CPAP Problems

There are many problems with using a CPAP.  Dr. Nugent works with medical doctors and can help patients with an alternative to CPAP. Below are some problems encountered with CPAP.

Nugent Sleep Apnea

Always the wrong pressure

Customarily, your CPAP pressure is calibrated to cover the worse-case scenario—REM sleep on your back. Thus, you will get the same pressure the entire night no matter which sleep stage you’re in and which position you’re sleeping in.

Automatic machines are designed to try to overcome the limitations of CPAP. However, despite the advances in technology and algorithms, it is still not able to predict when patients will enter REM sleep or switch onto their back.

Potentially makes your teeth crooked

Only 50 grams of force is needed to move your teeth. That is about 2 ounces. Nasal and full-face masks place continuous pressure on your front teeth. There are documented reports of patients using CPAP where the upper incisors were found to be shifted back.

The Heisenberg uncertainty principle

One of the doctrines of physics is that the position and the velocity of an object cannot both be measured exactly, at the same time, even in theory. Likewise, having a mask strapped to your face with positive pressure will by definition change the quality and quantity of your sleep. For many people, the benefits of CPAP will far outweigh with side-effects. However, for some patients CPAP causes more arousals than it helps.

oral appliance and sleep apnea

CPAP does not address minor forms of obstruction

When patients undergo a CPAP titration, the pressure is usually calibrated to get rid of apneas and hypopnea. The worst apneas are when patients are on their back and in REM sleep. Yet, more subtle degrees of obstruction that do not meet the 10 second threshold criteria are not addressed. This is why many patients can have CPAP adherence data showing an AHI of .1, no leaks, and using 100% of total sleep time, but they do not feel refreshed in the morning.

Often used with stuffy noses

Many people with obstructive sleep apnea have stuffy noses. Studies shows that having nasal congestion can significantly lower CPAP effectiveness. Allergy medications or nasal saline irrigation can help some people. A full-face mask can be used, which covers both your nose and mouth. In theory, this can work better, but full-face masks are normally more uncomfortable as they are very bulky.

Stop Sleep Apnea

Poor Long Term Compliance

In the academic studies, “adherence” rates range from 40% to 80%. However, in the real world only about 20 to 30% people who start using CPAP are still using it effectively at 1 year.

Not a permanent solution for most people

Even if you’re able to use CPAP, life situations change. You may gain more weight. You may travel for work and don’t want to haul your CPAP machine around. Or you may be in a new romantic relationship.

Periodic cleaning and maintenance is needed

This may not matter for people who are regimented and find it important to maintain their CPAP devices on a regular basis, but many others find it cumbersome. Additionally, your body’s CPAP pressure needs will change over the course of months to years, so it’s important to check the pressure at least every 6 to 12 months.




Discover how how Dr. Nugent uses custom oral appliances to treat Obstructive Sleep Apnea.