Combined CPAP and Oral Appliance Therapy
As with most medical or dental health concerns, there is no one-size-fits-all solution for treating sleep apnea. Patients who have tried CPAP and oral appliance therapy individually without success may benefit most from a combined solution. Contact Dr. Greenbaum and the dedicated team at the Bethesda Center for Dental Sleep Medicine to find out more about combined therapy for optimal relief from the symptoms of sleep apnea. We work alongside your sleep doctor to develop a plan to treat sleep apnea, improve overall health, and help you renew your quality of life.
Continuous Positive Airway Pressure (CPAP) treatment uses a facial mask worn over the nose and mouth to force air into the throat,keeping the airway open and allowing patients to rest through the night. This treatment option is tried and tested offering excellent results for those who wear the mask each night. However, CPAP therapy has a high rate of noncompliance due to patients being unable to get used to the feeling of air being forced down their mouth and throat, how loud the machine can be, and how uncomfortable the bulky straps and mask feel. In most cases, one week of nightly wear allows patients to adapt to the sounds and sensations, but some patients are unable to get used to their CPAP systems.
Oral Appliance Therapy
Oral appliance therapy is recommended for patients who have mild to moderate sleep apnea. These devices work using the same method used to open airways during CPR. By shifting the jaw forward, oral appliances keep the airway open,allowing sleep apnea sufferers to breathe easily through the night. Oral appliances are comfortable, effective, and portable,making them a great alternative to CPAP systems. Unfortunately, not all patients experience significant relief of symptoms with oral appliance treatment alone, and these devices are not recommended for patients who have severe apnea.
By combining both CPAP and oral appliance therapy, patients are able to achieve results only possible using the highest levels on CPAP machines. The oral appliance continuously holds the throat open, meaning even on very low settings, the CPAP system can provide adequate pressure to keep the throat clear. This combined treatment offers patients the opportunity to sleep soundly, breathe easily, and wake up feeling refreshed. Patients who use combined treatment have higher compliance rates because the decreased CPAP levels cause less noise and discomfort. Additionally, patients are able to achieve successful treatment on the road by carrying their oral appliance which is easily transported (even by plane!). Best of all, combined therapy offers significant relief and refreshment for even the most severe cases of sleep apnea.
Who Should Consider Combined Therapy?
Like any treatment option, combined therapy isn’t right for every sleep apnea sufferer. We are happy to help you get the treatment you need, and work hard to determine what solution best fits your situation. The following patients should consider combined treatment:
- Those who are non-compliant while using CPAP
- Those who are intolerant to CPAP treatment
- Those who do not receive the results they desire from oral appliance therapy alone
- Those whose apnea is not adequately relieved by CPAP or oral appliance therapy individually
Benefits of Combined Therapy
Patients considering combined CPAP and oral appliance treatment receive numerous benefits,including:
- More comfortable– There is no need to wear the bulky straps or full-face (mouth and nose) masks that make CPAP uncomfortable. Additionally, the oral appliance pushes the jaw forward,keeping the throat open allowing continuous airflow from the CPAP machine. This means patients are able to use the lower, more comfortable and quieter settings on the CPAP machine.
- More compliance– The only way sleep apnea and its side effects can be effectively relieved is for patients to follow their treatment plans consistently. Increased comfort and decreased noise lead to more patients wearing their oral appliance and CPAP system as directed.
- Better results– There have been numerous studies of patient response using combined therapies over the last several years. The American Academy of Dental Sleep Medicine conducted a study of sleep apnea sufferers’ Apnea-Hypopnea Index (AHI) numbers. AHI numbers are calculated by determining the number of apnea events patients experience each hour. The study showed that with no treatment the average AHI was 6.6, with CPAP the average AHI was 4.4, and combined therapy was a dramatic improvement over both with an average AHI of 2.6. A similar study used the Epworth Sleepiness Scale to determine the effectiveness of combined therapy with oral appliance treatment. Before treatment, the average sleepiness score was 12, using an oral appliance the average score decreased to 9, and using combined CPAP and oral appliance therapy the average score further decreased to 7. These studies (and numerous others)show that CPAP or oral appliance therapy alone is less effective than a combined treatment plan.
- Easier travel– CPAP patients who travel regularly (especially air travel) too often skip their treatment for sleep apnea while they are away from home, because CPAP machines are bulky and difficult to carry. They also require large amounts of water which cannot be transported by plane. Patients who use combined therapy, however, are able to easily carry along the oral appliance to maintain comfort at home and away.
Contact Our Team Today
Contact the Bethesda Center for Dental Sleep Medicine to schedule a consultation today. If you’ve experienced intolerance to CPAP treatment or are not satisfied with the results of oral appliance therapy, combined treatment may be the best solution. During a consultation, we’ll review your past treatment, and help you determine whether combined therapy is the right option to let you sleep through the night. If you have any questions or concerns about your oral appliance or sleep apnea treatment, contact our friendly team. We’re happy to help!