Combination Therapy for Sleep Apnea

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While oral appliance therapy and CPAP therapy are both effective ways of treating sleep apnea, many patients are not able to receive complete relief from just one. Thankfully, Dr. Cox and the team at Good Night Dentistry can also offer combination therapy for sleep apnea by working closely with your sleep physician. This approach allows us to tailor our treatment to the exact needs of our patients and provide them the ultimate solution to their sleep problems. 


Continuous positive airway pressure (CPAP) therapy is currently the most common approach physicians use to treat sleep apnea. It involves a patient wearing a facemask that is connected to an air pump. This pump forces air into a patient’s throat in order to prevent the breathing obstruction related to sleep apnea. While it has been shown to be extremely effective for those suffering from severe obstructive sleep apnea (OSA) and central sleep apnea (CSA), many patients have difficulty falling asleep because of the machine itself. The sensation of the air going into their throat can be very uncomfortable, and the mask often creates feelings of claustrophobia. Also, the machine can create quite of bit of noise, which can be disturbing to both the patient and their bed partner. These issues and more are why nearly 50% of CPAP patients stop using it within one year.


A major alternative to CPAP therapy is oral appliance therapy. These custom made mouth guards are ideal for patients snore, simply cannot tolerate CPAP, or have problems sleeping with their CPAP. They work by gently shifting the jaw forward to prevent the soft tissues in the throat and the tongue from obstructing the airway. They are fabricated using high-quality materials to assure they are comfortable, flexible, and durable. They are easy to use, maintain, and travel with, which is why patients typically have a much higher compliance rate with them. They are often able to get the same results without the discomfort of a CPAP machine, which is why The American Academy of Sleep Medicine and The American Academy of Dental Sleep Medicine often recommend them as the primary form of treatment for many patients.


Combination therapy allows a patient to benefit from the best qualities of each treatment method at once. By using a CPAP machine in conjunction with an oral appliance, more patients are able to get a solution tailored to their particular needs. It allows patients who suffer from severe OSA or CSA to benefit from the comfort and ease of oral appliance therapy without having to give up the reliability of their CPAP.  When a patient uses combined therapy, they’ll be able to wear just a nasal mask rather than a full facemask. This makes it much easier for people to sleep with their CPAP because they don’t feel so constricted. Also, because the oral appliance is shifting their jaw slightly forward, they can set the CPAP to a lower setting. This helps cut down on the noise as well as the sensation of air being pumped into the throat. The end result is a patient who is finally able to sleep comfortably throughout the entire night.


Of course, while combination therapy is excellent for some patients, it is not a “one-size-fits-all” kind of treatment. Combination therapy is often best for patients who:

  • Are CPAP intolerant or have difficulty using their CPAP regularly.
  • Do not achieve relief from their sleep apnea with just oral appliance therapy.
  • Do not achieve relief from their sleep apnea with only CPAP therapy.


Combination therapy offers a multitude of benefits for those patients who can’t find relief using just one treatment method:

  • More Comfort – Combination therapy allows a patient to wear a small nasal mask with their CPAP as opposed to the constricting facemask. Also, thanks to the help of the oral appliance, the CPAP can be put on a lower setting, which minimizes the sensation of air being pushed into the throat and even reduces noise.
  • Easier Compliance – The biggest problem with a CPAP machine is that so many patients do not consistently use it because it is uncomfortable. With combination therapy, they are able to rest more peacefully and easily, which makes it much easier for patients to reliably use it. This will enable them to get the correct amount of sleep each night, which will have dramatic benefits for their overall health.
  • Increased Effectiveness –According to a number of studies conducted by The American Academy of Dental Sleep Medicine, combination therapy is able to significantly reduce the amount of apnea events (times where a person’s breathing has stopped for more than ten seconds) people experience throughout the night.  One study found that patients with no treatment experienced about 6 apnea events per hour, while those with CPAP therapy had about 4. With combination therapy, that number dropped to 2. These results have been replicated in multiple studies, showing that combination therapy is able to maximize the effectiveness of both CPAP therapy and oral appliance therapy.
  • Increased Convenience – A CPAP machine is extremely hard to travel with, so for business people on the go, they usually just leave it at home. For patients using combination therapy, they can simply bring their oral appliance with them. They’re small, easy to pack, and can assure that they’ll always get the rest they need no matter where they are.


If you are dealing with sleep apnea but can’t get the rest you need with your CPAP machine or oral appliance, combination therapy might finally be your answer. Whether you come to visit Good Night Dentistry for your free consultation or prefer to do a virtual consultation in the comfort of your own home, Dr. Cox and our team will review past treatment plans, sleep study results, and several other diagnostics. Using this information, we’ll be able to determine if combination therapy is right for you. No matter what treatment plan we recommend, the end result will always be a full night’s sleep and an energetic morning. If you’d like to know more about combination therapy, be sure call us today at 704-964-6404.

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