Patients who wear CPAP for Only Half (4-5 hours) the Night are at Severe Risk for Cardiovascular Events!

Sleep apnea is a life threatening condition that can cause hear attacks, strokes, worsen diabetes,adversely affect short term memory loss and cognitive function and increase risks of motor vehicle accidents 600%. CPAP, or continuous positive air pressure is used to treat obstructive sleep apnea and is considered to be the gold standard of treatment. Unfortunately, the majority of patients do not tolerate CPAP and only 23-45% continue to use CPAP on a regular basis.

Approximately one in four patients love their CPAP from the first night and use it all night, every night with excellent results. The typical CPAP user averages only 4-5 hours CPAP use a night. These are the patients that are at the most severe risk. Typically heart attacks and strokes associated with sleep apnea happen in the early morning hours. Patients wearing their CPAP for only 4-5 hours or less have already discontinued CPAP use before the time of night when the worst risk for cardiovascular occurs.

Dental Sleep Medicine offers a comfortable oral appliance alternative treatment to CPAP that is preferred by the majority of patients offered a choice between CPAP and Oral Appliances. The American Academy of Sleep Medicine has already recognized oral appliances as a first line treatment for mild to moderate sleep apnea and as an alternative treatment for severe apnea when patients do not tolerate CPAP. Recent studies have shown successful treatment of severe apnea with oral appliances. The National Sleep Foundation hs declared that “Oral Appliances are a therapy whose time has come”. The website has extensive information about the dangers of sleep apnea and information on Dental Sleep Medicine and Oral Appliances.

Patients who wear oral appliances are much more compliant with treatment than patients utilizing CPAP. There is no question whether the majority of patients are better off with oral appliances if they have good therapeutic results. The majority of patients utilizing oral appliances do get excellent therapeutic results. There is no question that treatment all night with an oral appliance is superior to 4-5 hours or less of CPAP use if both resolve the apnea.

The important remaining question is are patients better off with only partial improvement from an oral appliance compared to complete elimination of apnea with CPAP or BiPAP if they only wear their CPAP for 4-5 hours.

Is there an oxygen desaturation threshold that puts patient at severe risk? If oral appliances keep patients above that threshold all night compared to only part of the night with part-time use of CPAP, which is the superior treatment?

Is it most important to have treatment in the early morning hours? If preventing cardiovascular events is the main concern should all CPAP compliance data be reexamined for not only total hours of usage but also for when usage is occuring?

When it comes to symptoms of daytime sleepiness, cognitive function and reaction time for prevention of motor vehicle accidents how important is total time of treatment. If a full night of CPAP is essential than patients who do not tolerate a full night of CPAP deserve a chance to try an oral appliance which has much higher compliance in terms of hours of nightly use. Previous studies have already shown that 7- 71/2 hours of CPAP use are ideal.

Dr Ira L Shapira is a Diplomate of The American Board of Dental Sleep Medicine, a member of the Academy of Sleep Medicine (AASM), a member of the American Acaemy of Dental Sleep Medicine (AADSM) a Founding Member of DOSA, The Dentall Organization for Sleep Apnea and treats patients in Northern Illinois and Southern Wisconsin in his Gurnee Dental Office ( and at Chicagoland Dental Sleep Medicine Associates ( with several Chicagoland locations.