CPAP or Oral Appliance Therapy?

Fri, Feb 25, 2011

One of the most common questions we hear is “Which is better?  Constant Positive Airway Pressurisation or Oral Appliance Therapy?”   (Oral appliance therapy, or ‘OAT’ is the technical name for dental treatments for snoring and sleep apnoea).

As with most things, the simple answer isn’t all that simple.  Most practitioners agree that CPAP is the ‘gold standard’ treatment for sleep disordered breathing conditions, because the nature of the treatment (i.e., gentle inflation of the airway to hold the airway walls apart) virtually guarantees the treatment will be effective. 

This is the case, no matter how severe the SDB condition is — which is why the Academy of Sleep Medicine proposes CPAP for all cases of ‘severe’ sleep apnoea.  OAT is endorsed only for snoring and mild to moderate sleep apnoea.

And while we agree with this absolutely, we’ve found this is only a guideline for a number of reasons…

First, because CPAP (like any treatment) is only effective if and when it’s being used.  If the patient can’t or won’t comply with the treatment (i.e., wear the mask etc while asleep) then obviously they will get no benefit from CPAP treatment.  In cases like this, oral appliance therapy can be an excellent alternative.

In most the cases OAT will NOT achieve the same degree of improvement as CPAP … but properly fitted appliances are still capable of achieving clinically significant improvements. 

Indeed, we’ve seen many cases where the patient went from sleeping with CPAP for only 4 hours per night to sleeping with their oral appliance for 8 hours per night.  So, even though the reduction in the patient's AHI (apnoea / hypopnoea index) was not as great, the longer period of use was more than enough to compensate.

Having said severe apnoea sufferers can sometimes be successfully treated with OAT, it’s important to note that the opposite also applies.  Sometimes even simple snorers cannot be successfully treated via oral appliance therapy.  This is typically due to structural abnormalities in the nasal passage, upper airway or oral cavity.  Surgery may be necessary to correct these issues — or the patient may choose to wear CPAP, even though the severity of their sleep disorder does not typically call for this form of treatment.

The bottom line is, you need whichever treatment is best for you — and the best treatment is the one which is effective AND tolerable.  That’s why it is so important to arrange your treatment through a practice which offers a full range of treatment options. 

For information on how The Sleep Therapy Clinics can help with CPAP, OAT or surgical intervention, call 1300 246 637 now or send us an email via the 'Contact Us' page.