The Best Sleep Apnea Treatment: CPAP vs. Oral Appliances: A Question of Compliance and Effectiveness

[PR-USA.net] — What is the best sleep apnea treatment? It is not CPAP, according to a recent study that showed 60% of patients abandon CPAP use. At least it is not the best treatment for the 60% of patients who abandoned it. This does not mean CPAP is not the most effective treatment, what it means is no matter how effective a treatment may be, it is a poor treatment if it is not used. Oral appliances are an extremely effective treatment for mild to moderate sleep apnea but less effective for morbidly obese patients and those with severe sleep apnea.

Oral appliances are the “Best Sleep Apnea Treatment” because patients actually use them. Compliance issues have always been the biggest problem with CPAP. Studies have shown most patients quit CPAP completely but even patients who use CPAP average only 4-5 hours/ night 4-5 nights a week. That is not the best treatment but it is better than no treatment. The best site for information on oral appliance therapy and dental sleep medicine is http://www.ihatecpap.com.

Medicare recognized how poor CPAP compliance was and now has minimum usage schedules for CPAP that will save Medicare millions of dollars because such a small percentage of patients actually utilize their machines on a regular basis.

CPAP is the “best treatment” for the 25% of patients who love their CPAP, and use it all night, every night.

Oral appliances may be less effective across a range of all patients at eliminating sleep apnea but they are much more effective at achieving patient compliance. A treatment that is used will always be superior to a treatment that is not used.

Oral appliance success can be greatly improved by titration of appliances in the sleep lab. When an appliance eliminates sleep apnea based on a sleep study it is effectively equivalent to CPAP. The issue of compliance almost always favors oral appliances but objective monitors for oral appliance use are not yet available. They probably will be available in the very near future making oral appliances a leading choice of sleep medicine physicians who care about patients desires.

The best treatment is one that works and is used. For most patients with mild to moderate sleep apnea the best treatment is an oral appliance due to much higher compliance. If compliance is equal and CPAP or appliances are equally effective than both would qualify as the best treatment. The patient can chose their desired treatment. Studies have shown the majority of patients offered a choice prefer a comfortable oral appliance over CPAP.

Some severe sleep apnea patients refuse CPAP, for those patients an oral appliance is superior to “no treatment”.

CPAP is almost always the best treatment for the morbidly obese patients but an oral appliance is still better than no treatment if CPAP is refused.

There are patients who are severe and/or morbidly obese and the “best treatment” is actually combination treatment of an oral appliance and CPAP combined. A mask retained by the teeth instead of straps may be considerably more comfortable for many patients and lower pressure from combined use makes CPAP easier to tolerate.

The best treatment may be CPAP but with a custom made nasal mask that is made from an impression of the patients face similar to how dentures are made. Custom masks combined with oral appliances are a new entry in the field coming from airway management.

Cleanliness is of major importance with both CPAP and oral appliance treatments. Dirty masks and hoses can lead to sinus infections, bronchitis and pneumonia while poor oral hygiene with an oral appliance can lead to periodontal disease. Dr Shapira advise all patients to keep their masks and hoses scrupulously clean. It is vital to be just as thorough in cleaning oral appliances and in maintaining oral hygiene care when wearing an oral appliance. They are not well suited for patients who do not regularly brush their teeth.

What is the best CPAP mask for patients who utilize CPAP? Studies have shown that different masks and machines usually do not increase patient compliance but they do increase comfort for patients who actually use CPAP. Other studies have shown that patients’ usage of CPAP initially predicts long term compliance with CPAP. Patients who reject CPAP initially rarely embrace CPAP use in the long term. What is the best CPAP mask? A mask the patient actually uses. This will be very patient specific.

What is the best type of CPAP machine? There is standard CPAP machines that come in many styles and shapes. The industry has done a good job of making CPAP machines quieter and smaller. BiPAP machines have lower pressure during expiration that reduces claustrophobic feelings in some patients and often eliminates the sensation of drowning on air. Ramping is a gradual increase in pressure allowing patients to fall asleep prior to pressure increasing. Humidification and heated hoses are also increasing patient comfort. Unfortunately all of these advances have not been shown to increase overall patient compliance.

Servo-ventilation machines are more efficient and effective in treating central sleep apnea, which is a neurological condition where the brain “forgets” to breathe.

The best sleep apnea treatment is always patient specific. The 60% of patients who do not tolerate CPAP will likely find comfortable oral appliances are the best treatment.

A small minority of patients do not tolerate CPAP or oral appliances. The best treatment for these patients may be surgery.

What is the best sleep apnea surgery? The morbidly obese and extremely severe sleep apneics may find that a tracheotomy is the best treatment. Patients breathe through their throat bypassing the pharyngeal blockages. Most patients do not want a trach.

Soft palate surgery is almost never the best sleep apnea treatment. UP3 or Uvulopalatopharyngealplasty is painful and has very high morbidity but more importantly rarely eliminates sleep apnea and patients still require CPAP or oral appliance therapy. Pillars, somnoplasty, LAUP or laser-assisted uvuloplasty are less painful but still ineffective in treating most apnea patients completely.

Maxilo mandibular advancement is extremely effective but is major surgery where the upper jaw (maxilla) is cut loose from the skull and often split in pieces, the lower jaw (mandible) is sectioned into 3 pieces and the hyoid bone is sectioned in pieces and then the patient is wired shut for six weeks. This surgery is often very successful. A geniohyoid surgery is less invasive only splitting the lower jaw in pieces and advancing the chin and tongue. While it is effective in patients with severely recessed lower jaws (weak chin) in most patients it is the “Jay Leno” surgery creating his unique profile.

For severely obese patients with severe sleep apnea bariatric surgery may be the best sleep apnea treatment.

It is also possible to do several tongue reduction surgeries that vary in effectiveness. Dr Shapira suggests that patients attempt CPAP and/or Oral Appliances before considering surgery. Patients with blocked nasal airways frequently improve with partial turbinectomies and correction of deviated septums but while helpful this will usually not eliminate sleep apnea.

Dr Shapira reminds patients of the famous quote: “There is no disease or disorder known to man that can’t be made worse by sticking a knife in it.” This does not mean to avoid surgery cautions Dr Shapira but rather to approach any surgery with caution and consider the possible problems associated with surgery.

Information on the dangers of sleep apnea, sleep apnea treatment and comfortable oral appliances is available at http://www.ihatecpap.com.

Dr Ira L Shapira is an author and section editor of Sleep and Health Journal, President of I HATE CPAP LLC, President Dato-TECH, and has a Dental Practice with his partner Dr Mark Amidei. He has recently formed Chicagoland Dental Sleep Medicine Associates. He is a Regent of ICCMO and its representative to the TMD Alliance, He was a founding and certified member of the Sleep Disorder Dental Society which became the American Academy of Dental Sleep Medicine, A founding member of DOSA the Dental Organization for Sleep Apnea. He is a Diplomate of the American Board of Dental Sleep Medicine, A Diplomat of the American Academy of Pain Management, a graduate of LVI. He is a former assistant professor at Rush Medical School’s Sleep Service where he worked with Dr Rosalind Cartwright who is a founder of Sleep Medicine and Dental Sleep Medicine. Dr Shapira is a consultant to numerous sleep centers and teaches courses in Dental Sleep Medicine in his office to doctors from around the U.S. He is the Founder of I HATE CPAP LLC and http://www.ihatecpap.com Dr Shapira also holds several patents on methods and devices for the prophylactic minimally invasive early removal of wisdom teeth and collection of bone marrow and stem cells. Dr Shapira is a licensed general dentist in Illinois and Wisconsin.

Source: http://www.shiftworkdisorder.com/the-best-sleep-apnea-treatment-cpap-vs-oral-appliances-a-question-of-compliance-and-effectiveness-101439.html

Behavioral Adjustment as a Sleep Apnea Treatment

Sleep apnea is not a condition one should take lightly. It affects your sleep, day-to-day life, and your future. Sleep apnea patients complain of a lack of energy, poor concentration, decreased productivity, slowed metabolism, and general loss of quality of life. In addition to the obvious disadvantages of lost sleep, sleep apnea can lead to high blood pressure, heart attacks, strokes, and even sudden death. Diagnosis and treatment can have a huge impact on your life.

One form of treatment for sleep apnea is behavioral adjustments. Mild sleep apnea and snoring can be treated with a few small adjustments to your life. Recommended changes in behavior include: avoiding alcohol before bed, losing weight, moistening the air, not eating close to bedtime, quitting smoking, raising the head of the bed or mattress, increasing daily exercise, and sleeping on your side. It is also not a bad adjustment to go to bed at a reasonable hour. Sleep deprivation has been known to cause sleep apnea. Another good suggestion is to avoid taking sleeping pills and mood-altering drugs. A healthy lifestyle goes a long way as well. Having a healthy, well-balanced diet and exercising daily will do much more for your life and body than just helping to eliminate snoring and sleep apnea. These are all good recommendations to treat snoring and mild sleep apnea, and help you achieve a better life.

For moderate to severe sleep apnea, further measures are usually necessary. It is a good idea to explore other options such as alternative oral appliances, if you have moderate to severe symptoms of sleep apnea.

Read more on Sleep Apnea Oral Appliances

Sleep Apnea: How and When to get Treated

It’s estimated that as many as 15 million people suffer from sleep apnea, it is more prevalent in men than women. If you snore, already been diagnosed with sleep apnea, use a CPAP machine or suffer from any symptoms of sleep apnea, then you are a good candidate for treatment.

Some symptoms of sleep apnea include: depression, dry mouth, falling asleep while driving or working, gasping or choking during sleep, general tiredness during the day, irritability or anxiety, restless sleep, and snoring with pauses in breathing. If someone suspects they may have sleep apnea, a sleep study (polysomnogram) should be done. This study will accurately measure what happens during sleep and how severe the problem is.

If left untreated, disturbed and interrupted sleep can cause a wide variety of problems, ranging from minor to very serious. Lack of sleep makes one drowsy during the day. Sleep apnea sufferers also complain of fatigue most often. But, that is just the beginning. Sleep apnea can be linked to the following health risks: cardiovascular disease, diabetes, hypertension, inability to lose weight, stroke, poor quality of life, and slowed metabolism or weight gain. All of which should be taken very seriously.

One way to treat sleep apnea is through oral sleep appliances and therapy. These have proven to be a viable alternative to CPAP. Research has shown that the tongue is really one of the major factors contributing the blockage of the throat and airway. By using an oral appliance and gradually repositioning the lower jaw forward, the tongue also moves forward opening the airway and creating better muscle tone in the oral pharyngeal area.

Some of the benefits of an oral appliance over the CPAP are: no uncomfortable masks or hoses, does not promote claustrophobia like the CPAP can, tolerated much better than CPAP, no mask impression left on the face, far more convenient for travel, airports, and much more.

If you or a loved one has any symptoms of sleep apnea, it is important to address and receive treatment. It will better the quality of your sleep, and your life.

Read more on Sleep Apnea Dentist in NJ and Sleep Apnea Treatments

What is Sleep Apnea?

Sleep Apnea is serious and potentially life-threatening medical condition that causes a person to actually stop breathing while asleep. These interruptions of oxygen cause a wide variety of symptoms, and are linked to some serious conditions such as weight gain, hypertension, and cardiovascular disease. 

Apnea sufferers can stop breathing as many as 40 times per minute. They awaken feeling as though they had little or no sleep because they’ve been fighting for oxygen all night.

Apnea episodes can occur from 6 to 100 times per hour. This oxygen deprivation causes people to feel exhausted when they wake up, as though they haven’t really been sleeping. They’ve spent most of the night fighting for air, so it’s no wonder side effects like feeling tired, headachy, and irritable are prevalent. Furthermore, the lower oxygen levels also put a strain on the heart.

Sleep apnea has a number of causes. While much research has been conducted and is still underway, there is no single identifiable cause in every sleep apnea patient. Some researchers have found that certain conditions like obesity, encephalitis, neurodegenerative diseases, and cervical spine complications actually lead to sleep apnea. Usually, sleep apnea is caused by mechanical and structural problems in the airway that interrupt breathing while you sleep. On the other hand, sleep apnea may occur because the throat muscles and tongue relax while you sleep and block the airway. In obese individuals, sleep apnea may be caused by the narrowing of the airway, due to the excess amounts of tissue in the throat and neck.

The most common type of sleep apnea is Obstructive sleep apnea. Obstructive sleep apnea is caused by a blockage of the airway. With Obstructive sleep apnea, air cannot flow into or out of the person's nose or mouth although efforts to breathe continue. The upper airway becomes obstructed by excess tissue. This obstruction may be located in the nasal passages or the structure of the jaw and airway, and may be one of the causes of sleep apnea. Another type of sleep apnea is Central sleep apnea, which is much less common. In a case of Central sleep apnea, the brain fails to send the appropriate signals to the breathing muscles to initiate respirations.

Sleep Apnea is a very serious condition, and deserves attention so that you can sleep better and live longer.

Read more on Sleep Apnea Causes

Snoring, a Sleep Disorder

Do you have trouble sleeping because of a loved one's snoring? Believe it or not, snoring can be more disruptive to the person snoring than it is to you.

Snoring is caused by a blocked airway. It is often dismissed as an annoyance, but it can actually be a sign of a very serious condition known as obstructive sleep apnea. The tongue falls backward during sleep and can fully or partially block the airway. There is then a struggle to obtain air, and this is what causes the vibration we call snoring. Much of the time the body will continue to get just enough air so there will be very little harm. However, snoring is a condition that means sleep apnea could be right around the corner.

Apnea episodes can occur from 6 to 100 times per hour. The oxygen deprivation causes people to feel exhausted when they wake up, as though they haven’t really been sleeping. It is no wonder they feel tired, headachy, and irritable because they’ve spent most of the night fighting for air.

The lower oxygen levels caused by snoring also put a strain on the heart. Because of this, snoring and obstructive sleep apnea are considered medical problems.

Read more on sleep disorder solutions.

Snoring? A quick and practical questionnaire...

Many patients come to us because their partners or family members noticed heavy snoring or frequent episodes where they stopped breathing. Spouses often report pauses in breathing followed by a gasp for air.

But not everyone can discover their situation this way. Many people sleep alone, or with partners who sleep too deeply to notice a problem. If you suspect you have a nighttime breathing problem but aren’t sure, ask yourself these questions:

• Do you snore on a regular basis, or wake others up in your household?
• Do you awaken frequently at night gasping for air?
• Are you excessively tired during the day?
• Do you fall asleep at unusual times during your day?
• Do you have morning headaches or frequent sore throats or dry mouth?

If you answered yes to any of these questions, you should consider getting a thorough sleep evaluation. Visit our website for Snoring Solutions.

Sleep Apnea Treatments

The lack of quality sleep can take a huge toll on your life. There are many disadvantages to lack of sleep. Sleep apnea patients complain of a lack of energy, poor concentration, decreased productivity, slowed metabolism, and general loss of quality of life. In addition, sleep apnea can lead to high blood pressure, heart attacks, strokes, and in extreme cases, even sudden death. It is not a condition to take lightly. Diagnosis and treatment can have a huge impact on your future, and on your life.

There are four main treatments for sleep apnea. Oral appliance therapy repositions the lower jaw and tongue to keep the airway open. The appliance is molded to the inside of your mouth and worn at night. We suggest that a follow up appointment is necessary to achieve the best results. A second treatment is simply to adjust some of your behaviors. For example, avoid alcohol before bed, lose weight, moisten the air, quit smoking, raise the head of the bed or mattress, and increase daily exercise to name a few. This is a good option for mild sleep apnea. Thirdly is the CPAP machine. CPAP stands for continuous positive airway pressure, and is a machine located next to the bed to provide a constant stream of air via a mask. This constant stream of air keeps breathing passages open, and has close to 100% efficiency when used. The last option is surgical treatment. There are several surgeries that can be preformed, but like any surgery there is risk involved.

With over two decades of training and experience in the field of dental sleep medicine, Dr. Blumenstock is one of the most active and influential practitioners of this type in New Jersey. We function in cooperation with a medical sleep team that includes sleep physicians, neurologists, pulmonologists, and ear, nose, and throat specialists. Since snoring and obstructive sleep apnea are medical problems, you’ll obtain an objective medical assessment before we explore oral appliance therapy.



Following referral from a physician, Dr. Blumenstock thoroughly examines all patients and discusses all options, advantages, limitations, and consequences. You will decide together what the best option is for you and your sleep apnea.

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