One of the common questions that a sleep physician often encounters is: “Should I go for CPAP or dental appliances to treat my sleep apnoea?" For the uninitiated, CPAP, which stands for Constant Positive Airway Pressurisation, is a medical apparatus commonly recommended for the treatment of obstructive sleep apnoea. Dental appliances offer another treatment option, as part of Oral Appliance Therapy (OAT), which is generally a dentist-administered solution. As you might expect, the answer to the above question is not so straightforward.
Obstructive sleep apnoea occurs when the muscles in the upper airway – which help to keep the throat open – collapse and obstruct the breathing passage during sleep. The complete or partial blockage of the airways causes breathing pauses known as “apnoeas”. Loud and persistent snoring, sometimes accompanied by repeated gasping and choking, are common OSA symptoms.
CPAP therapy uses air pressure to keep the throat muscles and air passage open, thus allowing the OSA patient to breathe normally during sleep. The CPAP device consists of a box-like base unit that is attached via tube to a mask, which is worn over the patient’s nose and mouth. The air pressure produced by the unit is supplied through the tubes into the breathing mask. Patients with Sleep Disordered Breathing (SDB) wear the device during bedtime to counter the effects of their nocturnal breathing problems. Besides relieving your sleep apnoea symptoms, CPAP therapy can also reduce the long-term risks associated with OSA such as diabetes, stroke, heart failure and even sudden death.
Although CPAP is considered the gold standard treatment for obstructive sleep apnoea patient compliance and acceptance is usually low. If a patient has no issues complying with CPAP therapy, the sleep aid device can be very effective with a high success rate. However, many patients find it difficult to tolerate wearing the breathing mask to sleep and put up with a constant stream of pressurised air blowing through their nostrils throughout the night. Due to compliance issues, it has been estimated that only 23% - 45% of patients find success with the CPAP method.1 Besides the unnatural feeling of sleeping with a breathing mask and breathing through forced air, other compliance issues include nasal congestion, skin irritation, dry throat, eye irritation, sore throat, leaky mask and noise generated by the CPAP device.
Fortunately, patients who have compliance issues with CPAP therapy can benefit from oral appliance therapy. One of the most common dental sleep apnoea devices is the Mandibular Advancement Splint (MAS). Consisting of two splints that are worn over the upper and lower teeth, the TGA-approved oral device is used to prevent the soft tissue from collapsing on the airway and obstructing normal breathing. It works by pushing the lower jaw (mandible) forward by 8-10 mm, which is usually enough to keep the airway open. The therapy, which basically involves wearing the splints during sleep, is effective in treating mild to moderate obstructive sleep apnoea, as well as reducing OSA symptoms like snoring.
On the whole, the Mandibular Advancement Splint (MAS) is more convenient as compared to CPAP, as you won’t have to lug around a device or require a power connection to undergo the treatment. Being small and unobtrusive, the splint does not interfere with your lifestyle especially when you are traveling. The dental device is also very competitively priced as compared to conservative treatments like CPAP and much cheaper compared to surgery. Conversely, CPAP therapy promises many benefits barring any compliance issues. It is also the first choice therapy prescribed by most sleep physicians and medical doctors.
If your sleep physician or medical doctor has recommended oral appliance therapy as a suitable treatment option for your obstructive sleep apnoea, Sydney CBD Dental will be able to help you find the right solution. For more information on the range of dental treatment options we offer for sleep apnoea, please contact Sydney CBD Dental provides at 02 9051 0503.
Infographic by Sound Sleeper.