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.
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:
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.
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:
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.
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.