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CPAP vs Oral Appliance Therapy: The Pros and Cons for Sleep Apnea




Sleep apnea is a common sleep disorder characterized by pauses in breathing or shallow breaths during sleep. It can lead to various health complications, including daytime fatigue, hypertension, and heart problems. Fortunately, there are effective treatments available to manage sleep apnea, with two primary options being Continuous Positive Airway Pressure (CPAP) therapy and Oral Appliance Therapy (OAT).



man sleeping


In this article, we'll explore the pros and cons of each treatment option to help individuals with sleep apnea make informed decisions about their care.



CPAP Therapy


CPAP, or continuous positive airway pressure, is a therapy that uses a machine to deliver a constant stream of air pressure through a mask you wear while you sleep. This airflow helps to keep your airway open, preventing the collapse that occurs during sleep apnea.


Here's a breakdown of how a CPAP machine works:


  1. Air intake: The machine takes in air from the room.

  2. Air filtration: The air is filtered to remove dust and allergens.

  3. Air pressurization: A motor pressurizes the air.

  4. Air humidification (optional): Some CPAP machines have a humidifier that adds moisture to the air, which can make it more comfortable to breathe.

  5. Air delivery: The pressurized air travels through a flexible tube.

  6. Mask: The tube connects to a mask that fits over the nose or mouth. The mask has a seal that helps to keep the air from leaking out.


The constant flow of air from the CPAP machine splints opens your airway, preventing it from collapsing during sleep and ensuring you breathe continuously throughout the night.


CPAP Mask Assembly on a Table.
Cherry Beans | Getty Images

Here are the pros and cons of CPAP therapy:


Pros

  • Highly effective: CPAP therapy is the most common and reliable treatment for sleep apnea, significantly reducing sleep apnea events and improving overall sleep quality.

  • Non-invasive: CPAP therapy is non-invasive, meaning it doesn't involve surgery or any procedures that enter your body.

  • Immediate Symptom Relief: Many individuals experience immediate relief from symptoms such as excessive daytime sleepiness, fatigue, morning headaches, and irritability after starting CPAP therapy.

  • Customized Treatment: CPAP machines can be adjusted to deliver the optimal level of air pressure tailored to each individual's specific needs. Settings can be fine-tuned based on sleep study results and ongoing monitoring to maximize effectiveness and comfort.


Cons

  • Discomfort: Some individuals may find wearing a CPAP mask uncomfortable or claustrophobic, particularly during the adjustment period.

  • Compliance Challenges: Adherence to CPAP therapy can be challenging for some patients, leading to inconsistent use or discontinuation of treatment.

  • Noise: The sound generated by CPAP machines may disrupt sleep for the user or their bed partner, especially at higher pressure settings.

  • Travel Limitations: Traveling with a CPAP machine can be cumbersome due to its size and weight. While portable CPAP machines are available, they may not offer the same features or comfort as standard machines, and finding power sources or adapters while traveling can be challenging.


CPAP therapy is a very effective treatment for sleep apnea. However, it can take some time to get used to wearing a CPAP mask and sleeping with the sound of the machine.



Oral Appliance Therapy


Oral appliances, also known as mandibular advancement devices (MADs) or mandibular repositioning appliances (MRAs), are dental devices used to treat obstructive sleep apnea (OSA) and snoring. These devices are custom-made by dentists or orthodontists and are worn during sleep to help keep the airway open and prevent its collapse.



 Oral appliance for management of jaws during sleep apnea
Scigelova | Getty Images

Oral appliances work by addressing the physical obstruction in the upper airway that causes sleep apnea. They come in two main types, each working in slightly different ways:


1. Mandibular advancement devices (MADs):

  • These look similar to a mouthguard and are the most common type of oral appliance for sleep apnea.

  • MADs work by gently pushing the lower jaw forward, which does two things:

  • Increases the space behind the tongue: This prevents the tongue from collapsing back and blocking the airway.

  • Tenses the muscles around the airway: This helps keep the airway open.

2. Tongue-stabilizing devices (TSDs):

  • These appliances are less common than MADs and are typically used for mild sleep apnea or when MADs are not well-tolerated.

  • TSDs work by holding the tongue in a specific position to prevent it from falling back and blocking the airway.


By keeping the airway open during sleep, both types of oral appliances can:


  • Reduce or eliminate snoring

  • Improve sleep quality

  • Decrease daytime sleepiness

  • Improve overall health and well-being


Here are the pros and cons of Oral Appliance Therapy:


Pros

  • Improved sleep quality: MAD use significantly reduced the apnea-hypopnea index (AHI), a measure of breathing events during sleep, even for patients with severe OSA. This improvement was consistent over time (at least 5 years).

  • More comfortable and convenient: Unlike CPAP machines with masks and hoses, oral appliances are generally considered more comfortable and easier to use. They are also much more discreet and portable, making them ideal for travel.

  • Better compliance: Due to the increased comfort and ease of use, many people find they are more likely to stick with oral appliance therapy compared to CPAP.

  • Quieter: Unlike CPAP machines that can generate noise, oral appliances are silent, making them ideal for those who share a bed with a partner.

  • No electricity needed: Unlike CPAP, oral appliances require no electricity, making them suitable for camping trips or situations where power might be limited.

Cons

  • Limited Efficacy for Severe Sleep Apnea: While oral appliances are effective for mild to moderate obstructive sleep apnea, they may be less effective for individuals with severe sleep apnea or certain anatomical abnormalities that significantly obstruct the airway. CPAP therapy or surgery may be more appropriate in these cases.

  • Potential Jaw Discomfort: Some individuals may experience temporary jaw discomfort, stiffness, or temporomandibular joint (TMJ) pain when wearing an oral appliance, particularly during the adjustment period or if the appliance is not properly fitted or adjusted.

  • Potential for side effects: Some people experience side effects like jaw pain, dry mouth, excessive saliva, and teeth shifting due to the way the appliance positions the jaw.

  • Cost and Insurance Coverage: Oral appliances can be expensive, and they may not always be fully covered by insurance.

  • Requires Ongoing Maintenance: Proper care and maintenance of the oral appliance are essential to ensure its effectiveness and longevity. This includes cleaning the appliance regularly, storing it properly when not in use, and seeking professional adjustments or repairs as needed.



Alternatives


While CPAP and oral appliances are the most common treatments for obstructive sleep apnea (OSA), there are other alternatives available. These include:


Lifestyle changes

  • Weight loss: Losing weight can significantly improve OSA symptoms, especially for mild to moderate cases.

  • Sleeping on your side: Sleeping on your back can worsen OSA, so retraining yourself to sleep on your side can be helpful.

  • Avoiding alcohol and sedatives: These substances can relax the muscles in your throat, worsening sleep apnea.

  • Quitting smoking: Smoking irritates the airways and can worsen sleep apnea symptoms.


Other therapies

  • Nasal decongestants: These can help open up the nasal passages in some cases.

  • Positional therapy: This involves using special pillows or devices to keep you from sleeping on your back.

  • Neurostimulation: This newer therapy involves implanting a device that delivers electrical stimulation to the nerves that control the muscles in the tongue and throat.


Surgery

  • Uvulopalatopharyngoplasty (UPPP): This surgery removes excess tissue from the back of the throat and uvula.

  • Mandibular advancement surgery (MMA): This surgery surgically moves the lower jaw forward to open the airway.

  • Maxillomandibular advancement (MMA): This surgery moves both the upper and lower jaws forward to open the airway.


Both CPAP therapy and Oral Appliance Therapy are effective treatments for sleep apnea, each with its own set of pros and cons. The choice between the two depends on individual preferences, the severity of sleep apnea, and other factors such as comfort, lifestyle, and adherence. Individuals with sleep apnea need to work closely with their healthcare provider to determine the most suitable treatment option that will effectively manage their condition and improve their quality of life.


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Dr. David Eleff, Otolaryngologist/Ear, Nose, and Throat Specialist at ENT Family in Hollywood, Florida.

This article has been medically reviewed by  otolaryngologist, David Eleff, M.D.

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