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Sleep Apnea Mouthpiece (Oral Appliance) Vs CPAP: Pros And Cons

Oct 28, 2019
Sleep Apnea Mouthpiece (Oral Appliance) Vs CPAP: Pros And Cons
Oral appliances made by licensed sleep medicine dentists are now approved as a first-line therapy for treating mild to moderate obstructive sleep apnea (OSA).

Oral appliances made by licensed sleep medicine dentists are now approved as a first-line therapy for treating mild to moderate obstructive sleep apnea (OSA).

If your sleep apnea events—partial or complete losses of breath while sleeping—number 5 to 30 per hour, your doctor may give you the option of using an oral appliance to open up your airway and ease your breathing. Oral Applinaces may also be used in patients with severe OSA, experiencing more than 30 events per hour, when a CPAP is not tolerated by the patient

If you have mild to moderate obstructive sleep apnea and have been given the choice by your doctor between using an oral appliance or electing CPAP therapy, which one should you choose? Making a decision can be tricky when you’re not clear about what the options mean. To better understand what choice is right for you, you need to know: what is a sleep apnea mouthpiece or oral appliance?

What Is a Sleep Apnea Mouthpiece or Oral Appliance for OSA? 

A sleep apnea mouthpiece or oral appliance, is a custom-fitted splint you wear in your mouth while you sleep. Over 100 different styles of oral appliance have been FDA-approved for use in the treatment of snoring and mild-moderate obstructive sleep apnea. To some degree, all oral devices for OSA resemble an orthodontic retainer or sports mouth guard.

The purpose of an oral appliance is keep your airway open by sliding your lower jaw forward slightly, just enough to make extra room at the back of the throat for the tongue and any excess soft tissue in the upper throat. By creating this extra space, your airway is no longer blocked by an obstruction and you can breathe smoothly without any pauses or interruptions in your sleep—and without snoring.

Dentists specially trained to practice dental sleep medicine—2800 professionals worldwide—can create custom sleep apnea dental devices for patients. Your sleep medicine dentist, together with your sleep specialist physician, will recommend an appliance that’s suitable for you.

Oral Appliance Therapy Pros & Cons

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What are the advantages and disadvantages of using an oral appliance to treat mild to moderate OSA, vs. opting to use CPAP instead?

Pros of Oral Appliance Therapy 

  • No dry nasal passagesSome patients who use CPAP complain of dry nasal passages, sore noses, or congestion; but oral devices don’t supply forced air to your nose and throat, so they don’t present the same issues.
  • Comfort, regardless of sleep position. Because your apnea mouthpiece is custom fit to your mouth and jaw, it doesn’t interfere with your sleep position, skin, or facial hair the way a CPAP mask might.
  • Less interference with colds and allergiesWearing an oral appliance has no effect on a stuffed-up nose during cold and allergy season. (Whereas CPAP requires a clear nasal airway for you to get the full benefit.)
  • Less stigma. Oral apnea appliances are subtler than CPAP machines. If you’re worried about wearing a “Darth Vader” mask to bed or keeping a large medical device on your bedside table, a mouth splint may be more to your liking.
  • A sleep apnea mouthpiece creates no additional sound that might keep light sleepers awake (either yourself or a bed partner). A CPAP, on the other hand, blows air continuously all night. It’s not noisy, but it does emit sound.
  • Ease of use. Oral OSA appliances are simple: they’re small and portable. They don’t require replacement parts. You don’t need to plug them in or use a battery. Care and upkeep is easy: you don’t need to clean out tubing or replace filters.
  • Travel-friendly design. Oral appliances are totally portable and come with their own travel cases. They are small and lightweight and won’t trigger TSA inspections at airports. You can even wear them if you sleep on the plane, eliminating embarrassing snoring during red-eye flights and naps. If you travel routinely for work, an oral device presents less hassle than a CPAP.
  • Affordability. If you pay out of pocket for OSA treatment, anti-snoring oral appliances are often less costly than CPAP.
  • High rate of compliance. Perhaps most importantly, you may be more likely to use an oral appliance than a CPAP. Many people find CPAP uncomfortable or intrusive and end up abandoning their therapy or being inconsistent with it. You can’t reap the health benefits of a treatment if you don’t use it. Oral therapy has a high rate of compliance in part because it’s so comfortable and easy to use.

Cons of Oral Appliance Therapy

Patients tend to report fewer issues with oral appliances than CPAP. Most complaints can be addressed at a follow-up dentist visit by making adjustments to the device. Some people may have trouble with:

  • Drooling or excess saliva (for example, if they sleep with their mouths open while wearing the device)
  • Dry mouth (see above)
  • Sore teeth or gums
  • Jaw discomfort or pain
  • Interference with dental or orthodontic work, such as damage to crowns or a change in one’s bite

A thorough initial exam with a sleep medicine dentist, plus regular follow-up visits to check on the fit and effectiveness of your appliance, can prevent or minimize most of these problems.

What Is a CPAP?

A CPAP (continuous positive airway pressure) machine, tubing and mask work together to keep your airway open when you sleep. If you have moderate to severe obstructive sleep apnea, CPAP therapy remains the first-line treatment to keep you from experiencing apnea events and loss of blood oxygen that threaten your health. (For mild to moderate OSA, depending on your physician’s recommendation, you may be given the option of either CPAP or an oral appliance.)

The CPAP machine is box that stays on your bedside table. Inside it is a motorized fan that draws air from the room. After intake, this air is filtered for dust and other particulate matter. Air can be humidified (an optional setting) to supply moisture and prevent dryness in your nose, mouth and throat. This filtered and humidified air is then pressurized to the setting required to keep your airway open. It’s delivered to your airway via tubing and a mask you wear while sleeping.

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CPAP machines come in different sizes. All require some sort of electricity or battery charge. Some are more compact than others. Some masks go over the nose alone, some feature nasal plugs that insert directly into the nostrils from below, and some cover both the nose and mouth. Increasingly, manufacturers are creating smaller and more portable CPAP machine and mask options to fit a multitude of lifestyles.

CPAP Pros & Cons

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CPAP is highly effective at improving sleep and blood oxygen levels in moderate to severe OSA sufferers. Using CPAP properly reduces the risk of developing chronic illnesses such as cognitive, memory and attention problems, high blood pressure, stroke, cardiovascular disease and diabetes. It also helps to alleviate unpleasant symptoms like snoring, sore throat, headaches and daytime sleepiness. CPAP users who comply with their therapy tend to see improvements in their energy levels and symptoms almost immediately.

However, if you you have mild to moderate OSA, your doctor may give you the option of choosing between an oral appliance and CPAP. Based on your symptoms, your general health and the results of your sleep study, your sleep specialist may feel you’ll achieve similar results with an oral appliance.

Knowing the pros and cons of CPAP can help you make an informed decision as to which therapy is better for you.

Pros of CPAP

  • Proven, fast health benefits. CPAP treats moderate to severe OSA very effectively, immediately improving and protecting your health.
  • Equipment options are better than ever. In the past, CPAP users would often complain about uncomfortable masks or cumbersome machines. Their choices in this area were somewhat narrow. However, today more designs are available than in the past.
  • Ability to experiment until you find the right match. If your machine or mask are unsatisfactory, you can talk to your sleep specialist about swapping them for new medical equipment—though you may have insurance restrictions on when and how often you can do so.

CPAP Machine Problems

  • Adjustment issues. For many users, CPAP requires time to get accustomed to the strangeness of wearing a device over the nose or mouth during sleep. Side and stomach sleepers may find they need to change their sleep positions to accommodate the mask and tubing. The feel of pressurized air in one’s airway also takes time.
  • Treatment rejection. For a small number of users, claustrophobia is a problem that can’t be overcome. For others, insomnia may result from the unfamiliarity of wearing a mask or having a machine emit noise. The noise of the machine may be overcome with earplugs or relaxation techniques, but other issues like discomfort or a new sleeping position may be more difficult for some people.
  • Lack of comfort. Discomfort is perhaps the chief complaint among CPAP users. A mask may not fit your face shape well. It may put pressure on the nose, forehead, temples or cheeks and can even leave marks on the skin. Some people complain of nasal dryness, soreness or a runny or congested nose. Some users develop sores, acne or ingrown hairs where the mask and straps rub the skin. Most of these issues can be addressed by fine-tuning your equipment and trying new masks, but this experimentation requires trial and error and can take time.

Which Therapy Should You Use for Your Obstructive Sleep Apnea?

The choice is yours.

Today, oral appliances are now approved as a first line therapy for mild to moderate sleep apnea and for severe sleep apnea when a CPAP is not tolerated by the patient. In the past, specialists considered anti-snoring mouthpieces such as these an alternative to CPAP, suitable only for those who could not tolerate the machines and masks. In recent years, however, sleep specialists have determined that for many people with mild-moderate OSA, the oral appliance is just as effective a treatment as CPAP, with the added bonus of requiring no adjustment period or lifestyle alterations.

For many people, oral appliances are the better choice because they’re easier to integrate into their lives without major upheaval. If this prospect sounds good to you, talk to your sleep physician to see if you might be a candidate for an oral appliance.

Reach out to Premier Sleep Associates today at 425-698-1732 if you have any questions about Oral Appliance Therapy for Sleep Disordered Breathing.

Oral appliances made by licensed sleep medicine dentists are now approved as a first-line therapy for treating mild to moderate obstructive sleep apnea (OSA).

If your sleep apnea events—partial or complete losses of breath while sleeping—number 5 to 30 per hour, your doctor may give you the option of using an oral appliance to open up your airway and ease your breathing. Oral Applinaces may also be used in patients with severe OSA, experiencing more than 30 events per hour, when a CPAP is not tolerated by the patient

If you have mild to moderate obstructive sleep apnea and have been given the choice by your doctor between using an oral appliance or electing CPAP therapy, which one should you choose? Making a decision can be tricky when you’re not clear about what the options mean. To better understand what choice is right for you, you need to know: what is a sleep apnea mouthpiece or oral appliance?

What Is a Sleep Apnea Mouthpiece or Oral Appliance for OSA? 

A sleep apnea mouthpiece or oral appliance, is a custom-fitted splint you wear in your mouth while you sleep. Over 100 different styles of oral appliance have been FDA-approved for use in the treatment of snoring and mild-moderate obstructive sleep apnea. To some degree, all oral devices for OSA resemble an orthodontic retainer or sports mouth guard.

The purpose of an oral appliance is keep your airway open by sliding your lower jaw forward slightly, just enough to make extra room at the back of the throat for the tongue and any excess soft tissue in the upper throat. By creating this extra space, your airway is no longer blocked by an obstruction and you can breathe smoothly without any pauses or interruptions in your sleep—and without snoring.

Dentists specially trained to practice dental sleep medicine—2800 professionals worldwide—can create custom sleep apnea dental devices for patients. Your sleep medicine dentist, together with your sleep specialist physician, will recommend an appliance that’s suitable for you.

Oral Appliance Therapy Pros & Cons

What are the advantages and disadvantages of using an oral appliance to treat mild to moderate OSA, vs. opting to use CPAP instead?

Pros of Oral Appliance Therapy 

  • No dry nasal passagesSome patients who use CPAP complain of dry nasal passages, sore noses, or congestion; but oral devices don’t supply forced air to your nose and throat, so they don’t present the same issues.
  • Comfort, regardless of sleep position. Because your apnea mouthpiece is custom fit to your mouth and jaw, it doesn’t interfere with your sleep position, skin, or facial hair the way a CPAP mask might.
  • Less interference with colds and allergiesWearing an oral appliance has no effect on a stuffed-up nose during cold and allergy season. (Whereas CPAP requires a clear nasal airway for you to get the full benefit.)
  • Less stigma. Oral apnea appliances are subtler than CPAP machines. If you’re worried about wearing a “Darth Vader” mask to bed or keeping a large medical device on your bedside table, a mouth splint may be more to your liking.
  • A sleep apnea mouthpiece creates no additional sound that might keep light sleepers awake (either yourself or a bed partner). A CPAP, on the other hand, blows air continuously all night. It’s not noisy, but it does emit sound.
  • Ease of use. Oral OSA appliances are simple: they’re small and portable. They don’t require replacement parts. You don’t need to plug them in or use a battery. Care and upkeep is easy: you don’t need to clean out tubing or replace filters.
  • Travel-friendly design. Oral appliances are totally portable and come with their own travel cases. They are small and lightweight and won’t trigger TSA inspections at airports. You can even wear them if you sleep on the plane, eliminating embarrassing snoring during red-eye flights and naps. If you travel routinely for work, an oral device presents less hassle than a CPAP.
  • Affordability. If you pay out of pocket for OSA treatment, anti-snoring oral appliances are often less costly than CPAP.
  • High rate of compliance. Perhaps most importantly, you may be more likely to use an oral appliance than a CPAP. Many people find CPAP uncomfortable or intrusive and end up abandoning their therapy or being inconsistent with it. You can’t reap the health benefits of a treatment if you don’t use it. Oral therapy has a high rate of compliance in part because it’s so comfortable and easy to use.

Cons of Oral Appliance Therapy

Patients tend to report fewer issues with oral appliances than CPAP. Most complaints can be addressed at a follow-up dentist visit by making adjustments to the device. Some people may have trouble with:

  • Drooling or excess saliva (for example, if they sleep with their mouths open while wearing the device)
  • Dry mouth (see above)
  • Sore teeth or gums
  • Jaw discomfort or pain
  • Interference with dental or orthodontic work, such as damage to crowns or a change in one’s bite

A thorough initial exam with a sleep medicine dentist, plus regular follow-up visits to check on the fit and effectiveness of your appliance, can prevent or minimize most of these problems.

What Is a CPAP?

A CPAP (continuous positive airway pressure) machine, tubing and mask work together to keep your airway open when you sleep. If you have moderate to severe obstructive sleep apnea, CPAP therapy remains the first-line treatment to keep you from experiencing apnea events and loss of blood oxygen that threaten your health. (For mild to moderate OSA, depending on your physician’s recommendation, you may be given the option of either CPAP or an oral appliance.)

The CPAP machine is box that stays on your bedside table. Inside it is a motorized fan that draws air from the room. After intake, this air is filtered for dust and other particulate matter. Air can be humidified (an optional setting) to supply moisture and prevent dryness in your nose, mouth and throat. This filtered and humidified air is then pressurized to the setting required to keep your airway open. It’s delivered to your airway via tubing and a mask you wear while sleeping.

CPAP machines come in different sizes. All require some sort of electricity or battery charge. Some are more compact than others. Some masks go over the nose alone, some feature nasal plugs that insert directly into the nostrils from below, and some cover both the nose and mouth. Increasingly, manufacturers are creating smaller and more portable CPAP machine and mask options to fit a multitude of lifestyles.

CPAP Pros & Cons

CPAP is highly effective at improving sleep and blood oxygen levels in moderate to severe OSA sufferers. Using CPAP properly reduces the risk of developing chronic illnesses such as cognitive, memory and attention problems, high blood pressure, stroke, cardiovascular disease and diabetes. It also helps to alleviate unpleasant symptoms like snoring, sore throat, headaches and daytime sleepiness. CPAP users who comply with their therapy tend to see improvements in their energy levels and symptoms almost immediately.

However, if you you have mild to moderate OSA, your doctor may give you the option of choosing between an oral appliance and CPAP. Based on your symptoms, your general health and the results of your sleep study, your sleep specialist may feel you’ll achieve similar results with an oral appliance.

Knowing the pros and cons of CPAP can help you make an informed decision as to which therapy is better for you.

Pros of CPAP

  • Proven, fast health benefits. CPAP treats moderate to severe OSA very effectively, immediately improving and protecting your health.
  • Equipment options are better than ever. In the past, CPAP users would often complain about uncomfortable masks or cumbersome machines. Their choices in this area were somewhat narrow. However, today more designs are available than in the past.
  • Ability to experiment until you find the right match. If your machine or mask are unsatisfactory, you can talk to your sleep specialist about swapping them for new medical equipment—though you may have insurance restrictions on when and how often you can do so.

CPAP Machine Problems

  • Adjustment issues. For many users, CPAP requires time to get accustomed to the strangeness of wearing a device over the nose or mouth during sleep. Side and stomach sleepers may find they need to change their sleep positions to accommodate the mask and tubing. The feel of pressurized air in one’s airway also takes time.
  • Treatment rejection. For a small number of users, claustrophobia is a problem that can’t be overcome. For others, insomnia may result from the unfamiliarity of wearing a mask or having a machine emit noise. The noise of the machine may be overcome with earplugs or relaxation techniques, but other issues like discomfort or a new sleeping position may be more difficult for some people.
  • Lack of comfort. Discomfort is perhaps the chief complaint among CPAP users. A mask may not fit your face shape well. It may put pressure on the nose, forehead, temples or cheeks and can even leave marks on the skin. Some people complain of nasal dryness, soreness or a runny or congested nose. Some users develop sores, acne or ingrown hairs where the mask and straps rub the skin. Most of these issues can be addressed by fine-tuning your equipment and trying new masks, but this experimentation requires trial and error and can take time.

Which Therapy Should You Use for Your Obstructive Sleep Apnea?

The choice is yours.

Today, oral appliances are now approved as a first line therapy for mild to moderate sleep apnea and for severe sleep apnea when a CPAP is not tolerated by the patient. In the past, specialists considered anti-snoring mouthpieces such as these an alternative to CPAP, suitable only for those who could not tolerate the machines and masks. In recent years, however, sleep specialists have determined that for many people with mild-moderate OSA, the oral appliance is just as effective a treatment as CPAP, with the added bonus of requiring no adjustment period or lifestyle alterations.

For many people, oral appliances are the better choice because they’re easier to integrate into their lives without major upheaval. If this prospect sounds good to you, talk to your sleep physician to see if you might be a candidate for an oral appliance.

Reach out to Premier Sleep Associates today at 425-698-1732 if you have any questions about Oral Appliance Therapy for Sleep Disordered Breathing.

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