If you have sleep apnea, you are looking for a treatment that will help you combat the negative effects of the condition. You want to reduce or eliminate your daytime sleepiness. You want to find your energy and motivation again. And you want to avoid the negative health consequences of sleep apnea, such as cardiovascular problems and metabolic problems.
And that’s why CPAP isn’t always the best treatment. Although CPAP has a very high efficacy, its effectiveness isn’t any better than oral appliance therapy.
CPAP Efficacy and Effectiveness
Efficacy is the absolute ability of a treatment to treat the condition it’s being used for. In other words, it’s the ability of CPAP to completely eliminate sleep apnea when it’s being used. With enough pressure, CPAP can allow anyone to be free of sleep apnea — while they’re wearing their mask.
But in order to really be an effective treatment, the treatment has to actually be used, and that’s where CPAP’s problem starts. If a person isn’t using CPAP, they have untreated sleep apnea for every night or portion of the night when they’re not using CPAP.
Compliance rates for CPAP may be as low as 50% after only six months on the treatment, and as low as 17% after five years! In other words, 83% of people prescribed CPAP essentially have untreated sleep apnea after five years.
And then there’s the question of whether CPAP compliance is enough to get an effective treatment. Typically, CPAP compliance is defined as using CPAP for at least four hours a night, 70% of nights. That could be as little as 35% of the time spent sleeping.
And, what’s more, some science indicates that even four hours a night every night might be inadequate for treating many common health effects of sleep apnea, such as diabetes.
Studies indicate that it takes about four hours of CPAP a night to eliminate subjective daytime sleepiness, six hours of CPAP a night to eliminate objective sleepiness (sleepiness that can be tested), and 7.5 hours of CPAP a night to restore full function. Significant life-saving differences are maximized at 6 hours of CPAP a night.
How many CPAP users achieve that level is not generally reported.
Oral Appliance Efficacy and Effectiveness
Oral appliances do not have 100% efficacy like CPAP does. It’s much lower, with many people still having some degree of sleep apnea. However, oral appliances are used much more often than CPAP, and for longer.
Although we haven’t had tracking for oral appliances for as long as we have had it for CPAP, preliminary data suggests that 95% of oral appliance users achieve the four hours a night for 70% of nights level, and 84% of users achieved the “all night, every night” standard. Thus, although the efficacy is much lower, the effectiveness can be as high or higher.
In fact, studies on a wide range of outcomes confirm this: oral appliances achieve the same level of health improvement as CPAP.
Choose the Treatment You Will Use
With the potential for effectiveness essentially equal between these two treatment options, you are free to choose the one that you like better. For most people that we see, CPAP is unpleasant, and people are very happy to find that they have another option.