Combined Therapy

CPAP therapy and Oral Appliance therapy both are effective ways to treat sleep apnea. However for more severe and complex patients, complete relief may not be able to be achieved from just one therapy alone.  By working closely with your sleep doctor, Dr. Dahlkemper can also offer combined therapy to achieve maximum relief.  

CPAP Therapy:

CPAP is the most common therapy in treating patients with sleep apnea.  The CPAP works by pushing air into the back of the throat acts as a splint to keep the airway open.  Many people discontinue use of CPAP due to it being uncomfortable or noisy and have difficulty with the air pressure or problems with leaky or ill-fitting masks.

Oral Appliance Therapy:

Oral appliances can be an effective first line treatment for patients with mild to moderate sleep apnea. The AASM and AADSM also recommend oral appliances for patients with severe OSA, who are unable to tolerate or cannot wear CPAP devices. Oral appliances are comfortable, easy to use, maintain, and travel with and that is why patients tend to be more compliant.

Combined Therapy: 

We are now able to design an oral appliance that works with a CPAP machine. For combined therapy, a patient wears an oral appliance, and they also use a CPAP at the same time, though they only have to wear a small nasal mask. Many patient with more moderate to severe sleep apnea use combination therapy (wearing CPAP and an oral appliance together) to help reduce the pressure on a CPAP machine.

Who Should Consider Combined Therapy?

  • Those with severe sleep apnea having difficulty using CPAP-intolerant or noncompliant

  • Those whose apnea is not adequately relieved by CPAP alone

  • Those whose apnea is not adequately relieved oral appliance therapy alone.

Benefits of Combined Therapy

  • Increased Comfort: With combined therapy, a patient only has to wear a small nasal mask with their CPAP, which feels much less restrictive. The machine can be put on a much lower setting thanks to the oral appliance.  This will drastically reduce the noise and amount of air that is being forced into the throat.

  • More Compliance: If the treatment isn’t comfortable and easy to use, a patient simply won’t use it, leaving their condition completely untreated. Combined therapy addresses many of the problems patients experience with their CPAP machine, they are much more likely to use it over time, leading to more consistent treatment and a better result overall.

  • More Effective: A study conducted by the American Academy of Dental Sleep Medicine showed that combined therapy is able to decrease the number of apnea events (where a patient temporary stops breathing) more effectively than CPAP therapy alone. Participants with untreated sleep apnea suffered about 6 apnea events an hour, and with CPAP therapy, that number was reduced to around 4. Combined therapy, however, was able to reduce it to 2, showing the advantages of this treatment method compared to the most popular one.

  • Increased Convenience: For anyone who has traveled with a CPAP, you know it can be a real pain. Taking it onto an airplane always causes a headache, and you just have to pray that wherever you’re staying is set up in a way that allows you to use your machine while it’s plugged in and you’re in bed. For those using combined therapy, they can simply take their oral appliance with them on the road, making it easy for those always on the go.