Does CPAP cure Sleep Apnea? Do Oral Appliances Cure Sleep Apnea? Can surgery cure sleep apnea?

CPAP and Oral Appliances are not cures for sleep apnea but rather effective treatment for sleep apnea patients. They are only effective when they are used on a regular basis , all night - every night.

CPAP compliance is an enormous problem even though CPAP treatment is extremely effective. Recent studies have shown 60% of patients abandon CPAP use. CPAP that is not used is not only not a cure but is a total treatment failure.

Oral appliances while usually extremely effective for mild to moderate sleep apnea and often effective for even sever sleep apnea are much better tolerated by patients. The majority of patients chose an oral appliance over CPAP when offered a choice. Compliance with oral appliances is very high and patients who "Hate CPAP!" often love their oral appliances.

Oral appliances are also not a cure for sleep apnea just a very effective treatment. When compliance is considered along with efficacy oral appliances are probably more effective overall than CPAP. If an oral appliance is not used it does not work. Compliance is a much smaller problem with oral appliances but they are not a panacea.

Is surgery a permanent cure to sleep apnea? Surgery for sleep apnea can be curative but most surgeries fall far short of curing sleep apnea.

Soft palate surgery has a long history. Uvulopalatopharyngealplasty or UP3 surgery is extremely painful and rarely cures sleep apnea. There is a high morbidity rate with this painful surgery and most patients still require use of either CPAP or an oral appliance. Some patients have severe scarring that can drastically worsen the condition. Variations of the UP3 procedure are LAUP or Laser Assisted Uvuloplast, Somnoplasty, pillars and snoreplasty. All of these surgeries rarely if ever cure the patient but carry the severe risk of creating a "silent apneic" where snoring is eliminate but apnea is still present. MOST PATIENTS SHOULD AVOID THESE SURGICAL PROCEDURES, IF YOU DECIDE TO PROCEED WITH THESE SURGERIES I STRONGLY SUGGEST A SECOND OPINION FROM A NON-SURGEON SLEEP SPECIALIST.

Nasal surgery, correction of deviated septums and/or turbinate reductions are also not considered cures for sleep apnea but do increase nasal breathing and are helpful . I FREQUENTLY REFER PATIENTS FOR THESE PROCEDURE THAT OFTEN OFFER EXCELLENT RESULTS, BUT RARELY CURE APNEA. They almost always result in an improvement is quality of life and rarely have any long-term morbidity.

Bimaxillary advancement, usually best done by oral surgeons or plastic surgeons are frequently an effective long-term cure of sleep apnea. Orthognathic surgery is major surgery and should be carefully considered before doing surgery. The surgery consists of cutting the upper jaw away from the skull often splitting the maxilla in half as well, The lower jaw or mandible is sectioned into three sections and frequently the hyoid bone is split into three pieces. The patient is then wired shut for six weeks. The surgery is drastic and can make significant changes in patients appearances but is also extremely effective. In many patients there can be profoundly positive cosmetic results. I STRONGLY SUGGEST THAT PATIENTS CONSIDERING THIS SURGERY FIRST USE AN ORAL APPLIANCE TO ELIMINAT THEIR SLEEP APNEA. THIS WILL SERVE AS A GUIDE FOR HOW FAR THE SURGERY NEEDS TO ADVANCE THE MANDIBLE. IT IS THE BEST WAY TO INSURE THAT REPEAT SURGERY OR INCOMPLETE CORRECTION OF APNEA DOESN'T LEAVE A PATIENT WHO STILL NEEDS CPAP OR AN ORAL APPLIANCE AFTER SURGERY.

Nasal Symptoms from CPAP Decreased with Heated Humidification. Patients Prefer Oral Appliances.

This blog entry is a reprint of a recent press release:

Nasal CPAP frequently causes problematic nasal symptoms including congestion, dry nasal tissues, nasal itchin, and sinus pain. A recent study showed that heated humidification decreases nasal inflamation.

FOR IMMEDIATE RELEASE

PRLog (Press Release) – Jul 03, 2010 – A recent study "Nasal inflammation in sleep apnoea patients using CPAP and effect of heated humidification." (see PubMed abstract below) looked at nasal symptoms caused by nasal CPAP. CPAP is considred the gold stanard of treatment but is rejected by 60% of patients accoring to recent studies. Many patients abandon CPAP in favor of Comfortable Oral Appliances http://www.ihatecpap.com The current study concluded that heated humidification "nasal obstruction of OSA patients on CPAP treatment is inflammatory in origin, and the addition of heated humidification decreases nasal resistance and mucosal inflammation. "

The percentage of patients who tolerate CPAP is usually determined by the initial experience with CPAP. CPAP suppliers should consider starting CPAP on all patients with the use heated humidification to improve compliance.

Many studies have shown that oral appliances have much higher compliance and patient satisfaction ratings than CPAP. There is a growing sentiment that for mild to moderate sleep apnea and snoring Dental Sleep Medicine and Oral Appliances should precede CPAP trial.

Oral Appliance compliance and patient satisfaction far exceeds those ratings for CPAP. Examples of many oral appliances can be found at: http://www.ihatecpap.com/oral_appliance.html

Patients in Chicago, Northern Illinois an Southern Wisconsin should contact Dr Ira L Shapira at Chicagoland Dental Sleep Medicine Associates for information and treatment of sleep apnea and snoring with a comfortable appliance.

Dr Shapira can be reached at 1-8-NO-PAP-MASK or thru his websites:
http://www.chicagoland.ihatecpap.com/
http://www.delanydentalcare.com/sleep_apnea.html
http://www.ihateheadaches.org
http://www.ihatecpap.com

Eur Respir J. 2010 Jul 1. [Epub ahead of print]
Nasal inflammation in sleep apnoea patients using CPAP and effect of heated humidification.
Koutsourelakis I, Vagiakis E, Perraki E, Karatza M, Magkou C, Kopaka M, Roussos C, Zakynthinos S.

Medical School of Athens University, Dept of Critical Care and Pulmonary Services, Evangelismos Hospital.
Abstract
Nasal continuous positive airway pressure (CPAP) can cause undesirable nasal symptoms such as congestion to obstructive sleep apnoea (OSA) patients, which symptoms can be attenuated by the addition of heated humidification. However, neither the nature of nasal symptoms nor the effect of heated humidification on nasal pathophysiology and pathology are convincingly known. Twenty patients with OSA on nasal CPAP who exhibited symptomatic nasal obstruction were randomized to receive either 3 weeks of CPAP treatment with heated humidification or 3 weeks of CPAP treatment with sham-heated humidification, followed by 3 weeks of the opposite treatment, respectively. Nasal symptom score, nasal resistance, nasal lavage interleukin-6, interleukin-12 and tumour necrosis factor-a, and nasal mucosa histopathology were assessed at baseline and after each treatment arm. Heated humidification in comparison with sham-heated humidification was associated with decrease in nasal symptomatology, resistance and lavage cytokines, and attenuation of inflammatory cell infiltration and fibrosis of the nasal mucosa. In conclusion, "nasal obstruction of OSA patients on CPAP treatment is inflammatory in origin, and the addition of heated humidification decreases nasal resistance and mucosal inflammation. Trial Registration clinicaltrials.gov Identifier: NCT00850876.

PMID: 20595158 [PubMed - as supplied by publisher]

# # #

Dr Shapira is the founder of I HATE CPAP LLC that promotes awareness of the dagers of sleep apnea and promotes the field of Dental Sleep Medicine.

He is a Diplomate of the American Board of Dental Sleep Medicine and founder of Chicagoland Dental Sleep Medicine Associates. He is a former Assistant Professor at Rush Medical School's Sleep center and has been involved in research and treatment of sleep apnea with oral appliances since the early 1980's.

Dr Shapira also founded I HATE Headaches LLC and the website www.ihateheadaches.org. He has several device and/or method patents on collection of stem cells from the jaws and developing wisdom tooth buds.

Dr Shapira is the Dental Section Editor of Sleep and Health Journal and has chaptered a chapter in a bmedical textbook on Anti-Aging Medicine.

Delany Dental Care was founded in 1984 as a general dental practice with special emphasis on treating sleep apnea, snoring, headaches, migraines and Temporomandibular (TMJ) disorders