For treatment of obstructive sleep
(OSA), continuous positive airway pressure, commonly known as CPAP, is
the standard treatment. The CPAP, an air pressure device with a mask worn
during sleep, is very (99%) effective at maintaining airflow and reducing or
eliminating the interrupted breathing that is caused by sleep apnea. In people
with OSA, these episodic pauses in breathing—called apneas and hypopneas—cause
disruptions to sleep and lower oxygen levels in the bloodstream. Sleep apnea is
associated with a number of cardiovascular
, including high blood pressure, stroke, atrial fibrillation, and
congestive heart failure. OSA is also linked to type 2
diabetes and other metabolic disorders. 

The biggest challenge to CPAP’s success in treating sleep
apnea has been compliance
with treatment – wearing the mask. Patients are often uncomfortable using the
device, especially at the beginning of treatment, and this reluctance can lead
to inconsistent use, or abandonment of the therapy altogether. 

Happymanpjs_artur84New research indicates
that some OSA patients may have another treatment option. Researchers at The
Netherlands’ University of Groningen compared treatment outcomes for OSA
patients using CPAP and oral appliance therapy. They found oral appliance
therapy to be an effective alternative to CPAP for treating sleep apnea. Oral
appliance therapy involves
a dental device similar to a retainer or a mouth guard. Worn during sleep, this
device works to keep the airway open, helping to prevent the collapse of the
tongue and other muscles at the back of the throat that restrict breathing. 

Researchers conducted a 2-year follow up to a clinical trial that
compared the effectiveness of CPAP and oral appliance therapy. During the
two-year study period, researchers assessed the treatment progress of 103
patients with OSA. They used several standard
measurements to track patients’ progress in treatment, including
polysomnography and a self-reported sleepiness scale. The severity of OSA is
categorized by the frequency of episodes of interrupted breathing, as ranked on
a scale known as the apnea-hypopnea
(AHI). For the purpose of this study, researchers defined “successful”
treatment as a reduction of AHI to less than 5 episodes per hour, or a
reduction of at least 50% from subjects’ initial AHI readings. Their analysis
found that oral appliance therapy is an effective alternative to CPAP for some
sleep apnea patients:

  • For
    subjects with OSA ranging from mild to severe, researchers found similar
    levels of success in both CPAP and oral appliance therapy.
  • Both
    oral appliance therapy and CPAP resulted in significant improvements to
    patients sleep quality, as well as to their levels of daytime sleepiness.
    Both treatments also showed similar reductions to levels of depression and
    anxiety, conditions frequently reported by sleep apnea patients.
  • Both
    treatments were effective in reducing frequency of interrupted breathing
    episodes—but CPAP was found more effective than oral appliance therapy at
    lowering AHI. CPAP also demonstrated greater effectiveness in raising
    blood oxygen levels than oral appliance therapy. 

Researchers concluded that oral appliance therapy was a viable
treatment option for patients with mild to moderate sleep apnea. For severe
cases of OSA, researchers recommend CPAP as they best treatment option. Other studies have also found
oral appliance therapy works effectively to improve sleep apnea:

  • Australian
    researchers compared
    the two treatment options among 126 subjects with moderate to severe sleep
    apnea. After 1 month of observed treatment, they found similar levels of
    effectiveness in both CPAP and oral appliance therapy. Both treatments
    showed similar capacity to improve daytime sleepiness and performance.
    CPAP was shown to be more effective in lowering AHI, while people complied
    more readily with treatment protocol for oral appliance therapy. 
  • Another
    comparison of both treatments found oral
    appliance and CPAP similarly effective. Researchers observed that both
    treatments decreased AHI, improved daytime sleepiness and function. As
    with other studies, CPAP was determined more effective at reducing AHI,
    and oral appliance had higher rates of compliance. 

Compliance has long been an issue with CPAP
therapy. Intermittent and inconsistent use of the device undermines its
effectiveness. To receive the full benefits of CPAP therapy, it must be used
consistently—and for many patients, that has proved difficult. Still, there’s
little question that when used correctly and consistently, CPAP can be
tremendously effective in treating
obstructive sleep apnea, especially severe cases. For
people with severe OSA, CPAP will likely remain the standard treatment. 

But broadening treatment options for less severe sleep apnea
is very good news. People with mild and moderate OSA—especially those who have
difficulty with CPAP—may consider speaking with their physician about using
oral appliance therapy to manage their condition. 

What’s most important is finding the right treatment
and sticking with it. Sleep apnea is a serious health condition. Fortunately,
treatments used correctly—whether CPAP or oral appliance—can significantly
improve your sleep and your general health.

Sweet Dreams,

Michael J. Breus, PhD 
The Sleep Doctor®

The Sleep Doctor’s Diet
Plan:  Lose Weight Through Better Sleep

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