CPAP Failure and Alternatives

CPAP – The Gold Standard

While CPAP (continues positive air pressure applied through a nasal mask) for years was considered the "gold standard" for treatment of Obstructive Sleep Apnea (OSA), however, it is not without its problems. Sometimes the pressure required to open the throat will make wearing the CPAP very difficult or and uncomfortable thereby greatly reducing patient compliance. Compliance simply means that a patient is regularly using their therapy as prescribed to keep their disease under control. In the case of sleep apnea, it means that the patient is using the CPAP machine every night as recommended.

CPAP Compliance

But multiple research studies have shown that CPAP compliance can be as low as 50% because of discomfort and inconvenience. Obstructive sleep apnea sufferers who do not use their CPAP machines increase their risk of heart failure, high blood pressure and stroke and are drowsy during the day and may fall asleep while driving. In addition to the increased health-risks OSA sufferers who stop wearing CPAP may continue to snore, gasp and choke loudly causing poor quality sleep and disturbing their bed partners.

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 to use the bathroom and it's too much bother to put it back on
• The mask irritates the skin and nose
• Air in the stomach, throat or sinuses
• The mask leaks air
• The pressure of the CPAP is to high/uncomfortable
• The CPAP machine is too noisy to allow sleep
• The tubing gets in the way
• The patient 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 Effective Alternative – oral appliances

Oral appliances are indicated for use in patients with mild-to-moderate obstructive sleep apnea who prefer oral appliances to CPAP, or for those 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. (Sleep. 2006 Feb.)

Custom fabricated oral appliances, which resemble sports mouth guards, are associated with a much higher 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 provided 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 follow-up sleep study.