Combined CPAP & Oral Appliance Therapy

There is no one solution for sleep apnea that works well for every patient, as is the case with most medical or oral health concerns. Many patients who try either CPAP or oral appliance therapies individually without success may benefit from a combination of the two treatment options. Dr. Donald M. Marks and his skilled team at State College Dental Sleep Medicine invite these patients to schedule a sleep apnea treatment consultation to find out more about combined CPAP/oral appliance therapy and how it may offer optimal comfort and relief for those suffering from sleep apnea. Our skilled dentist is happy to work alongside a sleep doctor to ensure your treatment planning is seamless, maximally effective, and minimally invasive. Contact us today to find out more.

CPAP Therapy

Continuous Positive Airway Pressure therapy or CPAP is the use of a facial mask that covers either the nose, mouth, or both, forcing air down the throat and ensuring airways remain unblocked during sleep, allowing patients to rest and relax through the night. As the longest used treatment for both central and obstructive sleep apnea, CPAP therapy is time-tested, offering predictable results. However, CPAP therapy also has a higher noncompliance rate because patients are frequently unable to accustom themselves to the sounds and sensations of CPAP systems. Typically, sleep doctors recommend patients use the CPAP system every night for one to two weeks. If they are unable to get used to the system after this amount of time, we may recommend oral appliance or combined therapy.

Oral Appliance Therapy

For patients with mild to moderate sleep apnea, comfortable oral appliances may be a viable alternative to traditional CPAP therapy. Oral appliances shift the jaw forward during sleep, putting pressure on throat muscles to keep the airway open. These appliances are comfortable, effective, and portable, and for many patients, treatment with an oral appliance alone is enough to keep their airway open through the night. For those patients with more advanced obstructive sleep apnea or those who suffer from combined central and obstructive sleep apnea, oral appliance therapy alone may not be effective.

Combined Treatment

An effective combination of both CPAP and oral appliance therapy allows patients to experience maximum comfort and effective treatment. Using CPAP alone, those patients who experience moderate to severe sleep apnea need to adjust to the high intensity of CPAP systems running on the highest settings, which can be very loud and uncomfortable. The combined treatment allows patients to use CPAP at much lower settings, significantly decreasing the sounds and sensations which may counteract the positive effects of CPAP, waking patients periodically throughout the night. Combined therapy uses only a nasal mask, which may be much more comfortable than the masks that cover both the mouth and nose or even those that fit over the mouth. Another benefit of combined treatment is portability. Even if patients don’t want to travel with both their oral appliance and bulk CPAP system, using just the oral appliance during travel can still be very beneficial.

Who Should Consider Combined Therapy?

Combined CPAP and oral appliance therapy is not the right solution for every sleep apnea patient. Our knowledgeable dentist and team are always happy to discuss the full range of treatment options with each patient, and if one treatment is ineffective, we work with patients to make changes to find the right solution. Some of the many cases in which we may recommend combined therapy include:

• Patients who are in CPAP noncompliance
• Patients who are CPAP intolerant
• Patients who do not achieve desired results through oral appliance therapy
• Patients who experience inadequate results using CPAP therapy alone

Benefits of Combined Therapy

There are a number of added benefits for patients who choose combined CPAP and oral appliance therapy, including:

• Increased comfort – with combined therapy, there are no bulky face straps or full mouth and nose masks that can increase discomfort associated with CPAP systems. Oral appliances keep the airway open, allowing for an unimpeded flow of air without the CPAP system needing to be at full pressure to force the throat open.
• Decreased noncompliance – sleep apnea and the wide variety of detrimental side effects associated with it can only be treated if patients consistently used their oral appliance or CPAP systems as directed. The improved comfort with combined therapy decreases cases of noncompliance and improves the effectiveness of sleep apnea therapy for every patient.
• Improved results – in the past several years, a number of reputable studies have been conducted to determine the effectiveness of combined therapy in the treatment of sleep apnea. One study reviewed apnea sufferers’ Apnea-Hypopnea Index (AHI). These numbers are calculated as part of sleep testing to help professionals determine patients’ overall quality of sleep. An American Academy of Dental Sleep Medicine study revealed that the average sleep apnea sufferer had an AHI of 6.6.  CPAP therapy resulted in an average of 4.4 AHI, and combined therapy users had an average of 2.6 AHI. Another way sleep physicians study patients’ sleep apnea results is by using the Epworth Sleepiness Scale. According to research, sleep apnea sufferers scored a 12 on this scale. Those using an oral appliance alone decreased their scores to 9, and those who used combined therapy decreased that number to 7. Both studies revealed that treatment with just one of these trusted sleep apnea therapies is not as effective as combined therapy.
• Ease of travel – CPAP users who travel frequently (especially by plane) often forego treatment while they’re away from home because CPAP machines are bulky and difficult to transport. Additionally, CPAP systems require large amounts of distilled water to function properly. Patients who use combined therapy can simply take their oral appliances with them during travel.

Contact Our Team Today

If you’re ready to schedule a sleep apnea consultation or you’re interested in finding out more about treating sleep apnea, contact State College Dental Sleep Medicine today. Our team is happy to help patients receive diagnosis, review treatment options, answer questions, and create a personalized treatment plan that allows them to sleep soundly through the night.