Continued Positive Airway Pressure or CPAP is a longstanding and clinically proven therapy for treating sleep apnoea. (Sleep Health Foundation, 2013) Sleep apnoea is a disorder that causes one to have pauses in breathing when sleeping. It disrupts sleep at night and causes many serious (and some less serious) problems. CPAP devices work by blowing pressurised air via the airway to prevent throat muscles from collapsing. It works to keep the airways open during sleep and prevent episodes of apnoea. The therapy reduces or eliminates nightly apnoea occasions and can often completely eliminate snoring. It is recommended by doctors and other health professionals as a standard treatment for sleep apnoea. While CPAP is effective and has been clinically proven, patients often don’t use the treatment on a continuous basis because the pressure it produces is too much to tolerate. Other patients find the mask or noise created by the machine uncomfortable. For this reason doctors have begun to combine CPAP treatment with Dental Appliances to improve its effectiveness. Despite its prominence as a standard treatment of sleep apnoea, CPAP is not a cure for the condition and is just a therapy.

The severity of sleep apnoea is classified by the frequency of apnoeic episodes per hour. The Apnoea–Hypopnea Index (AHI) is widely recognised measure with an AHI score of 0–5 being “normal”, 5–15 viewed as “mild” sleep apnoea, 15–30 “moderate”. An AHI score greater than 30 categorised as “severe” sleep apnoea. (Apnea–hypopnea index, 2016) Not only does sleep apnoea disrupt sleep but it can lead to more serious health problems such as stroke, heart diseases, or chronic daytime drowsiness. (Sleep Apnoea, 2015) Alternative treatments to CPAP are available and work to cure the condition and prevent to these problems. These options can include surgery and oral devices.

Positive Airway Pressure Machines

• APAP Therapy

Auto Positive Airway Pressure (APAP) therapy machines are set with low and high range pressure numbers and adjust automatically based on the patient’s need. As an alternative to CPAP therapy, APAP uses algorithm to detect the patient’s breathing changes and adjusts air pressure appropriately. CPAP has a constant, single setting air pressure and does not sense subtle breathing changes that require air pressure to be increased. The patient using APAP therapy can find the system more comfortable and may experience less extreme apnoeic events.

• C-Flex fitted CPAP therapy device

CPAP with C-Flex relieves pressure on the patients during exhalation to prevent them from resistance from incoming airflow. It is an additional feature on CPAP device that only reduces pressure during expiration and is useful to patients with need for little relief.

Oral Treatment

• Dental appliance

An oral or dental appliance are used for treating patients with mild sleep apnoea. Two well recognised dental devices are MAD or MAS (mandibular advancement devices or mandibular advancement splint) and SomnoDent.

Mandibular Advancement Splints work to change the jaw positions. They move the lower jaw slightly down and the tongue frontward to keep the airway open. MADs have been shown very effective in treatment of mild to moderate case of OSA. MASs can reduce the severity of severe OSA but may not prevent it completely. (Sleep Health Foundation, 2013) In severe cases MASs can be used in combination with CPAP machines to reduce the required pressure where it may be too high to tolerate. By using a MAS and reducing the discomfort of CPAP to the patient result can be good. A custom fitted MAS can be provided by a specially trained dentist. The mouthpieces for tongue retaining are placed in the mouth during sleep to keep the tongue in position. Your dentist will position the device so is sits on the tongue near the tip and is well supported by the lips. Custom designed and properly fitted oral devices will have the best results.

SomnoDent is a type of Mandibular Advancement Splint (MAS) that provides a safe, effective and comfortable alternative to CPAP machines. Used in conjunction with lifestyle and behavioural changes – such as regular exercise and nutritional diet – the SomnoDent oral device can address even advanced cases of sleep apnoea. There are different designs available to suit individual needs and a specially trained dentist can prescribe the most appropriate device.

SomnoDent Flex

Features the unique SMH BFlex material and a soft inner liner for maximum device retention.

SomnoDent Classic

The use of medical grade stainless steel ball clasps holds this customised oral device in place. Offers alternate version that allows more room for patient’s tongue.

SomnoDent Fusion

Combines screw calibration and wing calibration technology in one device. Custom calibration allows faster advancement, fine screw adjustments (0.1mm increments), broader range and flexibility.

SomnoDent G2

Standard metal-free device that is easy to clean, wear and adjust, Available with ball clasps for retention. Features alpha-numeric calibrating system for ease of calibration.

SomnoDent

Surgical Treatment

• Adenotonsillectomy

Adenotonsillectomy is not a therapy treatment but a surgical procedure. It entails removal of adenoids and tonsils from a patient to prevent obstructive breathing when these lymphatic tissues are too large relative to the air passage. The tonsils and adenoids sit where the nasal passage meets the throat and can cause blockages and breathing problems when they are inflamed or enlarged. This surgery is done as the first treatment for Obstructive Sleep Apnoea in children and has also been effective in adults in some cases.

• Nasal Surgery OSA Treatment

This surgery procedure is used when OSA is caused by such conditions as deviated septum, contracted nasal valve, or enlargement of turbinate tissues to reduce breathing problems. When sleep apnoea is mild, breathing difficulties may be eliminated through nasal surgery. For patients with chronic sleep apnoea, the surgery only serves to make alternate treatments (like oral devices and CPAP) more effective by making it easier for patients to comply. The pressure of air needed to eliminate obstruction during breathing is reduced when the nasal surgery is done.

• MMA Surgery

Maxillomandibular Advancement involves a surgery that moves the upper and the lower jaw forward to advance the area behind the tongue to reduce the chances of blockages occurring when the muscles relax. The procedure is appropriate for both adults and children and for both severe and mild Sleep Apnoea.

CPAP therapy is the most commonly used treatment for sleep apnoea but can pose challenges that makes the patients and treating health professionals look for alternative treatments. Continuous Positive Airway Pressure therapy and similar devices can be effective, however do not cure the condition and can be uncomfortable making compliance challenging. Alternative treatments should be considered such as oral devices and surgery. Alternative methods to CPAP therapy, both surgical procedures and therapies, should be always be prescribed and administered by a qualified professional and in consultation with a doctor. Oral devices may be available over the counter, however for best chance of obtaining good results its recommended specialist advice is sought.