Sleep Apnea – CPAP Verses Mouthpieces
A Mouthpiece Should NOT Replace Your CPAP
Can you use a stop snoring mouthpiece to treat Sleep Apnea [OSA]?
This is one of the most commonly asked questions about mouthpieces and in particular Mandibular Advancement Devices.
Almost all the manufacturers of MAD’s will tell you their devices are not to be used to treat Sleep Apnea because whilst snoring is a big part of Sleep Apnea it is not the sole issue associated with this problem.
Despite this fact people who suffer from OSA still do use them to help treat the diagnosis. Many of the forums talk about it in detail. The forum CPAP Talk has many examples of people using Mandibular Advancement Devices [MAD’s] to treat their OSA.
People share differing views however and at the end of the day it is always going to be a personal choice. Medical Practitioners will tell you in the vast majority of instances you should not rely on any form of anti snoring device to treat OSA by itself.
My research strongly suggests most people with Sleep Apnea who decide to try a mandibular device, do so in conjunction with a Continuous Positive Airway Pressure [CPAP], if for no other reason but to give themselves a break from the CPAP.
Many also use one as a short term substitute if they are sleeping away from home for a short period of time and do not wish to take the CPAP with them.
A few use them as a replacement for CPAP but in the vast minority. Some people just cannot adapt to a CPAP. This si not the recommended approach however as OSA is not just about snoring.
Studies – CPAP Machine Verses MAD
I have found a couple of studies or trials of CPAP and MAD’s and have provided a summary and link to each one for your convenience.
Study # 1
CPAP vs. Mandibular Advancement Device for Obstructive Sleep Apnea.
Adherence and some quality-of-life measures were better with the device than with continuous positive airway pressure.
Comparative studies of oral appliances and continuous positive airway pressure (CPAP) to treat obstructive sleep apnea (OSA) generally have been small, with various limitations. In this randomized crossover trial that involved 126 OSA patients, Australian researchers compared CPAP with a mandibular advancement device that is adjusted gradually to the maximal comfortable limit.
Sleep apnea was mild, moderate, and severe in 18%, 55%, and 27% of patients, respectively. Each modality was used for 1 month.
The mean baseline apnea-hypopnea index (AHI) was 26 events per hour. AHI decreased markedly in both the CPAP and device groups, but mean on-treatment AHI was significantly lower with CPAP (5 vs. 11 events/hour), and the proportion of patients whose AHI normalized was higher with CPAP (about 75% vs. 40%). The AHI difference between the two treatment groups was striking for patients with severe OSA and modest for those with mild or moderate OSA.
However, adherence was significantly better with the mandibular device than with CPAP (average self-reported use, 6.5 vs. 5.2 hours).
Twenty-four–hour blood pressure measurements were unchanged in both groups. Daytime sleepiness improved equally in both groups. When eight quality-of-life indicators were evaluated, the mandibular device was equal to CPAP in four and superior to CPAP in four.
COMMENT: The authors note that this is the largest randomized trial in which a wide range of outcomes was examined. As expected, CPAP reduces the numbers of apneas more effectively (especially in patients with severe OSA), but mandibular devices sometimes are tolerated better.
The authors suggest reasonably that both modalities should be considered as acceptable first-line treatments (even in patients with severe OSA), given the tradeoffs between physiologic efficacy and patient adherence.
Article Source – American Thoracic Society Journal
Study # 2
Mandibular advancement device in patients with obstructive sleep apnea : long-term effects on apnea and sleep.
AuthorsMarklund M, et al – Show all Journal Chest. 2001 Jul;120(1):162-9.
Affiliation – Department of Orthodontics, Umeå University, Umeå, Sweden. Marie.Marklund@odont.umu.se
STUDY OBJECTIVES: To evaluate the long-term effects on apneas and sleep and the tolerability of a mandibular advancement
device in patients with obstructive sleep apnea.
DESIGN: Prospective study.
SETTING: Department of Respiratory Medicine, University Hospital, Umeå, Sweden.
PATIENTS: Thirty-three consecutively treated patients.
INTERVENTIONS: Individually adjusted mandibular advancement devices. Measurements and results: Polysomnographic sleep recordings on 1 night without the device and 1 night with the device were performed after 0.7 +/- 0.5 years (mean +/- SD) and after 5.2 +/- 0.4 years from the start of treatment. Nineteen of the 33 patients experienced a short-term satisfactory treatment result with an apnea-hypopnea index of < 10 events per hour and a satisfactory reduction in snoring. Fourteen patients were regarded as being insufficiently treated with the device.
Seventeen of the short-term satisfactorily treated patients (90%) and 2 of the remaining patients continued treatment on a long-term basis. The apnea-hypopnea index was reduced by the device from 22 +/- 17 to 4.9 +/- 5.1 events per hour (p < 0.001) in these 19 long-term treatment patients, which did not differ from what was found at the short-term follow-up visits in these patients.
Patients with their devices replaced or adjusted experienced a better long-term effect than patients still using their original devices (p < 0.05).
CONCLUSIONS: The long-term effect and tolerability of a mandibular advancement device are good in patients who are recommended the treatment on the basis of a short-term sleep recording, provided that the device is continuously adjusted or replaced with a new one when needed.
A short-term follow-up is valuable in the selection of patients who will benefit from long-term treatment with a mandibular advancement device.
Article Source – PubMed.com
I do not suffer from Sleep Apnea and so I am not able to totally relate to the issues people experience as a result of suffering from the problem but controlling my snoring problem has always been a priority for me. To do this I have resorted to using a variety of snoring mouthpieces.
However, I do have two family members who do suffer from OSA and they spoken to me about their issues from time to time so I do have some understanding.
It is certainly not for me to make a recommendation to anyone concerning the use of a Mandibular Advancement Device to replace any other form of treatment someone may be using to treat their OSA.
The information provided in this article is simply to put some perspective on what people who suffer from OSA are trying as supplementary treatment to CPAP. It is important for me to stress that my research suggests that some people who suffer from OSA are using MAD anti snoring devices as an ADDITIONAL form of treating the snoring portion of OSA and not the entire problem.
Generally it is a convenience factor for short periods of time and to give themselves a break from the CPAP machine.
The American Sleep Apnea Association forum is another good source of information in respect to the use of CPAP and MAD.
I will leave the decision up to the individual. If you have a snoring problem which has developed in OSA then it is important to do something about it as overwhelming evidence has now confirmed that snoring is linked to stroke and heart disease. snoring is a major health issue these days.