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Adventures in Sleep

Alternatives to CPAP

Published March 6, 2014 4:49 PM by Penny Mehaffey

All of my experience in sleep having come from the sleep lab, I do not have any hands-on experience with oral appliances. I have done a few sleep studies with appliances in place but that is the extent of my exposure. 

I am comfortable supporting the oral appliance in theory. I think it is an excellent option and/or alternative. Thinking of the patients who just cannot tolerate CPAP -- what do we do? Do we tell them in no uncertain terms that CPAP is what they need and they need to try harder to use it? I don't think that's realistic and it's very not very user-friendly. 

I think we should embrace new therapies and try to have several options to present to patients. Is a little CPAP better than no CPAP at all?  Is an oral appliance better than no intervention ever? Yes! 

And can we also concede that while CPAP is the gold standard of treatment for sleep apnea, it is not always practical? Why not have the appliance available for times when CPAP is not practical or convenient, such as when travelling or flying (the oral appliance fits in your pocket) and when camping (no power or water is needed). If a patient has difficulty acclimating to traditional CPAP but really needs intervention should they not be given an option?  I think most practitioners would say yes. But I see very little actual implementation of alternatives. I wonder, what are other techs seeing?

posted by Penny Mehaffey


Over the last 21 years, I have seen some great outcomes treating folks with mild to mod OSA with OA therapy, and have seen my share of failures. I always make sure they are referred to a provider knowledgable in the field of sleep dentistry.  Interestingly, most of my patients are quite successful with PAP therapy (>>80%).  It does take time listening, teaching and encouraging them but they do well.

With every patient I see newly diagnosed w/ OSA, I go through the pros & cons of therapies, OA and PAP, but I want the patient to understand the various therapies out there.

Regarding folks who can't afford CPAP, there are many resources that can help them obtain equipment and supplies - may take some digging, but they are out there.

Chris, Sleep Medicine - Family Nurse Practitioner, NP Somnologist March 12, 2014 11:30 PM
Bellevue WA

I amfrom Johannesburg South Africa. Approx. 40% of patients cannot tolerate the CPAP. It does great work for the othe 60%. Severe sleep apnea is such a severe condition with many side affects, that no treatment is criminal. This is when an Oral Appliance comes into play.

I have being treating mild to moderate apnea,severe apnea and snoring with an appliance for 17 years and the very occassional side affect on the teeth is nothing compared with the satisfaction of a healthy patient.  

Dave Koton, Dentist & snore and apnea treatment - Doctor, the snore and sleep apnea centre March 12, 2014 4:56 PM

Patients should have other options if PAP therapy has been given a good trial.  For patients that do not have access to electric, OA therapy is better than not using anything.  Just remember that OA can give a false sense of security - make sure a sleep study is done with OA to assure resolution of apneas.  Another thing to remember is that an OA can also cause problems with teeth and TMJ issues.

Ted March 12, 2014 9:25 AM

Ive had many patients that could not afford cpap. I told them to bo out and buy a Boil  & Bite kit.  I showed them how to slightly move their jaw forward (very little to avoid TMJ issues).  Most of them called me to say thanks.  You would be suprised how little augmentation is needed to obtain results.  I made sure I had the backing of our medical director before hand.

Don March 12, 2014 5:43 AM
New Orleans

Yes. Oral Appliance (OA) is a viable alternative with limitations, however it works for Mild to Moderate OSA. OSA can be a moving target.  Patients on OA eventually use up the "turns" then what?  C-pap?

K. Vanderpool, Sleep Medicine - Sleep Therapist, V & V Sleep DME March 11, 2014 6:45 PM

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    Adventures in Sleep
    Occupation: Sleep technicians
    Setting: Various sleep facilities
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