If you have obstructive sleep apnea like 22 million other Americans, you are likely using CPAP (continuous positive airway pressure) therapy to manage your sleep disorder. . . Unless, of course, you’re struggling to wear the mask or nasal pillows every night.
If you’re uncomfortable or claustrophobic, you may actually end up sleeping without the CPAP gear more often than you’d like to admit to your doctor. Or maybe you have good intentions and start out wearing your sleep mask, only to wake up and find you’ve pulled it off your face in the night.
Unfortunately, if you can’t use the CPAP as advised, it can quickly go from being a life-saving piece of medical equipment to a singularly unattractive bedside table decoration.
CPAP is highly effective in treating apnea—but only if you comply and use it as directed by your sleep specialist. The problem is, not everyone with OSA can tolerate this form of apnea therapy, for a variety of reasons.
“I Can’t Stand Wearing my CPAP.” (Reasons People Can’t Tolerate CPAP)
If you can’t tolerate CPAP therapy, you’re not alone. According to The Cleveland Clinic, a mere 44% of people diagnosed with OSA continue their CPAP therapy after three years. That means that more than half of all diagnosed OSA patients stop therapy at some point. Even knowing the risks of untreated apnea, they stop using CPAP—which means their objections to the therapy are worth listening to.
Why do people with OSA stop using CPAP? (Why have you struggled to keep using it?) Sleep medicine specialists hear a variety of reasons. Maybe yours is on this list:
- The mask is uncomfortable. People with apnea sometimes complain that the CPAP mask chafes against their skin or irritates their facial hair. It may even cause sores or acne, or allergic responses to the silicon. The nasal pillows feel awkward resting inside the nostrils. The head and chin straps create indentations in the face or make it difficult to roll over or side sleep. Discomfort is probably the number one complaint that people report when they stop complying with therapy.
- Wearing the mask makes users claustrophobic. Some people report feeling trapped under the CPAP mask, especially if they need to wear a style that goes over both the nose and mouth.
- The forced air dries them out. Some OSA patients say that the forced air of a CPAP is too dry, even if they humidify it using the machine’s attached humidifier chamber. In some users, dry nasal passages, sinuses, and throat can lead to sores, infections, colds, coughs, and sinus headaches.
- Allergies get in the way of therapy. Nasal congestion and a runny nose from chronic allergies or a cold can come into conflict with wearing a mask. A patient with a stuffed-up nose may be forced to mouth-breathe until the allergies or cold are gone, completely missing out on the CPAP benefit. Some people even feel that wearing the CPAP mask makes their congestion worse.
- The tubing gets tangled. Restless sleepers who tend to move around a lot may find that their arms get tangled up in the CPAP hoses. In the course of their movements, they may even separate the tubing from the mask, rendering the therapy useless, or even breaking the components.
- The noise is bothersome. For some, the sound of the forced air is too distracting, keeping them from falling asleep.
- It’s unattractive. Stigma is a tough excuse to admit to a doctor, but in truth it’s a common reason people discontinue CPAP therapy. Many people feel embarrassed to wear a CPAP to bed, or dislike the look of a piece of medical equipment on their bedside table. They may feel it’s unsexy, or associate the need for a CPAP with being old or overweight (when in fact, even children can have obstructive sleep apnea; so can thin, fit people in the prime of their lives).
- It’s inconvenient. Frequent flyers, recreational travelers, outdoors enthusiasts, athletes traveling for games, matches and tournaments—these are just a sampling of CPAP users who wish for a less cumbersome, more portable, more discreet and easier-to-use way to treat their OSA when they’re on the road.
This is a brief list of reasons people with obstructive sleep apnea give for not continuing their CPAP therapy. People who’ve rejected CPAP have reported all kinds of reasons for not complying. But as with any form of medical treatment, if you don’t use the therapy every day—or at all—you won’t get the health benefit it offers.
The good news is, if you can’t tolerate CPAP, you don’t necessarily need to stop treating your apnea. An effective alternative does exist: dental devices, also known as oral appliance therapy.
Oral Appliance Therapy as an Alternative to CPAP: Is it Right for You?
Dental devices—mouthpieces that help to eliminate airway obstructions without the use of forced air—are now approved as a first line therapy for mild-moderate OSA. This means that if you’re diagnosed with OSA that is not moderate to severe, you can elect to use a sleep apnea mouthpiece instead of CPAP and your choice will be covered by most health insurance plans.
Many people with OSA are increasingly selecting this option for a number of reasons: apnea oral appliances can be more comfortable than wearing a CPAP mask; they are low-tech and don’t require outlets or batteries; they’re easy to wear; they’re portable; they don’t have replacement parts; they require little upkeep; and they’re subtle. Wearing one to bed is not unlike wearing a retainer or a mouthguard to prevent tooth grinding. You still have to use something every night, but it’s far less obtrusive to your lifestyle (and sleep position) than a mask, tubing, and a machine that needs to be plugged into the wall.
Even in the case of severe apnea, you can get the use of an apnea mouthpiece approved by your insurance, if you truly cannot tolerate CPAP. Insurers and physicians recognize that dental device therapy, while not ideal for people with severe OSA, is better for you than receiving no therapy at all.
You might be asking yourself two questions:
- “Which type of OSA do I have? Mild-moderate or moderate-severe?”
Ask your sleep medicine physician if you’re uncertain about where you fall on the Apnea Hypopnea Index (AHI). (The AHI is the measure of how many apnea events you have per hour.) Mild-moderate OSA can be anywhere from 1 to 30 apnea events per hour. Severe OSA is characterized by 30 or more apnea events per hour.
If you have mild to moderate obstructive sleep apnea, the switch from CPAP therapy to dental device therapy can be an option. If you have severe apnea, you will need to show that your poor compliance is due to an inability to tolerate your current CPAP therapy.
- What exactly is a sleep apnea dental device (also known as an oral appliance, sleep apnea splint or sleep apnea mouthpiece)?
An oral appliance is a custom-fitted mouthpiece resembling a sports mouth guard. It pulls the lower jaw forward, holding the soft tissues off the back of the throat. This slight shift in the position of your jaw keeps the airway open while you sleep, eliminating snoring and obstructions. With a referral from your sleep medicine physician, you can visit a sleep medicine dentist to get fitted for a mouthpiece that slides over your teeth.
Many patients who’ve been unsuccessful or unhappy with CPAP therapy find a dental oral appliance for apnea to be a more comfortable solution. Oral appliances for apnea tend to have a high rate of compliance. Because they are so effective and FDA-approved, a growing number of sleep experts now refer them to patients as a first-line treatment for OSA.
For patients who have a strong aversion to CPAP, the advantages of an oral device are numerous. Cost is one such advantage. If you don’t have health insurance, the out-of-pocket cost of a dental device is usually significantly less than CPAP gear—and dental devices don’t have parts or filters that need cleaning or frequent replacement.
Oral devices are not only effective for treating CPAP—they are also no-fuss, which means they’re increasingly popular as a therapy approach for anyone who cannot use CPAP, but who nevertheless takes their apnea seriously and wants to continue treatment.
The Cleveland Clinic