Doctors combine CPAP treatment with oral appliance therapy

I found this in my research and thought it was kind of interesting. I'm in the process of trying this myself.


Doctors combine CPAP treatment with oral appliance therapy
American Academy of Dental Sleep Medicine
Thursday, October 6, 2011

Doctors recommend continuous positive airway pressure (CPAP) as the gold standard of sleep apnea treatment. But 25 to 50 percent of patients do not use the treatment on a regular basis because they can’t tolerate the pressure produced by CPAP. To increase compliance and effectiveness of CPAP, some doctors are combining CPAP treatment with oral appliance therapy.

Research in the journal Sleep and Breathing shows that combination therapy normalized breathing disturbances in sleep apnea patients who were otherwise intolerant to CPAP. When CPAP was used with an oral appliance, patients were able to tolerate their treatment better than CPAP by itself.

Typically, the two treatments are given separately. Oral appliances are fitted by dentists trained in dental sleep medicine. These devices fit like sports mouth guards and move the jaw and tongue forward to open the airway. Oral appliances are most effective with mild to moderate sleep apnea patients.

This study included 10 OSA patients who didn’t tolerate CPAP. They were using oral appliance therapy but still experiencing pauses in breath during sleep. The patients were taken off oral appliance therapy for one week. They then wore CPAP and an oral appliance together for three nights. Oxygen levels were recorded during a sleep study and patients took the Epworth Sleepiness Scale.

Results show that the oral appliance/CPAP combination was well tolerated by all participants. The number of times patients stopped breathing per hour of sleep was reduced from 11 times per hour to three times per hour after combination therapy.

Before treatment, the average sleepiness score was 12. After oral appliance therapy, their average score was reduced to 9. After combination treatment, the score was further reduced to 7. This decrease shows that they had more energy during the day due to combination therapy.

http://www.aadsm.org/articles.aspx?id=2633

Full report
http://link.springer.com/article/10.100 ... 010-0437-1

October 6, 2011 is a long time ago for this stuff...

Odd that this thread would pop up now. This past week on the one of the Atlanta news shows, there was an interview with a dentist about this subject. It mainly dealt with the advancements with MAD's and sleep apnea. Oddly, this interview was being conducted at my Pulmonologist's office and sleep center. Of all my visits to this office, I've never seen this guy before. I guess they pull him out of the closet when they need a news bite.

Krelvin wrote:October 6, 2011 is a long time ago for this stuff...

I have alot more problem with the small sample size (10). It is my understanding that if a study is well designed, just because it is old, doesn't necessarily mean it is no longer valid. Like any study, it has to be evaluated under the context of when it was done initially and the current context. It just seems that if they had an adequate sample size that showed the effectiveness and it was a well designed study, that nothing has currently changed that would make me question that study.

Now, don't misunderstand me, I would still prefer up to date research. But for some reason, this isn't happening with dental appliances.

Personally, the thought of combination treatment doesn't appeal to me. But I guess if I had severe apnea and it was an choice between this vs. surgery, I might reconsider.

49er

Sounds completely sensible I think.
Likely can use a lower pressure and increased tolerance.

This worked for me. CPAP pressure down 4 or 5 using oral appliance.

Then after a few years I couldn't close my mouth properly.

Back on CPAP only, with a high pressure and jury-rigged manner of keeping it strapped to my face.

OntarioKevin wrote:Then after a few years I couldn't close my mouth properly.

Oh wow!

HanzT wrote: oral appliance

Gramps and I both have custom fitted appliances - about $1600 each at the time.

Neither of us could tolerate the oral appliances alone and together with a CPAP mask, it was even worse. The appliances sit idle in a drawer.

I think some tiny segment of the patient population may find combination therapy advantageous.

Doctors and Dentists, would combine Snake Oil and Cool Aid, if it would put more money in their pockets. Feel free to waste time and money, instead of making up your minds to make what works, work for you.

Many want to travel the path least traveled, if only so they can complain, poor me I'm lost. Any time spent off making XPAP to work, is valuable time wasted keep you body working effectively. Jim

Lucky it's your choice.

The latest doctor I saw this week, (an oncologist--just in case) asked me if I was
Working on "weaning myself off" cpap. WTF?! After getting my speech back,
I pulled out my notebook, and showed how I have been keeping track
of my efficacy data, and that I had already confirmed that I needed cpap just the same,
even when I was at a normal weight. Hmph! I know more about this than they expect a hematologist to know?
I guess so. At least I'm already in good hands--mine and those here.

Goofproof wrote:Doctors and Dentists, would combine Snake Oil and Cool Aid, if it would put more money in their pockets. Feel free to waste time and money, instead of making up your minds to make what works, work for you.

Many want to travel the path least traveled, if only so they can complain, poor me I'm lost. Any time spent off making XPAP to work, is valuable time wasted keep you body working effectively. Jim

Lucky it's your choice.

How is adding a dental device to using a cpap taking the road less traveled since someone now has to get used to having something in their mouth in addition to using the machine?

I have no idea. I am just looking for what works for me and thought I'd pass it on. This thread has received some strange responses imo. I have a dental device from the past (which insurance paid for) and just started using it with my apap machine. Last night my AHI was 1.12 and a pressure of just 7 min. So far so good. No one has to use it. It was just an idea that might help someone else.

A full face mask, should provide correct treatment, on it's own. Your AHI numbers aren't correct if your leak levels are too high, you need to consult your machines software to see the full picture of your treatment, not the machine screen. Jim