Obstructive sleep apnea is a condition in which your breathing stops for a very brief moment during routine sleep as a result of a narrowing or blocking of the airway. Patients may sometimes be experiencing hundreds of these apnea episodes, or interruptions in breathing, through any one given night. Most people diagnosed with this medical condition, obstructive sleep apnea (OSA), have a major problem with snoring. Snoring becomes problematic either for themselves or for a partner, spouse or other family member with whom they're sleeping.
There are several different common treatments for obstructive sleep apnea patients to get the condition under control, including snoring and apnea episodes. Oral appliances, or OAs, open the upper airway typically by pulling up while the OSA patient inhales and exhales. This makes the airways less narrow, which reduces snoring and, supposedly, apnea episodes as well. The other major treatment for OSA patients is with the use of continuous positive airway pressure machines. CPAP (Continuous Positive Airway Pressure) machines actually send forced air through the airways, holding them open to prevent apnea and reducing snoring.
Of course, there is much debate about the various treatments for obstructive sleep apnea and which yields the best results. In some cases, the patient may experience less apnea episodes (which is a good thing), but then experience more snoring or additional side effects. Research by scientists and professionals in the medical community has been conducted, especially over the past decade, to compare the effectiveness of CPAP versus other treatments like oral appliances.
CPAP Machines at Work
Before delving into the myriad of research scientists have performed with obstructive sleep apnea patients and CPAP technology, you must first understand how CPAP works to get sleep apnea and other symptoms, like snoring, under control. Most of the time in sleep apnea patients, the physiological cause of snoring and apnea episodes is because of the relaxation of muscles that occurs. This relaxation causes tissues in the back of the throat and the uvula to collapse, which extremely restricts the passage of air. In turn, this affects your breathing through the night.
When a CPAP machine is prescribed for a sleep apnea patient, he or she is given a large machine as well as a CPAP mask. What happens during the night is that the patient wears the mask, which is connected to the machine. The CPAP machine forces air – via the CPAP mask – using positive pressure that gets sent to the airway to prevent its obstruction and improve breathing. In addition to improving breathing, the CPAP mask and machine also improves snoring.
Research on CPAP Effectiveness
The research conducted on CPAP machines have greatly concentrated on their effectiveness for reducing snoring, apnea episodes and other symptoms associated with obstructive sleep apnea. When you consider the entire body of research, you may conclude the CPAP is perhaps the most effective treatment on the market for OSA patients. However, there are downsides as well.
Researchers at a university in Tokyo published a study in a 2004 issue of Internal Medicine in which they looked at the patient's quality of life, depressive symptoms and excessive daytime sleepiness before and after being treated with a CPAP machine. Before treatment with CPAP, researchers found that patients' quality of life was significantly associated with the responses on their self-depression scales. After treatment, however, self-depression scales significantly reduced as well as the excessive sleepiness scale scores. The researchers concluded that treatment of snoring and obstructive sleep apnea with CPAP improves patients' quality of life by alleviating depression.
Being treated with a CPAP machine at home also has great implications for your relationship with a spouse or bed partner. Researchers at a university in Chicago, Illinois, published a 2007 study in the American Academy of Sleep Medicine in which they examined the sleep of married couples, both in the laboratory and at home. The researchers measured both the husband's and wives' quality of life (QOL) using a special self-report scale, and they also required the participants to take a sleepiness scale.
While the husband's adjustment to being treated with CPAP was positive and actually raised his QOL scores, the same was not true for the wives. Whether it was the noise from the machine or simply being conditioned to arousal, the wives' QOL scores were lower than the husband's after being treated with CPAP. In other words, the husband adjusted better to being treated with CPAP than the wives' did. However, researchers conclude that a long follow-up period is needed in further research to determine if similar effects are seen.
Research on Oral Appliances
A comprehensive review published in a 2006 issue of Sleep looked at over 150 studies by researchers who conducted experiments and surveys designed to examine the efficacy of oral appliances. Oral appliances that were studied include those that are designed to hold the mandible forward and in place during sleep. The idea behind these devices is that the oral appliance will allow unobstructed breathing. Other studies the researchers reviewed used “boil and bite” OAs that the patients could fit themselves. The majority of the rest of the studies, however, used tongue-retaining devices (TRDs) that required a dentist to first make impressions and then a custom-made device to adequately fit the patient.
The researchers in the review article found that oral appliances are effective for controlling snoring and obstructive sleep apnea for the majority, but not all, patients. Specifically, approximately 52% of treated patients achieved success in controlling sleep apnea episodes when being treated with oral appliances. The researchers also compared the use and effectiveness of oral appliances to that of CPAP machines for sleep apnea and snoring. What they found was that oral appliances are overall less effective in improving sleep apnea than a CPAP machine is. However, oral appliances appear to be used more and many patients prefer these devices over CPAP when there is a choice between the two.
Overall, it appears that oral appliances and CPAP do work to get obstructive sleep apnea under control. However, these techniques or treatments may not work at the same rates of success and whether you're treated with CPAP over oral appliances, or vice versa, depends much on your specific situation and medical recommendations. Researchers have demonstrated overwhelming success using CPAP treatments on serious cases of obstructive sleep apnea and, while there may be a few downsides, CPAP seems to be the treatment modality of choice that's recommended most of the time.