When Is An Oral Sleep Appliance An Alternative Treatment To C-PAP?


C-PAP stands for constant positive air pressure. C-PAP devices deliver room air not oxygen to the patient at varying pressures. The maximum pressure level is set depending on the apnea of the patient Positive air pressure of a sufficient amount can keep a person’s airways open so that there is no obstruction to breathing. This pressure is delivered to a person usually through a mask over the nose or sometime a mask that covers the entire face or a tube under the nose. People fail or are intolerant of this type of treatment all the time and are classified as C-PAP intolerant or C-PAP failures.

Some of the common reasons people give for being C-PAP intolerant are the following:

  1. Mask leaks air all the time
  2. Just can’t get the mask to fit properly
  3. Too much discomfort caused by straps and headgear
  4. Disturbed or interrupted sleep caused by the presence of the device
  5. Noise from the device disturbs them and their bed partner
  6. C-PAP restricts movements during sleep
  7. Pressure on upper lip hurts or chin strap pressure hurts TMJ
  8. Claustrophobic feeling
  9. Unconscious removal of mask every night
  10. Patients don’t like the lines made on their face every day
  11. Leaking air around mask hurts eyes or dries eyes
  12. Stomach fills with air
  13. Air leaking around and out of mouth gives a terrible dry mouth

These are just a few of the reasons patients have given for not wearing their C-PAP device. Fortunately more and more the sleep physician, when they know there is a problem, will send them to me to make an oral appliance. Oral appliances have some draw backs as well, but are generally more universally accepted by patients. After one year, patients who have been prescribed the oral appliance are more compliant vs. patients who have been prescribed the C-PAP. Oral appliances can be recommended initially over C-PAP in cases where the patients’ Sleep Apnea is mild to moderate in severity.