CPAP is still considered the Gold Standard of treatment for obstructive sleep apnea treatment but the American Academy of Sleep Medicine (AASM) now considers Dental Sleep Medicine and Oral Appliances a first line approach for mild to moderate obstructive sleep apnea. Surgery is no longer considered a first line treatment for adults though removal of tonsils and adenoids that obstruct the airway are still considered a first line approach for pediatric apnea.
The primary problem with CPAP is poor compliance. This is the dirty secret of sleep medicine. The majority of patients prescribed CPAP do not use it long term. A recent study showed that 60% of patients abandon CPAP use. Even patients who use CPAP average only 4-5 hours a night not the recommended 7-71/2 hours. Unfortunately severe sleep apnea often requires use of CPAP for complete control of obstructive events. Recent articles show success in treatment of severe apnea in many patients with oral appliances.
Patients with severe apnea who do not tolerate CPAP are at lower risk with oral appliances than untreated.
Dr Keith Thorton created the TAP appliance. The TAP has the highest success of any appliance for treating severe sleep apnea. Dr Thorton has recently created the TAP-PAP appliance that combines a TAP 3 appliance with custom fittings for connecting a Fisher Paykal nasal pillow mask and hose. This is an enormous step that increases the comfort of the mask by securing the nasal pillow to the upper jaw eliminating straps and most leakage. More importantly in severe patients it allows lower pressures for CPAP reducing symptoms of sinus pain and dryness, facial sores, acne, ear pain, ear stuffiness, dizziness and a host of other problems patient cite.
It is also possible to take impressions of the face to make custom masks that are fitted similar to dentures. While this is an expensive alternative it is worthwhile if it prevents medical problems associated with CPAP non-compliance.
Only a few dentists across the country can make the TAP-PAP or the custom masks at this time. Dr Thorton limited his first courses to dentists who are Diplomates of The American Academy of Dental Sleep Medicine and who have extensive experience in fitting the TAP Appliances. In Chicago and suburbs I am currrently available to make TAP-PAP masks in my Gurnee Dental Office (http://www.delanydentalcare.com) and at Chicagoland Dental Sleep Medicine Associates with offices in Skokie, Schaumburg, Chicago, Bannockburn and Vernon Hills. Information is available at www.ihatecpap.com or http://www.chicagoland.ihatecpap.com/