Is it time to give up on CPAP?

[jstan]

I was diagnosed with OSA about 2 months ago (AHI = 13) and was immediately started on CPAP. When I got the diagnosis I was excited since I felt that I had finally found the answer to my constant fatigue and series of strange health issues in recent years. So, I started CPAP with enthusiasm -- I had the feeling that I would finally start feeling human again. Two months in and that enthusiasm has shifted to dread. I'm struggling battle by battle with this thing, but I feel like it's an unwinnable war.

First, I was given a mask that was far too bulky for my active sleeping style. So, within the first week I called my DME and got a new mask -- a much better nasal pillow. The new mask is reasonably comfortable and doesn't seem to restrict my movement too much, leak or fall off. First battle won.

Still, I couldn't sleep with the thing on. So, I called my sleep doc and he prescribed Ambien as a short-term fix to help me sleep until I adjusted to things. With the Ambien I can fall asleep nicely. Second battle won.

Unfortunately, I wake up 2-3 hours later when the drug wears off and can't fall back to sleep. I was getting tangled in the hose and thought this was what was waking me, so I rigged the hose to come down from my headboard and solved this problem. Third battle won.

Still, I was waking up like clockwork 2-3 hours after taking the Ambien. I was bothered by rain-out and thought that might be the problem. I got a Snuggle hose cover to deal with this problem, and it has helped (though not totally eliminated the problem). Forth battle won.

Still, though, I'm waking up like clockwork, 2-3 hours after taking the Ambien. I'm out of ideas. Despite winning every battle I can think to fight, I'm losing the war. There's nothing else I can think of that's modifiable to improve things. The real issue is that I have a mask strapped to my face, am tethered to a hose and have air being forced down my throat. And that's CPAP -- there's nothing I can do about that. I've tried to tough it out: I've laid in bed with my CPAP waiting for sleep; I've laid there and decided that it doesn't matter if I sleep, that I'll just wear it as long as possible; and I've worn it every night. But, here I am, two months in and I still have not managed a single minute of sleep with my CPAP without the aid of Ambien. Obviously, I can't take Ambien every night for the rest of my life. So, I'm out of ideas. I'm at the point where I want to call my doc and discuss surgery or oral appliances because CPAP is ruining my relationship with sleep and I don't seem to be getting used to it.

Now, I've been looking through the boards here (and a few other apnea forums) and the consensus is to stick with it -- to tough it out and deal with it. But, I feel like I have. I feel like I'm doing everything I can to make CPAP work for me and I feel that I'm not getting anywhere. And the truth is that I'm not alone. The statistics for long-term compliance with CPAP are terrible and, even among those who do comply, actual usage is low (I read that CPAP is used during ~50% of sleeping hours by those who do comply -- I don't remember the exact source, but it was a peer-reviewed journal article). So the advice I see for people in my situation doesn't seem to reflect the reality that some people just can't tolerate CPAP.

This is partially a rant (for which I apologize) and partially a call for help. What should I do? I can't just tough it out forever in the hope that I'll magically begin to tolerate CPAP. What can I do to make CPAP less horrible? Or, should I just give up and pursue an oral appliance or surgery? When is it time to say "I gave it my best and I can't do this anymore?" Thanks in advance for all of your thoughts.

[turbosnore]

Have you checked the data?
Do you have means to check the data?

I mean, maybe the data shows something...

Also, if the waking up is spontaneous, you might want to try tryptophan tabs.
Tryptophan is one of the needed amino-acids and it affects staying in sleep, so there shouldn't be any dangers.
It starts to work after couple of days (maybe a week) - the effect is not immediate.

I read somewhere that the tryptophan is the effective ingredient in the glass of warm milk.

[nichola]

2 months isnt a long time when you think about how long your body has been dealing with the sleep apnea.

I was originally waking up after a few hours too... I have been using it about the same length of time as you and I am only now just starting to sleep longer, and i had none of the issues you did. I liked my first mask, no rain out, no tangling etc

How do you feel after those two hours sleep?

Do you think maybe you are still subconciously resisting the idea? I know the nights i wsih i could just snuggle into my pillow like i used to i sleep worse with the cpap macxhine

Whats your AHI's like? I tend to wake up after a bad one.. so getting your AHI's under control with CPAP has been helping me sleep better and wake up feeling better too

[moresleep]

It appears that you have a fully data capable machine. Can you download and show us the data? It may provide a clue as to what is waking you up.

I can tell you that at first, I had a terrible time getting Cpap to work, because of sinus problems, mouth recirculation and other problems. (It sounds like you have fewer problems in those areas than I did.) But, even as Cpap started to work for me, I still found that I had a very hard time sleeping a full night. In my case, it was, I think, the terror-driven conditioning I had developed though all those years of near strangling every night. But, I eventually came out of it and started to sleep a full night. As for compliance, I don't know where those 50% figures come from, but in my case and the few Cpap users I know personally, we're all 100% compliant and have been for years. I would not feel comfortable going to bed without the Cpap.

A few suggestions: Don't use the Ramp feature. If the mask is not on right or is going to leak, you want to know about it while you are still awake. Set your Auto machine's pressure in a narrow range--you don't want it to have to waste too much time getting the pressure up where it is needed, nor do you want it to "run away" with the pressure. Don't use too much humidity; for me, the minimum amount necessary is the most I can tolerate. Beware of mouth recirculation; if you have that, you are going to have to try a chin strap, and, if that doesn't work, taping, or, back to the full face mask.

It's quite likely something is happening with the machine (or you) that is waking you up. It may be quite apparent from the data, so you really need to download those charts.

[Gaga58]

Jstan...first...don't give up!! You're too early in yet and I'm willing to bet there are things that can be done to solve some of those sleep issues for you. I'm only two months in as well and while it
wasn't perfect right off, I've had very few issues (or maybe just the ones I have don't bother me that much!). Like you I was only getting 2-3 hours in, but that was because I care for my mother who has dementia and a few months ago she was getting up every hour on the hour most nights. When I began to get that area under control I would still wake up every little bit, but a lot of that I think was habit...I'd been doing it for awhile, so the body just started waking me up. Over the course of a few weeks I have found that when Mom sleeps four hours or 6 hours...now, I do too! And once or twice I've actually gotten 7...it was lovely!! Trust me, I know how irritating it is to not get enough sleep and the more you go without the worse you feel until everything just bugs the crap out of you...but it does and WILL get better! I still have nights when Mom doesn't sleep but 2 or 3, but they are getting fewer, so I just accept it and go on. Like the others have already told you...get your data, if you don't know what you're looking at, they do here and hopefully they can tell something from it that might help you. But try to change your mindset on the lack of hours, for me it was just easier to shrug mentally and say, "ehh..I'll get more tomorrow night" and just let it go...sometimes I think we can be our own worst enemies in things like these!! Good luck to you!!

[JointPain]

Hi Jstan and welcome to the forum, and sadly to hosehead land as well.

The real issue is that I have a mask strapped to my face, am tethered to a hose and have air being forced down my throat. And that's CPAP -- there's nothing I can do about that. I've tried to tough it out: I've laid in bed with my CPAP waiting for sleep; I've laid there and decided that it doesn't matter if I sleep, that I'll just wear it as long as possible; and I've worn it every night.

Full marks for trying.

You've nailed the real issue. Your subconscious is not accepting sleeping with the hose strapped to your head and air forced down your throat. It doesn't think that's right and is keeping you alert because it senses something is wrong. Who can blame it?

The ambien was probably to give your subconscious a chance to get used to the mask, but it sounds like it needs a bit of extra help.

You can try wearing your mask when you're awake, reading a book, watching TV etc. to help get used to wearing the mask without the stress-inducing effort to get to sleep.

When you are trying to sleep and can't for subjectively too long, don't lie there trying to force your subconscious into submission. Get up and do something else quiet until you've calmed down and gotten sleepy (as opposed to tired) again and then try again when you're ready. Repeat as necessary.

One of our members, RobySue, will probably be along shortly and be able to explain it much better and give you some other things to try. In the meantime, please read her excellent blog post http://adventures-in-hosehead-land.blog ... er_19.html.

Good luck. Keep up the effort and you'll soon get over this hump and actually be looking forward to putting the CPAP on at night.

[cowlypso]

You can try wearing your mask when you're awake, reading a book, watching TV etc. to help get used to wearing the mask without the stress-inducing effort to get to sleep.

When you are trying to sleep and can't for subjectively too long, don't lie there trying to force your subconscious into submission. Get up and do something else quiet until you've calmed down and gotten sleepy (as opposed to tired) again and then try again when you're ready. Repeat as necessary.

This was exactly the advice I was going to give. Heck, your AHI isn't horrible, so maybe you take a few days or so where you hook up for a few hours during the day and skip it at night. That way you can try to establish a normal sleeping pattern again without the stress of the mask, and you can get used to wearing the mask without the stress of sleep. Then, put them together in a few days to a week and see how it goes.

[Mary Z]

Hang in there! You are giving it a good try- good move to post here- but you have barely gottten started. You have gotten some good advice. It takes some of us much longer to get used to sleeping with the machine than others. I would talk to my doc about the ambian, perhaps you can get something longer lasting. Benadryl will also help you sleep through the night. If after another four months you still can't tolerate CPAP maybe you should look into dental devices.
It's hard work for some of us, but you can learn to live with the machine and start feeling better.
Good luck, keep us posted.

[Pugsy]

You have software options available so you can see what is happening during the night. Maybe something will show up at that 2 to 3 hour mark. If nothing else it will show if the therapy is at least optimal on paper.
I have explained the software options here.
viewtopic.php?f=1&t=64906&st=0&sk=t&sd= ... re+options

Did you have trouble sleeping through the night prior to starting on the machine? In other words did you wake often and have trouble getting back to sleep or is this problem entirely new since therapy started.

There is a term for it.. Sleep maintenance insomnia. It is fairly common. How it is fixed depends on what is causing it.
Robysue's blog chronicles her own personal experience with it and I bet she will come by to offer some ideas.

In the meantime let's get you some software so you can see for sure how that part of the therapy is going.

[DoriC]

What are your settings? Do you have software? Are you leaking at the 2-3hr mark? Each sleep cycle is approximately 90minutes so it's possible you're needing more pressure in REM sleep.It could be something as simple as adjusting your pressures, adjusting Flex and Humidifier settings. Can you give us more info? Giving up is not an option so stay with us!

[ThirdOutOfFive]

One suggestion -- talk to the doc about other meds that cause drowsiness but are not addictive. I use doxepin, which is technically an anti-depressant, but which makes me drowsy. I have been using this for years, and it is not addictive. I keep using it because I have intractable insomnia due to another illness. I know other people who use benadryl, a cold medicine. It will help you sleep, and I don't think it is addictive.

I admire your problem solving skills and stick-to-it attitude. Don't give up. Keep working on it. And, please keep posting, so we know how you are doing.

[robysue]

jstan,

I bid you a very sad welcome to the CPAP&Insomnia club. And may your membership soon end.

Two months in and that enthusiasm has shifted to dread. I'm struggling battle by battle with this thing, but I feel like it's an unwinnable war.

Many a time during my first 8 months with the mask I felt like I'd won many a battle, but was still losing the war.

So I'd like to start by telling you just a wee bit about myself: I started CPAP on September 23, 2010 and by September 26 one of the worst, most persistant, longest lasting battles with insomnia had started. In my case, the predominant problem was bedtime insomnia: I simply came to dread bedtime and very act of getting ready for bed tended to wake me wide awake and led to both comfort problems (I was fighting aerophagia) and additional sleep problems. Once I finally feel asleep in those early days, it seemed like on many nights I slept until morning, but I still woke up feeling exhausted---as in I felt like I'd been running a marathon all night. And then, by the end of November, I started waking up in the middle of the night on many nights and having real problems getting soundly back to sleep. The nadir may have been my first bi-level titration study: It took me over an hour to get to sleep in the first place; I slept for about 80-85 minutes later (at the end of my first sleep cycle basically) and then laid in bed AWAKE (as measured on the EEG) for the next 3 hours. I finally feel back asleep about 20-25 minutes before the test was over. Mind you: I didn't think I was awake the whole time. I knew I was tossing and turning, but I also thought I was getting at least some short periods of light Stage 1/2 NREM sleep. It was about 5 or 6 weeks after that titration study that I finally admitted to myself that I needed more help in fighting the insomnia monster. And I came away from yet another meeting with the sleep doc's PA with a prescription for Ambien (which I did not want to take) and a CBT plan involving sleep logs and a sleep restricted schedule among other things. And slowly I started to make some real progress. About 6 weeks after starting my War on Insomnia (about 5 months into therapy) I started to notice the first positive change in how I felt in the morning since starting CPAP: In my sleep logs I was noting that I was sometimes waking up without any pain in my hands and feet---pain that I'd been waking up with routinely for many years. Not every day, but sometimes.

I still have my problems with insomnia----particularly when I'm under a great deal of stress from family and/or job (and this month is proving to be a very stressful one). But now that I'm almost 14 months into therapy, I know that my remaining problems with insomnia are no longer directly caused by the BiPAP (most of the time) AND I see real positives in how I feel when I wake up most mornings--as in at least 5 mornings every single week. The positive changes were small and subtle at the start, but as they've grown, they do make a profound difference. Do I feel great yet? No, my entrenched insomnia is still a bit too much around. Do I feel better than I did before starting CPAP? Yes---on most mornings I feel better than I did before CPAP: In my case the most important difference is that every morning now, I wake up with no pain in my hands and feet. My headaches are under control (this, however, has involved getting my migraines under control as well as the apnea). And slowly but surely my energy is coming back. On my best mornings I feel twenty years younger. I'm greedy now and I want all of my mornings to be like those best ones now.

I tell you all this to not to frighten you, but to be honest: It can take months for some of us to really master sleeping with hose. And during that time, it's easy to feel overwhelmed by the fatigue, the insomnia, the sense of the world being turned upside down by using a machine that is supposed to make your sleep better, but seems to do as much (or more) harm than good. But if we really want to take the best care of our bodies that we can, we have to keep slogging through until our body and mind both sort out how to trust the mask to help rather than fight the mask every night.

And no doubt about it: You've had a rough two months with a bad mask, hose entanglement problems, rainout, not being able to sleep, and waking up after the Ambien wears off. So let's look at the current battle that seems unwinable. You write:

Still, though, I'm waking up like clockwork, 2-3 hours after taking the Ambien. I'm out of ideas. Despite winning every battle I can think to fight, I'm losing the war. There's nothing else I can think of that's modifiable to improve things. The real issue is that I have a mask strapped to my face, am tethered to a hose and have air being forced down my throat. And that's CPAP -- there's nothing I can do about that. I've tried to tough it out: I've laid in bed with my CPAP waiting for sleep; I've laid there and decided that it doesn't matter if I sleep, that I'll just wear it as long as possible; and I've worn it every night.

Yes, there's nothing you can do about the fact that CPAP does indeed require sleeping with a mask on your face tethered to a hose and having air forced down your throat. On my rare bad nights that feeling still comes back to bite me. But those rare nights have dropped from "EVERY NIGHT" (at two months into therapy) to "once or twice a month"---with "twice a month" tending to happen only when non-PAP stressors are interfering with my sleep in the first place.

And I want to commend you for sticking with wearing the mask night after night after night. I did that too and I think in the long run that it is absolutely critical to do that in order to have a real chance of making this crazy therapy work.

So how can we help you get to where this feeling is not happening EVERY NIGHT? I think a significant part of your problem is that your are choosing to lie in the bed while WIDE AWAKE fighting the mask. Now note: I am NOT saying to sleep without the mask!!! Instead, I think you need to try an old trick from the anti-insomnia tool kit: If you are NOT asleep within about 20 or 30 minutes after you wake up and it's clear you are making no progress getting back to sleep, it is time to simply get up out of bed and go into a different room for a few minutes. When you are out of bed you should try to do something that will both get your mind off the mask for a few minutes AND help you get sleepy enough to go back to bed. Go back to bed only when you are both willing to mask up and sleepy enough to be able to get to sleep in a reasonable amount of time. Yes, getting out of bed is counter-intuitive. But it makes your bed a sanctuary for sleep: In other words, you have to teach your body and mind that it is not acceptable to lie in bed for hours not sleeping.

But, here I am, two months in and I still have not managed a single minute of sleep with my CPAP without the aid of Ambien. Obviously, I can't take Ambien every night for the rest of my life. So, I'm out of ideas. I'm at the point where I want to call my doc and discuss surgery or oral appliances because CPAP is ruining my relationship with sleep and I don't seem to be getting used to it.

Calling the doc to let him know your concerns about the Ambien is a good idea. And ask him for ideas on how to start weaning yourself off the Ambien. Also be honest about the fact that you are waking up unable to get back to sleep. And ask for help with that problem.

Some self-help ideas: You could try cutting the Ambien in half and seeing if that still lets you get to sleep. For me, I never took Ambien every day---I was just too worried about getting dependent on it. The PA and I agreed that I'd use the Ambien the night AFTER having a disastrous night where I defined disastrous. The idea was to avoid two extremely sleepless nights in a row. But like you, I found that I would wake up about 2 or 3 hours after taking it. And in the early going, it was tough to get back to sleep. And that's where the sleep restricted schedule became useful: By getting up at the same time every day, I forced my body to get to where it WOULD get back to sleep within 5 or 10 minutes of waking up. As my PA explained it to me: If you have 2--4 wakes during the night and the wakes are not too long and you go right back to sleep, they really are not that disrupting to the overall sleep cycles, and at that point you just need to not worry about them. That's pretty much where I am now: On a typical night I wake up 2--3 times but get back to sleep almost immediately. And when that happens, I wake up feeling pretty decent in the morning.

Now, I've been looking through the boards here (and a few other apnea forums) and the consensus is to stick with it -- to tough it out and deal with it. But, I feel like I have.

Remember two months is not that long. For some of us unlucky folks, the adjustment period takes many months. For a few really unlucky folks, it can take a year or more. But abandoning CPAP and not treating the apnea will allow it to worsen with time and continue to damage your body.

I feel like I'm doing everything I can to make CPAP work for me and I feel that I'm not getting anywhere. And the truth is that I'm not alone. The statistics for long-term compliance with CPAP are terrible and, even among those who do comply, actual usage is low (I read that CPAP is used during ~50% of sleeping hours by those who do comply -- I don't remember the exact source, but it was a peer-reviewed journal article). So the advice I see for people in my situation doesn't seem to reflect the reality that some people just can't tolerate CPAP.

Several comments:

1) Yes, you are doing a lot to make CPAP work. But it's not quite true that you are "not getting anywhere". You've already gotten through several serious problems that would have led many a less determined, less committed newbie to just throw the towel in and abandon CPAP. That's a significant factor indicating potential for real success if you keep plugging away for at least a couple more months.

2) Yes, CPAP has a high non-compliance rate: Figures in peer reviewed journals often cite figures of 40-60% of OSA patients prescribed a CPAP give up on the therapy within the first year. And many of those actually abandon therapy within the first two or three months, and some of them give up within the first two weeks. But there is a big difference between a patient abandoning therapy during the first rough few weeks or months and a patient being genuinely intolerant of CPAP therapy. There are some folks who are genuinely intolerant: They suffer unbelievable aeorphagia or air gets into their eyes through the tear ducts for example. And there are some folks whose apnea remains stubbornly persistent even with PAP therapy---in the sense that their treated AHI, while better than their diagnostic one, is still elevated. And there are folks who are unlucky enough to develop complex apnea when put on PAP therapy. But for the most part, most of those people who give up on PAP give it up for comfort reasons: The rainout problems; the getting tangled in the hose problems; the initial discomfort of the mask; problems with the mask leaking that they don't make a real effort to resolve; problems with mouth breathing that could be addressed, but aren't; and, for many of the folks who abandon it, simply the overwhelming feeling that making PAP work simply requires too much work and too many changes to their life style. And notably, many peer reviewed papers talk about the non-compliance problem in terms of patient comfort problems rather than patient intolerance and there's at least one peer reviewed paper that indicates quality patient education and support is the most critical thing that can and should be done to help more patients become compliant and stay compliant.

3) But in those same peer reviewed papers that I've seen and read, many of them make no mention about the role that insomnia can play in a patient's adjusting to PAP. There's a presumption that many OSA patients suffer from apnea-induced insomnia before starting PAP and that in this subset of OSA patients, the expectation is that "fix the apnea" should "fix the insomina". But if my own sleep doctors are typical of the average sleep docs out there, there doesn't seem to be much recognition that CPAP itself seems to trigger insomnia in some OSA sufferers. And, at least in my experience, docs don't seem to like to deal with patients who don't react to a prescribed therapy as expected.

This is partially a rant (for which I apologize) and partially a call for help. What should I do? I can't just tough it out forever in the hope that I'll magically begin to tolerate CPAP. What can I do to make CPAP less horrible?

Start by not making yourself fight the machine for long periods of time while lying awake in bed worrying about how little sleep you are getting and thinking about just how uncomfortable the whole CPAP thing is. You do this by making yourself get out of bed when you can't get to sleep at the beginning of the night or when you can't get back to sleep after waking up in the middle of the night. When you are out of your bed during the time you want to be asleep, don't focus your attention on the fact that you are up and awake. Try to relax: Make yourself a cup of sleepy time tea or a cup of warm milk. Or read a boring book. Or simply sit in the semi dark for a few minutes. And go back to bed only after you are both calm enough and sleepy enough to try again.

Next, if you haven't done it, LOOK at the DATA recorded by your machine. In the best case, it will tell you that your AHI is nice and low and that you are not having any real leak problems. But it may also reveal unexpected reasons why you may still be having so many problems adjusting. Perhaps after the Ambien wears off you are waking up after a cluster of events and a pressure change might be in order. Perhaps you are waking up to fix a leak (while still almost asleep) and then fully waking up without really knowing why.

And call the sleep doc's office and insist on a call back or an appointment (in the next week or so) to talk to the doc or a PA or a nurse practitioner about the combination of CPAP adjustment problems and insomnia.

And give the CPAP at least two or three more months before declaring it an abysmal failure.

Or, should I just give up and pursue an oral appliance or surgery? When is it time to say "I gave it my best and I can't do this anymore?" Thanks in advance for all of your thoughts.

Since your apnea is still in the mild range, there's a possibility that an appropriate oral appliance may be enough to keep your apnea under control. But keep in mind that the oral appliances also have their problems. And while the compliance rate with oral appliances is higher than that of CPAP, it is still not close to 100%. Problems with oral appliances include jaw problems and tmj problems because you are sleeping with your jaw forcibly advanced into a non-natural position. Some folks develop serious pain issues with the appliances---pain that does not go away in the daytime. Some folks find that they drool far more with the appliance than with out it, and that can lead to dry mouth problems. And some folks simply find the devices too uncomfortable to sleep with---the same way some people find CPAP too uncomfortable to sleep with.

As for surgery? I'd urge caution there: The success rates are not that high (often 50%) and are often temporary in the sense that the person winds up redeveloping apnea a few years down the line (as in 5 years). And post-surgery it can be tougher to adapt to CPAP.

Good luck!

[dogluvr]

I'm only 2 1/2 weeks into cpap and I have the same problems as you have described. However, I am far less patient I guess and found this website and complained to my doctor. Robsue's experience is invaluable so listen to her suggestions. My dr also tweaked the settings on my apap for a narrower range and when I told her I had heard over the counter melatonin might help, she was very supportive of my trying it. She said to take 10 to 20 mg, 1 - 2 hrs before bed. I take 5 or 10 mg and it definitely helps me feel drowsy and relaxed. After several days now, I am starting to sleep much better. I slept 7 1/2 hrs last night with hardly a wakeup and my AHI read 0.5. I was thrilled and where I think I have some time to go to start feeling better overall, I believe now, I can do it. I probably will try without melatonin in the near future also. You can do it. Hang in there and try the suggestions the other, more experienced cpap users have mentioned. Good Luck

[avi123]

[quote="jstan"]I was diagnosed with OSA about 2 months ago (AHI = 13) and was immediately started on CPAP. When I got the diagnosis I was excited since I felt that I had finally found the answer to my constant fatigue and series of strange health issues in recent years. So, I started CPAP with enthusiasm -- I had the feeling that I would finally start feeling human again. Two months in and that enthusiasm has shifted to dread. I'm struggling battle by battle with this thing, but I feel like it's an unwinnable war.

Reply to: Is it time to give up on CPAP???

There are alternatives!


As you mentioned, any chances that an Oral Appliance could help you instead of the CPAP? I am talking about an appliance like these that don't need any surgery.


http://www.centerforsoundsleep.com/pdf/ ... iances.pdf


Excerpts from the following source:


http://www.centerforsoundsleep.com/Oral ... herapy.php

Oral appliance therapy presents a less intrusive and cheaper alternative for many sleep-related breathing disorders. If necessary, oral appliance therapy can be combined with more conventionally used therapy to enhance the effectiveness of these treatments. Better yet, it allows people to continue their lives much more normally while providing long-term relief.

Treating sleep apnea

Oral appliances are extremely effective in managing obstructive sleep disorders because they position the lower jaw and tongue in a more forward position during sleep. As the tongue moves forward, the airway opens up, making breathing easier.

No one technique is effective for everyone; however, the American Academy of Sleep Medicine recommends oral appliances as a first line therapy for the treatment of mild to moderate sleep apnea and for those severe sleep apnea sufferers whose CPAP treatment has failed.

Acceptance rates of oral appliances versus CPAP

Anything new and different in the mouth takes getting used to, but in a recent study, 91 percent of sleep apnea patients who were treated with an oral appliance were still using their appliances comfortably at the end of one year. In comparison, CPAP compliance is less than 50 percent. Studies show that if patients are given a choice in treatment, the overwhelming majority will choose oral appliance therapy over CPAP.

Treatments for "simple" snoring and Upper Airway Resistance Syndrome (UARS)

Oral appliance therapy is an excellent way to treat both "simple" snoring and UARS. Remember that even "simple" snoring can disturb sleep quality of the snorer and the bed partner alike! Oral appliances treat "simple" snoring in much the same way as the more serious disorders. The jaw is held in a more forward position during sleep and the airway in the back of the throat opens up. As a result, the annoying vibration or snoring stops and peaceful sleep can resume.

There is considerable evidence that the intense vibration in the soft palate caused by snoring initiates an inflammatory response in that tissue. It is suspected that, over time, this chronic tissue inflammation induces swelling and causes "simple" snoring to deteriorate into more serious disorders. Oral appliance therapy reduces or eliminates the swelling by stopping the vibration.

Check if this is for you!

[stevos2000]

Before CPAP I had bad insomnia and after of course I still do. I could fall asleep but couldn't stay asleep. My doctor gave me ambien to help adjust to CPAP. Like you, I awoke after 3 hours. The I cut it in half and took the second half when I awoke. That got me maybe 5 or 6 hours or so. Still felt crummy. As far as I'm concerned ambien is a lousy drug. Finally, I got a prescription for lunestra which got me a whole nights sleep of 7 to 8 hours. (And my dream memory back) This left me feeling much better. Lunestra is supposedly OK for long term use, so you might talk to your doctor about it. I know its not politically correct to talk about long term use of a sleeping drug, since CPAP is supposed to be the cure all in the long run. But if you do have insomnia above and beyond apnea you might want to think about it. I will try to reduce my need for this at some point, but for now I am very much enjoying sleeping for 7 to 8 hours every night.