CPAP INTOLERANCE & NON-COMPLIANCE
CPAP stands for Continuous Positive Airway Pressure. It’s a medical device that sits next to your bed, a hose with a mask at the end is worn over the nose and/or mouth while sleeping. An air-compressor pumps air through the mask into the airway, keeping it open during sleep. CPAP is considered the "gold standard" for the management of sleep apnea because it is highly effective in a lab setting. For cases of severe OSA, a CPAP can be the only effective treatment.
To be considered “compliant” with CPAP treatment, the mask must be worn at least 4 hours per night, 21 days per month. Even with this lenient definition, rates of CPAP compliance have been estimated as low as 17%*.
As many as 4 out of 5 CPAP users are non-compliant! Which means they are not treating their condition and they are putting their lives in danger every night. For patients that cannot tolerate CPAP or are habitually non-compliant, Oral Appliance Therapy can be an alternative treatment. Not every case qualifies for Oral Appliance Therapy, and any treatment decisions need to be made with your primary care doctor and/or a board-certified sleep physician.
While CPAP has been shown to be more effective at reducing polysomnographic variables in lab settings, due to the higher compliance rate of Oral Appliance Therapy, their effectiveness is nearly equivalent in real world settings**.
Oral Appliance Therapy
Oral Appliance Therapy (OAT) uses a custom fitted dental appliance, similar to a retainer, to ensure unrestricted airflow during sleep. The device positions the lower jaw forward, which moves the base of the tongue slightly to ensure the airway remains open during sleep. The appliance fits in the palm of your hand, uses no power and has no hoses or pumps.
Oral Appliance Therapy consists of four steps:
Screening and home sleep test schedule on first visit
Home sleep test results are reviewed by a board-certified sleep physician who makes a diagnosis and therapy suggestion
Delivery of custom-made oral appliance
Easy follow-up maintenance once or twice a year
Do not mistake OAT with a drugstore snoreguard, which is not FDA cleared for treating OSA. Attempting to treat OSA with an unapproved device and not under the care of a trained professional could exacerbate the condition leading to potentially serious complications.
How it Works
Schedule a screening at our office
If the screening indicates you are at risk for OSA, we will arrange a Home Sleep Test
Sleep in your own bed while the device monitors your sleep
Results from the test are downloaded and sent to a board-certified Sleep Physician for review and diagnosis
If the physician recommends Oral Appliance Therapy, we will take impressions of your teeth and create a custom device for you
After the device is made, it may require adjustments to ensure optimal airflow
A follow up home sleep test is used to verify the device is working as intended
Our office has been DreamSleep Certified for treating Obstructive Sleep Apnea. DreamSleep is a national network of Dentists and Physicians working together to raise awareness and treat Obstructive Sleep Apnea.
*When adherence is defined as greater than 4 hours of nightly use, 46 to 83% of patients with obstructive sleep apnea have been reported to be nonadherent to treatment. Weaver TE, Grunstein RR. Adherence to continuous positive airway pressure therapy: the challenge to effective treatment. Proc Am Thorac Soc 2008; 5:173.
**Head-to-head trials confirm CPAP is superior in reducing OSA parameters on polysomnography; however, this greater efficacy does not necessarily translate into better health outcomes in clinical practice. Comparable effectiveness of OAm and CPAP has been attributed to higher reported nightly use of OAm, . Sutherland K, Vanderveken OM, Tsuda H, Marklund M, Gagnadoux F, Kushida CA, Cistulli PA, Oral Appliance Treatment for Obstructive Sleep Apnea: An Update. J Clin Sleep Med. 2014 Feb 15; 10(2): 215–227.