Oral Appliance versus CPAP

I just got diagnosed with mild/moderate obstructive sleep apnea. I’m a 55 year old female, not overweight, non smoking, rarely drink, so lifestyle changes to manage this for me are limited. I’m considering a custom dental appliance that was one of the options that my doctor recommended. It is covered by my insurance, with a local facial pain clinic that makes the appliance. I was looking for some advice from anyone who has gone this route, to see if they are having success and what the shortcomings may be. I’m not completely opposed to the CPAP option, but would prefer something less cumbersome if that would work. Any insight or advice from anyone would be appreciated! Thank you!

What kind of a doctor recommended the oral appliance? I would think an oral appliance would be less expensive than a CPAP machine, and yes, certainly less invasive, and if insurance will pay for it, that’s a plus. I don’t know anything about oral appliances, but my feeling is… if they actually worked, we would all be using one instead of using CPAP machines! My advice, it’s worth a try, but how will you know it’s working? I would hope they would put you through a sleep study while using the appliance to see what your numbers look like. I would NOT be satisfied with someone handing me an oral appliance with “Here you go, call me if you have any problems” and leaving it at that.

I’m certain my insurance company would not spend $8,000 on a machine for me if there was a much simpler cheaper and effective option readily available. Nor would they be doing research on implantable devices for sleep apnea… waste of time and money if a simple oral appliance would be effective. Or maybe this oral appliance is the sleep world’s best kept secret that the big companies don’t want anyone to know about because it would drive them out of business… something to think about.

Please let us know if the oral appliance works, we would all opt out of CPAP therapy if there is anything out there more effective!

Thank you for your insight Kim! I went to my regular physician and was given the oral appliance option. It’s $3600 without insurance, but my insurance covers it which makes me think it must be a viable option? It somehow keeps the lower jaw forward which is supposed to keep the airway open. It isn’t a good option for severe apnea, but the doctor thought it could work for me. Wondering also if anyone knows if it is a good idea to go to an ENT specialist too. I have nasal polyps and wonder if that could be part of my problem. This is all so new to me and I’m just trying to make an informed decision on treatment. My primary care clinic didn’t seem well versed on sleep apnea, so I’m just trying to get answers on my own. Thanks again for your response!

I used a VPAP machine, religiously, for the better part of 6 years. I am 72, 5’11”, and 160lbs. After getting a Fitbit 4 years ago, which I use to monitor sleep quality, I noticed that my sleep quality was never really great. This didn’t surprise me, since my VPAP machine would often wake me most nights, when its occasional pressure increases caused the mask to start walking off my face. Fumbling for the reset button and repositioning the mask usually made me fully awake. I tried different masks and different VPAP settings, but the issue persisted. I have positional sleep apnea, which happens when I lie on my back.
Two years ago I hit on the idea of using a wearable, logging pulse oximeter instead of VPAP. The oximeter continuously monitors blood oxygen level for up to 16 hours on a charge, and triggers a vibrating alarm when O2 level drops to a threshold set by me. It still wakes me up as the VPAP machine did, but all I have to do then is to have the presence of mind to roll-over. No switches to fumble for. The device also keeps a graphic record that I download to my iPhone in the morning. See below:

dkruse, I don’t know what type of oral appliance you are talking about, but my BIPAP machine (which is about 2x the cost of a CPAP machine) was $3,700. Most oral appliances are in the $100 range. I’m not the most well-informed person when it comes to these appliances, but $3,600 for an oral appliance sounds excessive. And I do think nasal polyps would definitely affect your diagnosis. Maybe it’s time you saw a pulmonary doctor instead of your GP. To my knowledge GPs are not the final call on diagnosing sleep apnea. They send you to a pulmonologist to do a sleep study, which is the only way to confirm a diagnosis of sleep apnea.

Thank you for your insight! I just saw the doctor at the facial pain clinic and the custom mouth appliance is actually $2600. It’s a lower and upper custom mouth type guard that has large rubber band type things that hold the lower jaw forward, preventing
tongue from falling back and obstructing airway. It makes sense to me. You also repeat sleep study after wearing it for a couple of months to make sure it’s working. I have a small jaw and had teeth removed for braces when I was young, which apparently
doesn’t allow ample room for tongue and increases risk for sleep apnea. By moving lower jaw forward when you sleep, the tongue stays forward too. You then have to wear another lower jaw mouth piece each morning for 15 minutes to reset the jaw so it doesn’t
stay forward. The doctor at the pain clinic recommended that I see and ENT to address polyps first, but thought I was a good candidate for the mouth piece. It sure looks a lot less intrusive than a CPAP, and if it can work as well, I’m leaning toward giving
it a try.