CPAP Intolerant?

 

Problems Wearing Your CPAP?

If you have been diagnosed with Obstructive Sleep Apnea (OSA), you are probably familiar with the term “CPAP,” which is the acronym for “Continuous Positive AirwayPressure.”

 

A CPAP unit is a machine that delivers lightly pressurized air through a hose that is hooked to a mask that you wear while you sleep. The flow of air acts like a "splint," keeping your upper airway open and preventing apnea.

While it is considered the “gold standard” for the treatment of OSA, studies show that only 23%-45% of patients for whom CPAP is prescribed actually use the machine on a regular basis.

 

Additionally, CPAP use averages only 4-5 hours per night vs. the 7-9 hours of recuperative sleep recommended by organizations such as the National Sleep Foundation.

 

Reasons for CPAP intolerance frequently cited by patients include:

• Mask leaks (and/or an inability to get a make to fit properly)

• Claustrophobia

• Uncomfortable straps and headgear

• Latex allergies

• Noise from the CPAP machine that disturbs sleep of the patient (or his/her bed partner)

• Restricted movement during sleep because of the CPAP apparatus

 

CPAP equipment has undergone many improvements since the first one was invented in 1980 Collin Sullivan, MBBS, PhD, FRACP, using a vacuum cleaner and a length of hose. There are always improvements being made to CPAP masks, too. However, if you have tried CPAP and found that it simply does not work for you, an oral appliance may be your next best option.

 

For some patients, including those with mild-to-moderate OSA, an oral sleep appliance may eliminate the need for CPAP or surgery. For patients with more severe sleep-disordered breathing problems, an oral sleep appliance may be a convenient adjunct therapy. This recommendation is consistent with the American Academy of Sleep Medicine’s practice parameters, which state:

 

“…oral appliances are indicated for use in patients with mild to moderate OSA who prefer OAs to CPAP, or who do not respond to CPAP, are not appropriate candidates for CPAP, or who fail attempts with CPAP or treatment with behavioral methods such as weight loss or sleep-position change.”

 

Kushida CA, et. al. Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances: An update for 2005. SLEEP2006 29(2): 242.

 

If you are CPAP intolerant and would like to explore the benefits of an oral sleep appliance, you should know that one size does not fit all. To be effective, an oral sleep appliance must be properly fit and calibrated to each, individual patient by a dentist who has the appropriate training and experience in dental sleep medicine. “Training and experience” is defined by the American Academy of Sleep Medicine as follows:

 

“Oral appliances should be fitted by qualified dental personnel who are trained and experienced in the overall care of oral health, the temporomandibular joint, dental occlusion and associated oral structures.”

 

Kushida CA, et. al. Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances: An update for 2005. SLEEP2006 29(2): 240.

 

We are happy to consult with those who feel that they are having a problem with snoring, sleep apnea, or unable/unwilling to tolerate a CPAP unit. If you have not been diagnosed with sleep apnea we will refer you to a sleep specialist for proper diagnosis prior to treatment.