Comparison of CPAP to sleep appliances

The global gold standard to treat obstructive sleep apnea is the CPAP – Continuous Positive Air Pressure. The aim is to push the air using a ventilator like machine by a nasal/oral mask to keep the tongue and other airway blocks clear.

The biggest challenge is patient compliance as it is very difficult to travel with as well as wearing a cumbersome equipment during sleep. However, my biggest concern is that it doesn’t take care of the cause of the problem. Lately, the customised intra oral sleep appliances have been replacing the CPAPs due to it’s ease of wearing, pocket friendly size and pricing. These appliances literally hold the lower jaw and tongue in a forward position to keep the airway open. However, over the counter appliances should be avoided as they may cause TMD due to the faulty bite the jaws are held in.

It doesn’t mean that the CPAP will be stopped completely. We generally follow a protocol based on the AHI parameter of the sleep study done. If the AHI is below 30, a neuromuscular sleep appliance would be ideal. If it’s above 45, a naso-maxillary expansion maybe required prior to the use of the sleep appliance. If the AHI is above 60, all the above with the CPAP is advised.