The use of Continuous Positive Airway Pressure (CPAP) devices
for the treatment of obstructive sleep apnea (OSA) has been considered the gold standard in the treatment of Obstructive Sleep
Apnea (OSA). But "poor compliance with PAP treatment may be the reason why a recent study suggests that PAPs for
OSA patients were not fully effective in preventing stroke and deaths of any causes." (Yaggi et al. NEJM 353)
Why do people have difficulty with using CPAP devices? From personal experience, here is what
I found:
* The mask was very uncomfortable. After graduating from the simple to the more complicated masks, I still
could not find anything comfortable.
* I could not move in my sleep without dislodging the mask.
* Once the mask
is dislodged, I could not sleep because the noise or air movement would wake me up. I had to get up to replace the mask
again.
* Breathing in was easy but breathing out was difficult. I resorted to breathing through the mouth which
defeated the purpose of CPAP treatment.
* When I finally give up using the devices in the middle of the night, I would
throw the mask over the side of the bed. This would wake my wife up.
After
struggling with the CPAP for months, I decided to look for alternatives. That was when I found oral appliances (particularly
OSB). I have not used the CPAP since.
"Studies have shown that the
mean compliance to CPAP may vary from 3.4 to 4.7 hours per night, whereas the compliance to tMRAs is around 6.8 hours per
night. Thus, most patients with OSA who are treated with CPAP spend 2 to 3 hours per night without any treatment: a period
of time that might have received treatment if another method had been used." (Sleep & Breathing: 11. No 4. Dec 2007)
"The efficiency of intra-oral appliances is twice the efficiency of CPAP treatment."
(Sleep & Breathing Dec 2007)
tMRAs (titrable Mandibular repositioning appliances)
is recommended for the treatmet of mild and moderate OSA according to AASM (American Academy of Sleep Medicine) criteria.
In our office, after a thorough evaluation of sleep and breathing problems, we may recomend one or a combination of different
devices for the treatment of mild to moderate OSA.
