Many veterans with post-traumatic stress disorder (PTSD) struggle with sleep apnea. It’s one of the leading categories of disability handled by the Veterans Administration (VA). However, treating sleep apnea in vets is a challenge because they have a hard time complying with their continuous positive airway pressure (CPAP) treatment.

Now a new study claims that the answer is advanced forms of PAP, but there are reasons to doubt the conclusion. Besides, another, simpler treatment option that might be better is available: oral appliance therapy.

Trying to Explain the Compliance Problem

One of the reasons why veterans with PTSD have trouble complying with CPAP is that they feel claustrophobic and report feelings of being smothered.
The authors of this article propose that it’s not the mask which causes those feelings. Instead, it’s what they call expiratory pressure intolerance (EPI). EPI occurs when people try to breathe out, but can’t because of the force of the CPAP pushing inward. This creates feelings of being smothered or drowning in air.

In their experience, they say, people with mask problems don’t just stop using their CPAP. They ask for new masks to alleviate the problem. To test their theory, researchers looked at the compliance rates they could achieve by using advanced forms of PAP, such as auto-servo-ventilation (ASV) and auto-bilevel positive airway pressure (ABPAP). These types of PAP automatically adjust to users’ breathing and allow low pressure periods for people to breathe out.

However, they found that their compliance rates were only 58%. While it’s true that this is higher than other studies recently with patients like veterans who have both sleep apnea and PTSD, this doesn’t seem high enough. A treatment that only achieves 58% treatment levels can’t be considered acceptable for our veterans with PTSD. This is a mark of their sacrifice and they deserve better from us.

CPAP Alternatives Might Do Better

There is reason to doubt that the basic premise of this study is valid. After all, many CPAP machines have pressure release valves that allow for people to breathe out. Also, adapting the pressure so it’s comfortable is something that should be fixable during titration.

Most likely, the problem with CPAP is manifold. Pressure is part of it. But so is the mask. And the tubes. And the routine. It’s all so confining and creates a potentially claustrophobic feeling, whether this is literal or metaphorical.

Sleep apnea appliances are a much less invasive solution. They allow for the most natural breathing, and they’re very easy to use. You just put them in before you go to sleep. You can roll over and otherwise move freely. There’s nothing binding or restricting you. And you can breathe freely. In general, the compliance rate for oral appliances is very high (about 96% when measured with the CPAP standard), although we don’t have much research in veterans with PTSD. We need this research and hope that it is going forward so we can finally understand what is the best solution for this group in need of treatment and deserving of our best efforts.

Are you having trouble with CPAP in Omaha? Want to learn whether an oral appliance can help you? Please call (402) 493-4175 today for an appointment with a sleep dentist at the Advanced Dental Sleep Treatment Center.