Issue 15.13
What is the best sleep apnea treatment? It is not CPAP according to a recent study that showed 60% of patients abandon CPAP use. At least it is not the best treatment for the 60% of patients who abandoned it. This does not mean CPAP is not the most effective treatment, what it means is no matter how effective a treatment may be it is poor treatment if it is not used. Oral Appliances are an extremely effective treatment for mild to moderate sleep apnea but less effective for patients with severe sleep apnea.
Oral appliances are the “Best Sleep Apnea Treatment” because patients actually use them. Compliance issues have always been the biggest problem with CPAP. Studies have shown most patients quit CPAP completely but even patients who use CPAP average only 4-5 hours/ night 4-5 nights a week. That is not the best treatment but it is better than no treatment. You can get more information on oral appliance therapy at www.premiersleepsolutions.com or by calling 435-674-2100.
Medicare recognized how poor CPAP compliance was and now has minimum usage schedules for CPAP that will save Medicare millions of dollars because such a small percentage of patients actually utilize their machines on a regular basis.
CPAP is the “best treatment” for the 25% of patients who love their CPAP, and use it all night, every night.
Oral appliance success can be greatly improved by titration or adjustments of appliances in the sleep lab. When an appliance eliminates sleep apnea based on a sleep study it is equivalent to CPAP success. The issue of compliance almost always favors oral appliances but objective monitoring for appliance use are not yet available other than sleep lab.
The best treatment is one that works and is used. For most patients with mild to moderate sleep apnea the best treatment is an oral appliance due to much higher compliance. If compliance is equal and CPAP or appliances are equally effective then both would qualify as the best treatment. The patient can choose their desired treatment. Studies have shown the majority of patients offered a choice prefer a comfortable oral appliance over CPAP.
Some severe sleep apnea patients refuse CPAP, for those patients an oral appliance is superior to “NO TREATMENT”
There are patients who are severe and/or morbidly obese and the “Best Treatment” is actually combination treatment of an Oral Appliance and CPAP combined. A mask retained by the teeth instead of straps may be considerably more comfortable for many patients and lower pressure from combined use makes CPAP easier to tolerate. Custom masks combined with oral appliances are a new entry in the field coming from Airway Management.
Cleanliness is of major importance with both CPAP and Oral Appliance treatments. Dirty masks and hoses can lead to sinus infections, bronchitis and pneumonia while poor oral hygiene with an oral appliance can lead to periodontal disease.
To get more information and to start oral appliance therapy, contact Southern Utah’s #1 Oral Appliance Provider @ Premier Sleep Solutions/Dr. Shad Morris (435) 674-2100, 75 S. 100 E Suite 1E St. George, UT 84770.