In the sleep lab, under controlled conditions, CPAP is almost always efficacious.  In other words, it accomplishes what is intended and most of the respiratory events are stopped.  Oral appliance therapy, by contrast, will stop the respiratory events in about a third of patients and significantly reduce the events in most of the remainder of people using this therapy.  In other words, oral appliance therapy is not as predictable as CPAP in controlled clinical conditions like a sleep lab.

To illustrate this point, look at the image below that shows information taken from one of our patients’ sleep study.  The chart on the left shows the average respiratory events per hour.  The darker blue shows the average number of respiratory events she would have per hour on CPAP, in this case only 1.  By contrast, with an oral appliance she would have an average of 9 respiratory events an hour.  Remember that we would like the number of events per hour to be under 5.  Assuming that she sleeps 8 hours a night, she would have 8 events per night with CPAP and 72 events per night with an oral appliance.

Extending this same way of comparing the therapies, the following chart shows the disparity between the two therapies projected over a week’s time.

Using this type of comparison, it is easy to understand why CPAP is regarded as the “gold standard” therapy and demonstrates how full time CPAP wear is a wonderful therapy for most people.

HOWEVER, it must be understood that the vast majority of CPAP users do not use their CPAP all night every night.  In fact good compliance is regarded as 4 hours of CPAP use 5 days a week.  The comparison between oral appliance and CPAP using this model is shown in the following chart.  Using this model, it is obvious that an oral appliance used during all sleeping hours is a significant improvement over wearing CPAP for 4 hours a night, 5 days a week.  NOTE: Virtually all oral appliance users use their appliance all night, every night because of the ease of use of this therapy.

 

 

For simplicity, in the Featured Patient of the Week section of this blog, the CPAP vs Oral Appliance comparison will be shown as it is in the following chart.