./night for 5 nights/week. Most users in one study used the CPAP for about 3 hours. For every night not using CPAP, negates a night of compliance, one study reported. [i]

More recent studies and long-term outcome trials are beginning to suggest that regular use of an oral appliance, even if it doesn’t completely alleviate sleep apnea, may have equal or greater long-term health benefits than partial use of a CPAP (for ½ the night which is considered compliant) in terms of health outcomes.[ii] The growing number of studies suggesting equal or greater benefit of Oral Appliances with CPAP seem to all reach the same conclusion; Oral appliances are used much more regularly than CPAP. The higher use of an oral appliance despite potential lesser efficacy outweighs lower use of CPAP despite higher efficacy.

Some sleep appliances seem to have a higher rate of discontinuance than others. Oral appliances that restricted movement of the jaw, such as single piece appliances, TAP appliances, or other so called “monoblock” styles may lead to more jaw discomfort over time. This could contribute to discontinuance.

CPAP comes in two large categories; nasal styles and full face masks. Both are effective. Full-face styles place pressure on the chin and can, after a year or two trigger TMJ problems that may contribute to failure. Use of a supporting TMJ appliance with full mask CPAP is recommended for protection of the TMJ.

If you have sleep apnea and other medical conditions related to Obstructive Sleep Apnea (OSA) such as hypertension, pre-diabetes or diabetes, heart arrhythmias, weight gain; make a commitment to treat your apnea on a consistent basis. I have some patient’s who start the night with CPAP and upon waking, use the oral appliance the rest of the night if they don’t want to put the CPAP back on. That is ideal. Treatment should be all night, every night, not just for a few hours every night. This will produce a better outcome than partial use or non-compliance of either option alone.

You may not be able to prevent “getting” apnea, but you can certainly take control of the medical co-morbidities it causes by committing to full-time treatment, by whatever means you decide. Schedule an appointment today for an evaluation.

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[i] Adherence to CPAP: challenge to effective treatment. Weaver, Grunstein. Proc. AM. Thoracic Soc. 2008; 5(2):173

[ii] Health Outcomes of CPAP versus OAT for Obstructive Sleep Apnea. A randomized Controlled Trail. Supplement is available at – Am. J Resp Crit Care Med Vol 187, Iss.8, April 2013

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