Study Comparing CPAP and Oral Appliances

[moonslice]

This study was published recently in Journal of Dental Sleep Medicine.

http://www.jdsm.org/ViewArticle.aspx?pid=30229

Volume: 03 Number: 03 7/10/2016

The interesting thing to me was that while CPAP did a better job at lowering AHI, the health outcome was not improved compared to oral appliances. They think it's because there is a greater compliance with oral appliances. The study showed that more people favored oral appliances.

Thoughts? Anyone tried oral appliances and switched back to CPAP?

[kteague]

Sigh. So some marketing people sat around a table and strategized how to combat the reality that an oral appliance is overall 2nd in efficacy to CPAP, and this is what they came up with?! This study is like telling a diabetic who needs insulin that we know that the efficacy of insulin is greater than a pill, but in the long run, since so many diabetics skip shots sometimes, a pill will get you the same outcomes in the long run. How about just use the insulin as prescribed? This "study" is just creative marketing.

[Wulfman...]

Oral appliances are only effective in certain cases.......like with jaw structure/position.
Wouldn't help a person who had enlarged turbinates or deviated septum or other structural problems.

Some people need both dental devices and XPAP.

Everybody's different and the most effective therapy is not necessarily an "either or" situation.
Lots of discussions on dental appliances in the archives of the forum.


Den

.

[moonslice]

Wuff, my search didn't reveal those I guess. Maybe I need a different search term. It's interesting that some people need both. I'm wondering if I have the option to get an oral appliance and still keep the cpap. My insurance was vague on that, and the ENT who would be making the oral appliance said he was noting my difficulties with cpap, as if he'd need to do that for insurance....

I don't think that fact that oral appliances are better tolerated than CPAP by many people is creative marketing.

[greyhound]

I was told I was a good candidate for a dental appliance. Although I was (still am) very satisfied with my CPAP, I hope to have a decent alternative when I traveled. Unfortunately, I didn't find the dental appliance helpful at all. It was a very expensive test that did not work at well for me.

[moonslice]

Greyhound, what did you not like about it? I happen to have a dental cleaning appointment tomorrow, so I'm going to try to get a look at one if they have a model to show me. If I do try an appliance, it's unlikely I'll go through the dentist since they don't file insurance.

[chunkyfrog]

Most insurance companies only go with the number one solution.
Liability issues, I suppose.

[Pugsy]

I never really thought much about going the oral appliance route.
First of all my OSA was far from mild and I had some ugly desats and from all I read it wasn't that effective for people with severe OSA. Secondly I adapted easily and quickly to cpap so there wasn't any real need to investigate further.

Now if my OSA had been on the mild side and I just couldn't handle the cpap thing...yeah I would have looked at anything because I believe that some therapy, even if it isn't ideal, is better than no therapy.

Oral appliances aren't without their own little issues though. I found that out just by using a nasal pillow mask that used a mouth guard on the upper teeth to stabilize the nasal pillows.

[Elidh]

A couple of years ago I asked my dentist about a snore guard-type appliance, because my husband was complaining about my snoring. The dentist asked if I'd ever had a sleep study. I didn't want to pursue that, couldn't imagine sleeping in a "lab" with people watching me. So, I was fitted for a Silent Nite appliance (paid out of pocket) and, yes, it pretty much eliminated the snoring. But I knew I was waking up all through the night and I was feeling lousy and fuzzy to the point that I went to a neurologist a few months ago, fearing I was getting Alzheimer's. She asked if I'd ever had a sleep study and, by that time, I was ready to do anything to feel better. Well, I have severe OSA, diagnosed from the sleep study (I wore the appliance during the study). I had my titration study a few weeks ago (did well on the CPAP, not wearing the Silent Nite) and next week I am getting the machine. I 'm so excited! Not sure I added anything to this discussion - just can't wait to think clearly again!

[moonslice]

Elidh, I asked my dentist about the snore guard before I was diagnosed and he told me it was illegal to make one for me unless I ruled out OSA first. Maybe I misunderstood him, but he refused it unless I had a sleep study first. I didn't do the sleep study then. I waited until another doctor also recommended it, so I finally gave in. Also, I think there is a difference between the guards made for apnea versus the ones just for snoring. Hope you feel better.

[Omne]

This study was published recently in Journal of Dental Sleep Medicine.

http://www.jdsm.org/ViewArticle.aspx?pid=30229

Volume: 03 Number: 03 7/10/2016

The interesting thing to me was that while CPAP did a better job at lowering AHI, the health outcome was not improved compared to oral appliances. They think it's because there is a greater compliance with oral appliances. The study showed that more people favored oral appliances.

Thoughts? Anyone tried oral appliances and switched back to CPAP?

If I tried to get one in my mouth I would be gagging all over. I can't even tolerate a mouth guard. My dentist has a heck of a time taking impressions.

[kteague]

I don't think that fact that oral appliances are better tolerated than CPAP by many people is creative marketing.

I agree that stating that oral appliances are better tolerated than CPAP by certain individuals is not creative marketing. I don't doubt it is true. The part I was referring to as creative marketing was the outcome comparisons between a well used oral device and not-well-used CPAP treatment. I'm not against oral appliances. I just don't like to feel "spun" after reading studies.

[greyhound]

Greyhound, what did you not like about it? I happen to have a dental cleaning appointment tomorrow, so I'm going to try to get a look at one if they have a model to show me. If I do try an appliance, it's unlikely I'll go through the dentist since they don't file insurance.

Sorry I did not see your question before your dental appointment.

The primary problem was that the device just didn't work. I slept terribly and my AHI continued to be too high. The dentist's outpatient AHI monitor confirmed my "treated" AHI levels. I also found the device to to be uncomfortable, even after struggling to overcome my gag reflex. As a result, I've resigned myself to carrying my CPAP when I travel.

[Jay Aitchsee]

So here's another take on oral appliances with another study.
http://archinte.jamanetwork.com/article ... id=2296119
The way I read it is that an oral appliance reduced AHI more than a placebo device but did not improve daytime sleepiness or quality of life compared to the placebo.

Results: Oral appliance therapy was not associated with improvements in daytime sleepiness from baseline to 4-month follow-up when compared with the placebo device.

[zoocrewphoto]

If I tried to get one in my mouth I would be gagging all over. I can't even tolerate a mouth guard. My dentist has a heck of a time taking impressions.

Same here. They use the child size xray things to do my teeth at the dentist. And they have to hurry. A few years ago, I finally had the last 3 wisdom teeth out. One had been broken for about 10 years, but I avoid the dentist like the plague since the gagging thing is really hard for me. Needles don't help.

My dentist was awesome. She wasn't sure if she would be able to do them due to my gag reflex. She thought I might need to go to a surgeon. But she was able to do them. I actually got the first one out there a few years earlier when it broke (and the loose piece was still stuck to my gums. I picked them because they were good with people who have trouble with the dentist. They are awesome.