CPAP vs. Mouthpiece



Last updated: November 7th, 2017

A Mouthpiece As A CPAP Alternative

When considering treatment for obstructive sleep apnea or snoring, there are many choices. Often, treatment comes down to CPAP or a mouthpiece. Mouthpieces (oral appliances also known as mandibular advancement devices) are the leading alternative to CPAP.

In brief, a mouthpiece may be the best treatment solution for snoring and sleep apnea simply because it is most likely to be worn each night.

CPAP devices are more geared towards patients that have severe sleep apnea because. CPAP is considered the most effective treatment when used as directed for sleep apnea. However, many people who are advised to use a CPAP device stop wearing the device shortly after receiving it. The common complaint is discomfort from the mask that is required. When not used as directed for the entire night, a CPAP device is usually ineffective at treating sleep apnea.

The severity of sleep apnea may make it necessary for some people to use a CPAP machine. For many, it is still worth trying to see if a mouthpiece will work.

A mouthpiece may be recommended to someone if their CPAP treatment doesn't have good results. Both CPAP and a mouthpiece can be used together for the maximum benefit.

How Does CPAP Work?

CPAP work by using pressurized air which goes into the upper airway during sleep through a nasal mask and tube connected to a pump. The pressurized air acts opens the upper airway, preventing it from collapsing during sleep.

How Does A Mouthpiece Work?

A mouthpiece designed for the treatment of snoring and/ or sleep apnea works by advancing the lower jaw forward. Unlike CPAP, the device works by making it easier to breath as opposed to pumping air into the nose.

Effectiveness Of CPAP Compared To Mouthpiece

A study conducted by the Journal of Dental Sleep Medicine indicates that for treatment of sleep apnea, both CPAP and a mouthpiece have similar overall effectiveness when used as directed. Sleep apnea is a chronic disorder so consistent usage of whatever treatment option is considered is one of the most important factors.

CPAP study results:

  • To use CPAP adequately, it must be used 4 or more hours a night.
  • Only 50% of patients report using a CPAP device 4 or more hours a night after 6 months
  • After 5 years, only 17% of patients continue to use CPAP at the acceptable rate

Mouthpiece study results:

  • Over 1/3rd of patients will resolve their snoring and sleep apnea problems completely with a mouthpiece
  • Approximately 1/3rd of patients will have a mostly successful result in reducing sleep apnea events during sleep
  • Approximately 1/3rd of patients will have less success with a mouthpiece
  • A mouthpiece is often worn 7 or more hours at night in the initial 3 months and 6 or more hours a night after 1 year
  • A mouthpiece is often worn 95% of sleep time

CPAP Usage And Results

CPAP Usage And Results Chart

Source: CPAP effectiveness assessed by the Sleep Adjusted Residual AHI (SARAH Index)

  • SARAH Index - Sleep Adjusted Residual Apnea Hypopnea Index
  • AHI - Apnea Hypopnea Index

NOTE: The SARAH Index and AHI are two different ways to measure stoppages in breathing while asleep.

This chart indicates that CPAP is effective when used most of the night, as seen with the 6 and 8 hour usages. Most people do not wear the device for the full 8 hours, many wear the device less than 4 hours a night. This means that CPAP can only be considered effective treatment for sleep apnea when it's worn most of the night, which it often is not.

Mouthpiece Usage And Results

Mouthpiece Usage And Results Chart

Source: Oral appliance effectiveness assessed by the Sleep Adjusted Residual AHI (SARAH Index)

  • SARAH Index - Sleep Adjusted Residual Apnea Hypopnea Index
  • AHI - Apnea Hypopnea Index

NOTE: The SARAH Index and AHI are two different ways to measure stoppages in breathing while asleep.

In contrast to CPAP, mouthpieces are reported to be worn 95% of sleep time. The improvement in breathing at night is high for many patients.

Pros And Cons Of CPAP

Pros:

  • Often considered the most effective form of treatment for sleep apnea when the person using it can tolerate wearing it

Cons:

  • Most patients have side-effects
    • Mask/ pressure related side-effects are the most common
    • Some experience claustrophobia while using the CPAP mask
    • Nasal congestion, runny nose or rhinitis may occur
    • Some experience excessive belching, stomach bloating and agonizing gas pains from swallowing air
  • Expensive (ranges from $500-3,000)
  • Requires electricity and can be difficult to travel with

Pros And Cons Of A Mouthpiece

Pros:

  • Drug free
  • Does not require electricity
  • Easy to carry
  • Inexpensive (around $100 for a self-fitted mouthpiece)
  • Often as effective as CPAP in treating mild to moderate sleep apena

Cons:

  • May not be as effective as CPAP, particularly for severe sleep apnea
  • Some people may have jaw pain and need to use a tongue stabilizing device

Both CPAP And A Mouthpiece

It is possible for a person to wear a mouthpiece and use a CPAP device. Wearing a mouthpiece while using CPAP is considered the most effective treatment for obstructive sleep apnea, according to the Agency for Healthcare Research and Quality (AHRQ). Weightloss and surgery may also be effective but not as effective as wearing both a mouthpiece and using a CPAP device.

CPAP, A Mouthpiece Or Both?

Based on the studies that have been done comparing mouthpieces to CPAP devices, a mouthpiece should strongly be considered as a treatment for sleep apnea. A mouthpiece is worth trying for anyone who was not successful with CPAP treatment. A mouthpiece is also a good choice for those with CPAP as it brings the most effective results. See reviews of mouthpieces for snoring and sleep apnea here.


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