Combination Therapy More Effective Than CPAP Alone

According to research presented last week at the American Academy of Dental Sleep Medicine (AADSM), combination therapy is more effective in treating obstructive sleep apnea than CPAP alone. The study also showed that people tended to be more tolerant of CPAP therapy when it was combined with oral appliance therapy.

The small study looked at 10 women and 10 men who were being treated for severe obstructive sleep apnea. The patients experienced a mean of 66 apneic events or breathing pauses prior to treatment. When treated with CPAP, the number of events decreased to only 4.4 per hour, and 2.6 with combined therapy. Although the vast majority of breathing interruptions were corrected with CPAP alone, patients experienced considerable benefit from MAS when measured by the Epworth Sleepiness Scale (ESS). ESS scores decreased from a mean of 10.1 before treatment to 7.9 with CPAP treatment to 4.9 with combination treatment, showing that even if the changes in breathing interruptions may not seem to be as significant, the contribution to a person's quality of life may be dramatic.

Researchers also note that patients who did not comply with CPAP therapy alone were comfortable with combination therapy, but did not release clear data to support this assertion.

If you are struggling with CPAP therapy and are looking for a more comfortable alternative, oral appliance or combination therapy may be a better option for you. To learn more, please contact a local sleep dentist today.

SUAD not Working: what about combination therapy?

Comment: Steve Would like information about OPAP treatment for sleep apnea.

Comment Christy
Hello,
Steven my name is Christy I work with Dr. Ira Shapira in the Chicago-land area. He is the founder of the ihatecpap web site. The site is dedicated for alternative treatment to the machines. We have sleep apnea trained dentist all around the country. Where exactly do you live what the closest larger city. Please forward me this info and I will try to locate someone in your area to help you.
Keep Smiling
Christy

Steve:
I live closest to Philadelphia. I have a custom made oral appliance (Suade device/?spelling). While I have noted some improvement, I still have sleep apnea. I suspect I could tolerate and would benefit from CPAP if the machine were attached to an oral appliance with appropriate connections. I was unable to tolerate conventional CPAP with face mask.
I have not been able to find any local practitioners who offer that particular option (oral appliance with connector to allow connection to CPAP unit), but rather only offer oral appliances.
Thanks for your help. It is really, really appreciated.

Dr Shapira

I frequently see out of town patients in my Gurnee office but I am sending you contact info for George a regional sales manager for TAP who has the best appliance interface but would require a new appliance. I am copying this e-mail to George.

The OPAP is not my favorite appliance. There is considerable danger of inflating stomache which is problematic

CPAP Pro also makes an appliance that attatches to an appliance but does not advance the mandible.

It is possible to add an extension to the maxillary portion of the SUAD and connect a nasal mask with Velcro to the appliance extension. It is also possible to connect to CPAP Pro

Without access to you sleep study I do not know details but some patients can use a positioner to stay off their back in conjunction with an appliance if there is a positional component to the sleep apnea.

Another option is to revamp SUAD and reshape to remove retrusive reflex contacts to tongue and/or add protrusive tongue reflex aaptations.

Occasionally adding an anterior vertical stop to a SUAD can improve success as can additional anterior moverment. I usually do not use a SUAD as an initial appliance but titrate with TAP ! and then make SUAD to the titrated treatment position.

The TAP 1 appliance is still the the most effective appliance due to ability to advance mandible beyond maximum protrusion and ease of titration during sleep study. The TAP 3 fits the new interface that Keith Thornton designed. They also can make a custom fit nasal mask connected to TAP 3

There are always custom appliances that can improve efficacy but are not FDA approved.

The full Breath appliance invented by Bryan Keropian also works via a different method of maintaining airway by rstraining the tongue.

I hope this is helpful.

Dr Ira L Shapira