CPAP lowers breathing pauses during sleep more reliably than an oral appliance, but both treatments improve daytime sleepiness to a similar degree, and an oral appliance is a recognized option for adults who cannot tolerate CPAP. This article explains how the two compare and what that means if you live in West Hills or the west San Fernando Valley.
Which works better, CPAP or an oral appliance?
CPAP is more effective at lowering the apnea-hypopnea index (AHI). In a systematic review and meta-analysis comparing the two, CPAP reduced the AHI and raised the lowest oxygen level more than mandibular advancement devices, while the improvement in daytime sleepiness scores did not differ significantly between them (Cammaroto 2017). A therapy only works on the nights it is used, though, and some people who stop using CPAP will wear an oral appliance.
Do oral appliances help blood pressure the way CPAP does?
In pooled randomized trials, oral appliances lowered daytime systolic and diastolic blood pressure, and oral appliance therapy and CPAP were about equally effective in lowering blood pressure (de Vries 2018). Evidence on longer-term cardiovascular outcomes is limited.
Who should consider an oral appliance?
The American Academy of Sleep Medicine and the American Academy of Dental Sleep Medicine recommend that sleep physicians consider an oral appliance, rather than no treatment, for adults with obstructive sleep apnea who cannot tolerate CPAP or prefer an alternative (Ramar 2015). The same guideline suggests a custom, adjustable appliance made by a qualified dentist over a non-custom device, and follow-up sleep testing once the appliance is adjusted. The European Respiratory Society’s guideline on non-CPAP therapies also addresses custom dual-block mandibular advancement devices (Randerath 2021). See options if you can’t tolerate CPAP.
Is CPAP still the first treatment to try?
For most adults with obstructive sleep apnea and daytime sleepiness, yes. The AASM recommends positive airway pressure over no therapy for adults with excessive sleepiness, and recommends education and early troubleshooting to help people keep using it (Patil 2019). If mask fit, pressure or dryness is the problem, your CPAP supplier or physician may be able to fix it before you switch.
What is the comfort difference?
CPAP uses a mask and hose; common complaints are mask leaks, dryness and difficulty sleeping with the mask. An oral appliance is worn on the teeth and holds the lower jaw slightly forward. Common early side effects are jaw or tooth soreness in the morning and changes in how the teeth meet, which is why the guideline suggests ongoing dental follow-up (Ramar 2015).
How does insurance treat each one?
Both are usually billed to medical insurance, because obstructive sleep apnea is a medical diagnosis. Sleep Apnea and TMJ Dental Group is out-of-network with all insurance plans, including Medicare. You pay the office directly and receive itemized paperwork to submit to your plan; whether it reimburses you depends on the plan. Read more about oral appliance therapy for sleep apnea and the mandibular advancement appliance.
Where can I be evaluated in West Hills?
Dr. Masudian, DDS, MPH, a Diplomate of the American Board of Dental Sleep Medicine, sees adults for oral appliance therapy at 23101 Sherman Pl, Suite 415, West Hills. The office is expected to open in mid-January 2027. Call (818) 877-0118 or request an evaluation.
References
- Ramar K, Dort LC, Katz SG, et al. Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: an update for 2015. J Clin Sleep Med. 2015;11(7):773-827. PMID 26094920. doi:10.5664/jcsm.4858
- Patil SP, Ayappa IA, Caples SM, et al. Treatment of adult obstructive sleep apnea with positive airway pressure: an AASM clinical practice guideline. J Clin Sleep Med. 2019;15(2):335-343. PMID 30736887. doi:10.5664/jcsm.7640
- Randerath W, Verbraecken J, de Raaff CAL, et al. European Respiratory Society guideline on non-CPAP therapies for obstructive sleep apnoea. Eur Respir Rev. 2021;30(162):210200. PMID 34853097. doi:10.1183/16000617.0200-2021
- de Vries GE, Wijkstra PJ, Houwerzijl EJ, et al. Cardiovascular effects of oral appliance therapy in obstructive sleep apnea: a systematic review and meta-analysis. Sleep Med Rev. 2018;40:55-68. PMID 29195726. doi:10.1016/j.smrv.2017.10.004
- Cammaroto G, Galletti C, Galletti F, et al. Mandibular advancement devices vs nasal-continuous positive airway pressure in the treatment of obstructive sleep apnoea: systematic review and meta-analysis. Med Oral Patol Oral Cir Bucal. 2017;22(4):e417-e424. PMID 28578372. doi:10.4317/medoral.21671
