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CPAP vs. Oral Appliances: Which Treatment Option Is Best for Sleep Apnea?

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Illustration of sleep apnea patient and cpap vs oral appliance for treatment

If you have sleep apnea, snoring is the least of your worries. When left untreated, sleep apnea can lead to complications including daytime fatigue, type 2 diabetes, high blood pressure, metabolic syndrome, cardiovascular disease, and liver dysfunction, among others, so treating sleep apnea is essential for a longer, happier life. 

If you’ve been diagnosed with sleep apnea, you’re likely wondering about the effectiveness of CPAP vs. oral appliances. While CPAP is the gold standard for treating Obstructive Sleep Apnea (OSA), oral appliances, also known as sleep apnea mouthguards, are becoming more and more common as a less invasive treatment option, though they aren’t a one-size-fits-all solution. Oral devices can help keep your airways open to facilitate easier breathing while you sleep.

In the question of CPAP vs. oral appliances, determining which option is best for you is ultimately between you and your healthcare provider. Depending on the severity of your sleep apnea, it’s possible that a CPAP machine is going to be the more effective treatment for you. However, if you’re unable to tolerate the continuous airway pressure, you may be better suited to an oral appliance that’s more appropriate for mild to moderate OSA.

In this article we’ll talk more about the differences between sleep apnea moutguards and CPAP machines for treating sleep apnea so you can be armed with information when you speak to your healthcare provider. First, we’ll take a look at the three different types of sleep apnea, then briefly discuss the pros and cons of each treatment option to help you better consider your choices. 

Types of Sleep Apnea 

If you’ve been diagnosed with sleep apnea and are considering treatment options, it’s important to understand the differences between the three types of sleep apnea, as each one is treated differently. Here’s a quick look at how they compare: 

Obstructive Sleep Apnea 

This sleep disorder happens when throat tissues obstruct your body’s airway. Obesity can put you at risk for developing obstructive sleep apnea, and a 2017 study found that obstructive sleep apnea can accelerate weight gain. This isn’t the only cause of OSA, however, and those who still have their tonsils or simply have excessive amounts of tissue in the throat or soft palate of the mouth are also at risk for developing OSA.

Central Sleep Apnea 

This type of sleep apnea involves a disconnect between the brain and muscles that allow breathing to occur. Central sleep apnea causes erratic breathing during sleep cycles because your brain isn’t sending signals to make your body breathe. You basically start and stop breathing several times throughout the night, and because it’s physiologically different from other types of sleep apnea, it can be more challenging to diagnose and treat.

Complex Sleep Apnea Syndrome 

The name of this sleep disorder hints at what it is: a blend of obstructive sleep apnea and central sleep apnea. Complex Sleep Apnea is more difficult to treat because it involves two types of sleep apnea and might be further complicated by other respiratory conditions.  

How Does CPAP Treat Sleep Apnea? 

CPAP, an acronym for Continuous Positive Airway Pressure, works by pushing air into the nose or mouth while you are sleeping to keep your airway open. Without this constant stream of pressure, your airway will collapse on itself, causing apneas and hypopneas. 

Those who use CPAP as a sleep apnea treatment wear a mask that fits over their mouth, nose, or both. Therapy air flows from the CPAP machine through a heated or non-heated hose and is delivered by way of the CPAP mask. CPAP machines last about five years on average, but with proper care and maintenance, they can last up to seven years before replacement is needed. 

CPAP machines typically include a heated humidifier to help combat the dryness that can occur with CPAP therapy. They also usually feature a ramp mode that helps you fall asleep at a gentler pressure and may even automatically detect your breathing to start and stop therapy when your mask is removed. 

While traditionally, a CPAP machine provides consistent pressure, APAP machines that automatically deliver the lowest pressure needed to clear the airway obstruction are becoming more popular. An APAP machine typically provides more comfortable therapy since it can adapt to your needs on a breath-by-breath basis and doesn’t need to be recalibrated if you are sick or experiencing allergy symptoms

Pros 

  • Works Well as an Effective Sleep Apnea Treatment 
  • Targets the Tissue Obstructions of Obstructive Sleep Apnea
  • Lasts for Years With Proper Care
  • Modern Machines Have Many Comfort Features To Encourage Better Compliance

Cons 

  • Masks Can Be Uncomfortable To Sleep In and Can Cause Skin Irritation 
  • Sinus Infection, Congestion, and Nosebleeds Can Occur Among Other Common CPAP Side Effects
  • Upfront Cost and Cost of Ownership

How Do Oral Appliances Treat Sleep Apnea? 

Those who have difficulty with CPAP may want to try an oral appliance for sleep apnea treatment. A mouthguard for sleep apnea will move your jaw forward to keep your airway open or prevent your tongue from falling into your airway and obstructing your breathing.  

The two main forms of oral appliances are:

  • Tongue Retaining Devices: This style of mouthguard is designed to pull and hold the tongue forward using suction so that it does not collapse backward into the airway. Also known as Tonge Stabilizing Devices (TSD).
  • Mandibular Advancement Devices (MAD): Mandibular Advancement Devices typically snap onto the teeth and are fitted by a dentist. They work to hold your jaw more forward to prevent airway obstruction. 

Sleep apnea oral appliances are best used as a substitute for CPAP or for mild to moderate sleep apnea cases. A sleep apnea oral appliance must be professionally fitted by a dentist. While oral appliances are usually less expensive than CPAP, they must be replaced more often. While you’ll typically pay $1,500 to $2,000 for a custom sleep apnea mouthguard, the MyTAP Oral Appliance is available for a much more approachable $200, making it a very appealing option for those seeking a reliable sleep apnea mouthguard.

Pros 

  • Easier for Travel Since It Doesn’t Need Electricity To Operate
  • May Be More Comfortable Than a CPAP Mask 
  • Less Expensive Than a CPAP Machine

Cons 

  • Not Suitable for Severe Sleep Apnea Cases 
  • Uncomfortable To Wear
  • Needs Replacement More Often
  • Can Be Expensive  

Sleep Apnea Oral Appliance vs. CPAP: Which is Best? 

Deciding between a sleep apnea mouthguard and a CPAP machine is a decision that only you and your healthcare provider should make together. If you decide on an oral appliance, you may also need to consult your dentist. The best sleep apnea treatment is the one that you use. However, CPAP is the option most healthcare providers and sleep experts recommend for sleep apnea treatment. 

Sleep apnea dental appliances can treat mild to moderate sleep apnea by either pushing the jaw forward to open the airway or by preventing the tongue from obstructing your airway. These oral appliances are not suitable for treating severe sleep apnea. 

Oral devices don’t need a power source, so they can make camping, travel, and sleeping on a plane possible without worrying about getting a travel-sized CPAP machine and a battery to power it. For some people, oral appliances have fewer side effects than CPAP and are more comfortable to wear while sleeping. 

Scientific studies have shown that CPAP is still the most effective choice for most people with sleep apnea who want a healthy night’s sleep. However, research also shows that adherence to dental appliances for treating sleep apnea is higher. 

Frequently Asked Questions About Oral Appliances vs. CPAP Machines

How Long Does an Oral Appliance for Sleep Apnea Last?  

Sleep apnea oral appliances don’t last forever. Most should be replaced every one to two years, depending on wear. 

Is a CPAP Necessary with Sleep Apnea? 

CPAP is the most effective treatment for sleep apnea, so it is often the recommendation of healthcare providers and sleep experts. However, dental appliances for sleep apnea can also be an effective treatment for mild cases of sleep apnea. Oral appliances are not recommended for more severe sleep apnea cases. 

Can I Treat Sleep Apnea Myself?  

Sleep apnea is best treated by a healthcare professional trained in sleep medicine. If you have sleep apnea, taking actions such as losing weight and quitting smoking can have a positive effect on your condition.  

While there isn’t a cure for sleep apnea, becoming more active, avoiding alcohol or sedatives, and changing sleeping positions can reduce sleep apnea symptoms, but these actions alone won’t take the place of CPAP or a dental appliance. 

Which is More Effective, CPAP or Oral Appliance? 

Numerous scientific studies show CPAP devices to be the most effective treatment for sleep apnea. Oral appliances are less effective than CPAP machines, but more people adhere to using them as a sleep apnea treatment. Reasons for choosing an oral appliance instead of CPAP may include the side effects of CPAP such as discomfort and sinus infections.  

People who use CPAP machines will sometimes use sleep apnea dental appliances when it is inconvenient to wear a CPAP device, such as when sleeping during air travel or camping. Those with moderate to severe cases of sleep apnea should consult their healthcare provider when considering an option besides CPAP for treatment. 

Final Thoughts

Sleep apnea is more than snoring. The condition results in lost sleep, which can lead to everything from poor decision-making at work to dangerous drowsiness when driving or operating heavy machinery. 

Sleep apnea can stop you from breathing and can result in potentially serious conditions such as obesity and metabolic syndrome, diabetes, and cardiovascular disease. 

Deciding between a CPAP machine and an oral appliance is a personal choice that should be made with the advice of a qualified healthcare professional. Mild to moderate cases can benefit from using an oral appliance, while more severe cases should find more relief with a CPAP machine. Sleep apnea isn’t something you should treat on your own. Sleep medicine professionals can improve your health through the effective treatment of sleep apnea. 

Because sleep apnea has such serious consequences, choosing the most effective treatment is essential. Most sleep medicine professionals and healthcare providers consider CPAP the best choice for most people with sleep apnea. 

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