Continuous Positive Airway Pressure (CPAP)

Sleep Apnea Dental ApplianceWhat is CPAP?

CPAP is the acronym for Continuous Positive Airway Pressure. CPAP is the most common treatment for Obstructive Sleep Apnea (OSA) because that is what medical doctors know. The CPAP machine contains of a face or nasal mask that is connected to an air pump that provides a positive flow of air into the airway in order to keep the airway open. Literally, air is rammed down the airway to prevent the airway from becoming obstructed and/or collapsed.

CPAP is a highly effective treatment and one that medical doctors know about. However, there is no benefit to a treatment that is not used. Patient compliance remains a massive issue due to CPAP machine side effects. Compliance means that the patient is using their CPAP machine every night as recommended. Did you know, Supreme Court Justice Antonin Scalia died with his CPAP unused on the nightstand? The government released their requirement for CPAP compliance, which requires that the patient uses CPAP at least seventy percent of the time over a thirty day period, for at least four hours every night.

CPAP Facts and Statistics

According to the American Academy of Dental Sleep Medicine (AADSM) up to 50% of sleep apnea patients do not comply with or tolerate CPAP. Additional studies by different organizations have shown much lower compliance rates.

CPAP side effects and complaints affect between 30-70% of patients.

In one study, almost half of patients rejected treatment before even trying CPAP or soon after pressure titration and trial. An additional 12-25% stop CPAP treatment within three years.

Texas has more CPAP users in than any other US State, followed by California and Florida.

Compliance is low because of the discomfort and other side effects of the CPAP mask, the inconvenience of the tubing and the added bulk and burden while travelling with the CPAP machine. Patients cannot get comfortable sleeping because they are tethered to a hose connected to their face.

Sleep Apnea Deer Park

Common CPAP Side Effects and Complaints

  • Discomfort: Caused by straps and headgear or poor fit
  • Claustrophobia: Feeling of suffocation from the mask
  • Relationships: The fear of compromised relationships
  • Restrictions: Inability to move or change positions during sleep
  • Noise: The CPAP machine is too noisy to allow sleep
  • Perceived Effectiveness: Lack of noticeable symptom improvement
  • Tooth Movement: Pressure on upper lip causing tooth related problems, including shifting in tooth position and tooth pain
  • Irritation: Mask irritations on the skin and nose
  • Air intake: Air trapped in the stomach or sinuses
  • Intolerance: Patients often report removing the mask during sleep without knowing it or general intolerance of the pressure
  • Smooshed Face Syndrome: Upper jaw was pushed backward and the upper teeth pushed backward changing the angle they come out of the jaws. The lower jaw and chin were also pushed backward and there was less freedom of movement available between the upper and lower jaws. These same changes are often seen in patients with chronic headaches, migraines and TMJ disorders

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CPAP Alternatives

In a 2-year randomized trial of 103 mild to severe obstructive sleep apnea patients, there was no statistical difference between the proportion of patients obtaining successful treatment from an oral appliance, termed Mandibular Advancement Splint in the study and CPAP. The study also did not find any statistical difference between the treatments in terms of Epworth Sleepiness Scale. Other bodies of research shows that¬†Oral Appliances as an effective alternative to CPAP except for extremely and morbidly obese persons. ¬†Thus, it is important for the patient and physicians to choose the therapy that is most acceptable to improving the patient’s health and quality of life. Lastly, it is important to note that the American Academy of Sleep Medicine recommends oral appliances as a primary or first line of treatment for mild to moderate obstructive sleep apnea.

oral appliance and sleep apnea

What is the best sleep apnea treatment?

The best sleep apnea treatment eliminates the problem with a minimum of negative side effects. For patients with severe sleep apnea and who tolerate CPAP the best treatment is often CPAP. For the majority of patients who do not tolerate or hate CPAP, oral appliances may be the best sleep apnea treatment.

CPAP or ORAL APPLIANCE

 

Research Source: Almeida FR. Long-term effectiveness of oral appliance versus CPAP therapy and the emerging importance of understanding patient preferences. SLEEP 2013;36(9):1271-1272.