Most people who seek help for a sleep breathing disorder like snoring or sleep apnea are diagnosed by a sleep doctor and given a pressure mask, or CPAP. Millions of these are sold every year. For World Sleep Day 2021, Phillips, one of the two biggest CPAP manufacturers, surveyed 13,000 people in 13 countries around the world. Of the people who were prescribed CPAP, only 18% of them were using it. Of the people who were at risk, 27% said they would not take a sleep test because they did not want a CPAP.
It gets worse. The US Agency for Healthcare Research and Quality released a draft report about the use of CPAP for obstructive sleep apnea that concludes there is low evidence that CPAP has any long-term positive health effects. Any such report is debatable, but it is clear that CPAP is not the universal therapy that cures everyone some physicians believe it is.
The reasons people won’t use the simple device that helps them feel better during the day and, as far as they’ve been told, helps them live longer, healthier lives are as varied as any group of people can be. Common reasons they tell me include:
- I can’t stand anything on my face.
- The mask moves around and blows air into my eyes.
- I swallow air.
- It leaves marks on my face. (More of a problem when people actually went to work!)
- My spouse hates it.
- I want to travel, camp, RV, boat, etc., and it’s too inconvenient.
It is a wonderful time to be a dentist involved in airway therapy – providing good solutions to manage and resolve your patient’s sleep breathing problems. Oral appliances are better accepted by patients in every head-to-head study that has ever been done. While many people go to bed with their CPAP on, by morning, it’s off. Oral appliances are still in their mouths. Research points out that many hours of therapy is better than fewer hours of it, so the health effects are the same.
How do you talk with your patients about their therapy? It isn’t productive to bash CPAP – believe me, they’ll do that themselves. I tell people I love CPAP – when it is used, it’s great. CPAP is the treatment of choice for my father and brother. As you scan through your patient population with questions about sleep and breathing (you are using a screener, right?) you will find plenty of folks who want a CPAP alternative.
If you want to be a provider of oral appliance therapy, there is much to learn. The device portion is straightforward, but there are medical concerns, TMJ joint issues, finance, and office systems to sort out. The challenge is well worth the effort, of course. Dr. Pankey always puts rewards at the center of the philosophy. Nothing I’ve done in dentistry is more rewarding than helping people breathe.
Not every dentist will foray into providing dental sleep medicine but becoming well informed and adding airway conversations to your consultations will impact the lives of many. If you would like to dive deeper and develop your knowledge about dental sleep medicine and learn about the realities of introducing it into your practice, I recommend the Pankey Institute’s 5-day immersive Dental Sleep Medicine course.