Sleep and Health Journal

Dr. Jeffrey Pancer is a graduate of the University of Toronto, Faculty of Dentistry. He and his wife Lynnda have two children, Lowell and Natalie, both of whom are married. They have two grandchildren, Lowell’s daughter Eve, 17 months old, and Rubin, Natalie’s son who is three months old.

ORAL APPLIANCES VS CPAP - Good news for patients who say “I Hate CPAP”

By Ira Shapira, DDS

Patients with sleep apnea often are fitted with CPAP as the first line of treatment for sleep apnea and it is a godsend for many. However, a large number of patients do not tolerate CPAP and search for alternatives. The American Academy of Sleep Medicine (AASM) has changed this outlook forever with its new “Practice Parameters for the Treatment of Snoring and Obstructive Sleep Apnea with Oral Appliances: An Update for 2005”, published in the journal Sleep in February 2006. The new parameters state that oral appliances are indicated for treatment of mild to moderate OSA (obstructive sleep apnea) in patients who prefer them or do not respond to CPAP. At the same time, the AASM still recommends CPAP as first line treatment for severe OSA before considering oral appliances.

Ira Shapira

While sleep medicine still considers CPAP/BiPAP to be the gold standard of treatment for sleep apnea, low compliance rates (23-45% based on several studies) have always been a problem. The alternatives in treatment are lifestyle changes including weight loss and positional training, surgery and dental appliances. The advantages of surgical interventions have been that they require no patient compliance after initial healing, though surgical morbidity is often very high. Dental appliances on the other hand have high patient compliance and minimal morbidity. The majority of patients continues use and prefers them to CPAP/BiPAP.