ResMed Inc. is the world’s second- biggest maker of CPAP machines that help regulate breathing for people with sleeping disorders. They announced a 30% increase in mask sales and an increased net income of 190.1 million up from 146.4 million one year earlier. ResMed also announced a two-for-one split of the company’s outstanding shares of common stock.

The future for CPAP companies may not be as bright as these statistics show. There are still enormous levels of undiagnosed and untreated sleep apnea and CPAP is a great treatment. The problem is that 60% of patients do not tolerate the treatment. Oral appliances are now recognized as a first line treatment for mild to moerate sleep apnea and are rapidly growing in popularity. ResMed recognizes this fact,( see RESMED INC ANNOUNCES ENTRANCE INTO ORAL APPLIANCE THERAPY. IS CPAP STILL THE GOLD STANDARD FOR APNEA TREATMENT? https://www.sleepandhealth.com/node/496)

This shows forward thinking by ResMed executives who understand that almost all patients given a choice between CPAP or a comfortable Oral Appliance prefer the appliance. Patients like ther convenience of no mask, no hose and no CPAP machine.

Unfortunately for CPAP companies, profits are tied to sales of masks more than machines and most patients just can’t stand CPAP. A recent study showed 60% of patients abandon CPAP use. Medicare will now only pay for CPAP worn 70% of nights and at least 4-5 hours. What happens to patients who do not tolerate CPAP? Most are lost to treatment, a major failing for the sleep community.

The good news is that oral appliances are rapidly increasing both in popularity and success rates. As more patients are being diagnosed the percentage with mild to moderate apnea is increasing. These patients are more likely to utilize an oral appliance over CPAP. The reason is simply comfort. Many patients “hate CPAP” due to problems with masks, facial sores, sinus problems, intolerance, claustrophobic feeling and other irritations.

The website http://www.ihatecpap.com has helped hundreds of thousands of patients learn about Dental Sleep Medicine and comfortable oral appliances. It is predicted that up to 80-90% of of mild to moderate sleep apnea patients will utilize an oral appliance instead of CPAP.

CPAP will probably always be the gold standard for treatment of the morbidly obese patients. But as sleep medicine diagnoses sleep apnea in younger, thinner and healthier patients CPAP will probably lose out to oral appliance therapy. CPAP manufacturers will continue to look at increasing their share of the oral appliance market. One company, Somnomed has come out with an auto-titration device for sleep labs. They are a rapidly growing world wide business and will probably be the next Dental Appliance company to be acquired by a CPAP anufacturer. The problem is there are no disposable supplies with oral appliances so they do not create the same level of profits as mask sales.

The CPAP industry is promoting physicians into forming DME’s to turn CPAP and Mask sales into profit centers for physicians. In offices where there is a financial interest in promoting CPAP over Oral Appliances physicians are not inclined to inform patients about the oral appliance alternative. The I Hate CPAP website has had a powerful effect in spreading the word about oral appliances to patients and increasing the health of patients who do not tolerate CPAP but has been banned from having a booth at meetings of the American Academy of Dental Sleep Medicine. The CPAP manufacturers are major exhibitors and big money is a stake.

One oral appliance manufacturer, Airway Management, the maker of the TAP line of appliances now offers a TAP-PAP appliance that can increase comfort of CPAP by utilizing an oral appliances to get rid of strap that hold the mask in place. Currently they only attatch to Fisher-Paykal masks another CPAP manfacturer.

The low compliance of CPAP is well known throughout the sleep industry due to compliance monitors in the machines. Oral appliances are in Beta testing for compliance monitors and when that happens there will be an increase in the switch from CPAP Therapy to Oral Appliance Therapy.