Is CPAP my only option? Perhaps Not.

Sleep Apnea is more prevalent than ever before but is no longer an unknown disorder. Due to education and awareness people have come to realize the importance of treating this disorder. Data suggests many are looking for modalities other than the “standard” CPAP therapy.

Studies show up to 83% of users do not use their CPAP therapy as prescribed, many give up on it completely. Many find the mask uncomfortable or claustrophobic or they find it frustrating to have to regularly clean the hose, mask or nasal pillows to prevent infection. For many that travel, camp or backpack, it is not conducive to their lifestyle.

There are also side effects that crop up from this therapy that not everyone is aware of. As CPAP uses a positive pressure of room air to keep the airway open, a stuffy nose or bloated abdomen can occur. Another issue could be spreading any infections throughout the room in the “exhaust” air like the flu or COVID. Another commonly seen side effect is a dry mouth, which is not only uncomfortable, but also raises your risk of gum disease and tooth decay. Research has shown, over the long haul, CPAP can even change your face shape and contour.

One study tracked 46 CPAP patients for two years to assess the impact on facial structure in long-term CPAP users. The researchers compared cephalometric x-rays of patients at the beginning of the study with images taken at the study’s end. A “ceph” x-ray is one that is taken outside the mouth and shows the whole side of the head, letting a physician or dentist see the relationship between the teeth, jaw, and profile.

While “none of the patients self-reported any permanent change of occlusion or facial profile,” the ceph x-rays showed changes in the dental arches, with both the upper and lower jaws shifting backwards – something that could possibly worsen apnea symptoms over time.

A more recent case study reported that CPAP usage appeared to cause a patient’s front teeth to shift, creating gaps in their smile.

It is likely that there is a high degree of variability in tooth movement with CPAP as there is a wide variation in the way a patient’s tongue is forced forward with the air pressure when CPAP is in use. The continuous direct pressure used in the same location of the airway night after night also may have a direct correlation to tooth movement. Whether these side effects occur only beyond a certain pressure of CPAP is unknown.

CPAP is toted as the “gold standard” for treating Sleep Apnea, yet over 80% of the population designated to wear it are unable to comply with the therapy. Compliance is difficult for many and acceptable compliance is as low as 4 hours a night 5 out of 7 nights, which still leaves most people on CPAP untreated for 30%-50% of their time asleep. CPAP is a great therapy IF you can tolerate it and we have many patients in our practice that do.

For those that can not or will not tolerate CPAP other modalities must be offered if the epidemic of sleep apnea is to be controlled. Custom Oral Appliance Therapy has been shown to be as effective for many patients, especially with its increased compliance compared to CPAP therapy.

A properly fabricated Oral Appliance is created by scanning an individuals’ teeth, it is then custom made and can hold the teeth in place like a retainer obtained from a general dentist or orthodontist. While in place it stabilizes the lower jaw in a measured forward position allowing the airway to remain open during sleep.

Some side effects of Oral Appliance Therapy can include excessive saliva, especially in the first few weeks and minor morning soreness of teeth for the first few mornings. Stiffness or discomfort in the jaw muscles and/or joints can occur and can be best managed with regular exercises, stretches and improving treatment efficacy by advancing the jaw away from the airway. Tooth and Bite changes can occur and can be monitored for to limit or mitigate these issues should they arise. Most side effects are minor, and self limiting or can be adjusted for by your treating Dental Sleep Medicine Professional.

Physicians are not always aware of the data showing oral appliance therapy as a first line treatment for many with sleep disordered breathing (sleep apnea). A Custom Oral Appliance should always be provided by an experienced and qualified sleep dentist (Diplomate in Dental Sleep Medicine). CPAP patients struggling with compliance or have been unable to tolerate at all should be made aware of this other treatment option by their physician or their CPAP therapist.

If CPAP is your only real option for treating the life-threatening condition of Sleep Apnea and you tolerate it, please stay on this therapy as it could save your life. Also be sure your dentist knows you wear a CPAP so they can monitor you for tooth movement to ensure your CPAP mask is not negatively affecting your bite or the position of your teeth.

If you are unable to tolerate CPAP or it is not an appropriate therapy for you,
a Custom Oral Appliance may be a great option for you

Remember Sleep Apnea can be serious and costly to your health if not managed.

At Sleep Better Live Better we offer both CPAP and Oral Appliances.

We are the only office that is licenced and qualified to do so. We have helped thousands of people over many years. We could very well be your answer, your hope for more vitality and a healthier life.

Breathe easy knowing there is a range of therapies out there to suit your needs and help address those serious sleep apnea issues!

Make an initial consultation appointment now, book online or call our office, we look forward to meeting you and helping you add years of life lived with vitality.


Your Sleep Better Live Better Team

Roberta Kreiser RPSGT, CCSH, RST SLEEP THERAPIST         Sharnell Muir DMD, Diplomate ABDSM, Diplomate ASBA

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