CPAP or Sleep Appliance, which one is right for me?

CPAP or Sleep Appliance, which one is right for me?

This is a common question that many health professionals are frequently asked. In the simplest form, OSA or Obstructive Sleep Apnea is a condition where the soft tissues and base of the tongue occlude and block the airway while you sleep. This can be caused by a lot of things including a bad bite or jaw relationship, or extra tissues in the next whether from carrying too much weight or from too much musculature in the neck (like in body builders). The major issue is that when you lay on your back the lower jaw has nothing to counteract gravity and it simply slides back and when it does it takes the base of the tongue with it – and the only place for it to go is into the airway and it closes that off to some extent.

To familiarize you with the basics of therapy, the CPAP is simply a machine that will blow air into the airway while you sleep. It is essentially an airhose that blows air with enough pressure that any obstruction or blockage gives way to the air. So in this airway that is too small, the CPAP can be turned up enough that it blows through that closed airway and you get the much needed oxygen.

On the other hand, there are many mouth appliances that are designed to protect an open airway in some form or fashion. Some will be one piece that locks your upper and lower jaws into a particular position while it is in. Those generally are not comfortable and compliance is an issue. There is one that is a suction cup that grabs the tip of your tongue and pulls it forward all night – I can’t imagine that being comfortable! The design that we see most success with is made by a company called SomnoMed and the appliance is SomnoDent. In particular, the one they produce that we helped develop as it doesn’t crowd your tongue and allows for a better or more comfortable jaw position. These are two piece appliances – one for  the upper arch and one for the lower. There is a ramp built into them that will prevent the lower jaw from dropping back at night and occluding the airway.

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The gold standard is the CPAP and it is what physicians are familiar with – however it is something to get used to when you are sleeping as it is like having a little breathing machine (picture a quiet Darth Vader) sleeping next to you. For sure it is helpful as it forces air into your system and is you are dealing with OSA that is essential! OSA is seen as the root cause of many issues such as hypertension and heart and coronary artery disease, diabetes, obesity, and the list goes on. It is a very dangerous condition that many people suffer with. The CPAP is a major help if you can adapt to using it – but that is so spotty that in the literature they call success wearing it about half the night and only four nights a week. In my book I think we can do much better! I would like you to be protected seven nights a week!

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What the mouthpieces or ‘Mandibular Advancement Appliances’ will allow you to do is protect a more open airway all night – and that will allow you to either see dramatic improvement with that treatment alone – or if the CPAP is still beneficial, you will be able to turn the pressure of the air way down as the obstruction is significantly less. That makes sleeping with CPAP much more likely.

In any event, if you or someone you know is dealing with OSA, it is a very serious and progressive issue. Initially it is simply not good but as it progresses it becomes life threatening.

If you would like to find a dentist close to you with LVI training in Sleep and Breathing Disorders or OSA use our search function to find a TMJ Dentist near you. They can tell you if they have had the training at LVI for managing sleep in the most physiologic and comfortable way.


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Categories CPAP OSA Sleep Apnea Sleep Appliance
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