As I travel the country participating in sleep apnea conferences I often hear from sleep physicians that oral appliances do not achieve the same therapeutic success as CPAP. I find this to be an outrageous claim, arguably I have a demonstrated bias toward oral appliance given my history in the dental field. Also the fact that my original training in mandibular positioning to support the airway was with Dr Rickets and Dr Gelb (giants in the field) in the ’80’s. I witness fantastic successes every day with oral appliances in the hands of dentists trained to administer and monitor these devices.
A key feature that distinguishes the sleep oral appliance treatment from the CPAP therapy is that an oral appliance works over time with the muscles and ligaments to achieve a treated position. A sleep study is indicated after 6 months to confirm that the patient is in fact in a treated position. It is true that in some cases, the patent’s oral appliance cannot be adjusted further due to comfort issues. In these cases combination therapy is indicated. This is when the training and experience of the trained dentist and his team come into play.
Body position is a key factor in some of these sleep apnea cases. In fact a recent study indicated that for patients with positional apnea, body position therapy is as effective as CPAP in treating sleep apnea.
When used in combination with oral appliances body position therapy can help patients achieve a great night sleep and an improved quality of life. I wrote up the article below to show what happened when my friend Mark Walczak who has severe OSA used combination therapy to treat his Positional Sleep Apnea
Mark Walczak: A Big Guy with Big Sleep Problem
I have been in the sleep therapy field for over 20 years. In that time I have witnessed the effect on patients of what I can only call an over reliance on CPAP therapy in treating OSA. Many of my close friends are ex NFL players like Roy Green, Carl Eller, Derrek Kennard, Markus Allen, Eric Dickerson and Mark Walczak many have tried CPAP but found themselves unable to comply with their prescribed therapy. Pro Player Health Alliance was founded to help these icons of the NFL share their experiences and perhaps help patients find therapy that will help them maintain their health and get a good nights sleep.
I am particularly struck by the story of Mark Walczak who has suffered with sleep apnea for many years. After undergoing an in lab sleep study it was shown that Mark had an AHI (Apnea Hypopnea Index) of 62. This is classified as severe sleep apnea “a big guy with a big sleep problem”. Mark was prescribed with CPAP and tried to wear it but was unable to make the therapy work for him.
Studies indicate that CPAP compliance is very low and is dependent on great coaching and highly engaged medical team that work a wide range of patient interfaces and desensitization protocols. This is all in an effort to help the patient adjust to wearing a mask at night with a column of pressurized air blowing into the airway. The sound of the devices and the effort to maintain a clean and effective device, all this combines and contributes to reduced compliance rates. Mark ended up a casualty of this process as do about 50% of patients who start the process according to recent studies.
As part of his journey to healthy sleep he met with Dr Roger Briggs DDS from Scottsdale AZ. Dr Briggs made a Herbst sleep appliance for Mark. The Herbst appliance reduced Marks snoring and his sleep apnea to a moderate level (AHI 17) however it was not completely eradicated and with further testing it was shown that there was now a significant positional component. The decision was taken that a SlumberBump positional therapy device would be added to Marks sleep time protocol.
SlumberBump is a very simple device that is worn around the chest to help position the patient on their side while sleeping. Studies indicate that positional therapy is as effective as CPAP in mild sleep apnea patients.
In combination Mark Walczak wears a Herbst mouth piece and a Slumberbump to bed and his AHI as registered with a sleep study went from untreated AHI of 62 all the way down to an AHI of 1. This took some time, and there were trained dental and sleep clinicians monitoring and guiding the process. I would say that the best part of this approach is that the patient has control over how often how much and understands their condition so much better.
I have to say oral appliance therapy in combination with body position therapy with a SlumberBump is a winner in my book.