Randomized Multimodal Therapy for OSA

There are several choices for your initial treatment.

We are asking you to choose which therapy most appeals to you so that we can see if it is effective for you. The following information should be used, along with a discussion with your sleep physician or study coordinator, to decide on your initial therapy.

YOU WILL BE ALLOWED TO CHOOSE YOUR INITIAL THERAPY FROM THE CHOICES BELOW.

We can help you decide, but there is NO ONE BEST THERAPY. However, the goal is to get you to a very effective level of OSA treatment (this may take a few months and could require several tries). After trying your initial therapy for a while, we will test if your chosen therapy works and confirm how much you are using it. If it does not meet the standard of “good therapy” after about 1-3 months, you will be asked to move on and try the next choice.

Continuous Positive Airway Pressure (CPAP)

Oral or Dental Appliance (OAT)

or Mandibular Advancement Device (MAD)

Positional Device

  • Continuous Positive Airway Pressure (CPAP)

    a. This is a small pump that generates a steady gentle stream of airflow and pressure. It is connected to a comfortable mask you must wear whenever you sleep. The device is approved by the FDA.

    b. The pressure in the mask holds your air passages open and prevents their collapse during sleep.

    c. Once fitted and adjusted, we will test how much you use the mask, and confirm how effective it is for you. If CPAP does not work for you or if you do not use it most of the time, you will be allowed to try another therapy.

    d. Pros and Cons:

    • Properly fitted CPAP, when worn, is highly effective and almost always works to treat obstructive sleep apnea.

    • CPAP is the most widely prescribed treatment for obstructive sleep apnea.

    • About 50% of people find CPAP comfortable and highly beneficial.

    • Some people have difficulty wearing the mask, and 30-40% of people started on CPAP do not use it enough for full treatment.

    • We urge you not to pre-judge comfort of CPAP until you try it on.

    • About ¼ of people prescribed CPAP experience some temporary side-effects. These include air leakage around the mask, mild skin or nose irritation, dry nose and mouth, chest discomfort, and feels of being trapped or claustrophobic.

    In order to be effective, CPAP needs to be used every time you sleep for the entire night or as long as possible. Most people need to continue using CPAP for their entire lives.

  • Oral or Dental Appliance / Mandibular Advancement Device (OAT or MAD)

    a. This is a mouthpiece (like a sports tooth guard) that you wear while sleeping. It works by gently pulling the lower jaw forward, which opens up the throat and prevents it from collapsing when you go to sleep. The device is approved by the FDA and widely prescribed for obstructive sleep apnea (OSA).

    b. The device is custom fitted to your teeth by a dentist, both for comfort and required “advancement.” This may take several weeks.

    c. When properly fitted, you will be tested for the device’s efficacy in treating your OSA. If it does not work adequately for you, you will be allowed to try another therapy.

    d. Pros and Cons:

    • MADs treat OSA well in some people but less so in others.

    • Success is hard to predict except by trying.

    • Most studies show about ½ of people who try a MAD will have a good result.

    • Some studies show more severe OSA responds less well to MADs but this is controversial.

    • MADs are generally considered very comfortable.

    • Over time MADs may cause your teeth to move forward. This is monitored by your dentist.

    • Other side effects are mild discomfort that tends to get better over time.

    In order to be effective, a dental appliance needs to be used every time you sleep for the entire night, and whenever you are sleeping. Most people need to continue using a dental appliance for their entire lives.

  • Positional Device

    a. In some cases staying off you back during sleep is all that is needed to substantially improve or cure your obstructive sleep apnea. Your clinician can tell if this is an option from your prior sleep study. If this is so, we encourage you to consider this option and will test how well it works for you.

    b. A positional device, when worn, will detect if you are on your back and gently vibrate to encourage you to roll onto your side. The device is approved by the FDA.

    c. The device can be worn around the neck or on the stomach and vibrates whenever you roll onto your back.

    d. If you are using a MAD and it is not fully effective, positional therapy can be added at your sleep provider’s suggestion.

    e. After you are comfortably fitted, you will be tested for the device’s efficacy in improving your obstructive sleep apnea. If it does not work adequately, you will be allowed to try another therapy.

    f. Pros and Cons:

    • Positional therapy can be used only if your diagnostic study shows your obstructive sleep apnea goes away when you are on your side.

    • The device will encourage you to stay off your back.

    • The device may disrupt your sleep initially as it needs to wake you up to remind you to to move off your back.

    • While only 10-20% of patients have “positional” sleep apnea and are eligible for this therapy, it is very effective at keeping you off your back. There are few side-effects of the therapy.

    In order to be effective, positional therapy needs to be used every time you sleep for the entire night or as long as possible. Most people need to continue the device to get adequate therapy.