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C-PAP (Continuous Positive Airway Pressure): A Synopsis

Many patients cannot tolerate C-PAP therapy. In many of these cases Oral Appliance Therapy is a very effective alternative. Many members of the medical community consider C-PAP the “gold standard” treatment for obstructive sleep apnea. There is a great deal of clinical data to support this opinion. However this assertion and the data that supports it is based on C-PAP compliance. For various reasons many patients fail to remain compliant. Depending on the degree of non-compliance, C-PAP therapy can range from highly effective to marginally effective to a total failure!


A Few of the Reasons Why Patient’s Fail with C-PAP Therapy

  • Inability to tolerate the mask
  • Feelings of claustrophobia
  • Movement in bed constricted (by the tube)
  • Cannot sleep on the back (required by the therapy)
  • Discomfort from flow of pressurized air
  • Sinus issues
  • Digestive issues
  • Sense of bloating from pressurized air
  • Beards that prevent the mask from sealing on the face
  • The noise of the machine
  • The unattractive appearance of the mask and tubing


“Although it has taken some time to adjust to the oral appliance it is 110% better than using the CPAP machine.”

– Catherine Perkins

How C-PAP Works: A Simple Explanation

C-PAP therapy involves a machine the blows air, under pressure, through a tube into a mask that is strapped to your face. It works like a vacuum cleaner in reverse. The objective of C-PAP therapy is to blow pressurized air into your mouth and/or nose to prevent an obstruction of the airway. The amount of air pressure required is determined by a sleep technician during an in lab sleep study. Once set, pressure levels cannot be adjusted by the patient. With the air way open, the CPAP user can breathe properly during sleep keeping blood oxygen levels at high, healthy levels. The result is a good and healthy night’s sleep.


Recent Enhancements in CPAP

Advances have been made in CPAP technology. Bi-PAP (Bi-Level PAP) is a device that self-adjusts while you sleep, lowering the pressure to a specific pressure as you breathe out and increasing the pressure to a specified level as you breathe in. Many patients find Bi-PAP more tolerable than traditional C-PAP.

A third type of PAP therapy is Auto-PAP. This machine not only adjusts for the inspiration and expiration, but can alter the pressure of air relative to the severity of the apnea event as each episode occurs.

Important Note: While refinements in CPAP technology have made the therapy more tolerable for some, the basic issues of toleration and comfort persists. In the final analysis, CPAP is a great therapy option for some and a total failure for others.


“I have had a really great experience with my oral appliance. There is no question that I’m waking up less times during the night and achieving more/better sleep… My wife also tells me that I never snore when wearing the device… To say I find it more comfortable then the C-PAP would be a huge understatement.”

– Kevin Halligan

Is C-PAP Therapy For You?

Most physicians will recommend C-PAP based on it being widely recognized as a “gold standard” of care.

Prescribing C-PAP make sense in many, even most cases. Prescribing C-PAP should not however be an automatic decision. Your personal sleep habits and circumstances need to be considered by your doctor. For instance, if you have great difficulty falling asleep and are highly sensitive to the slightest noise when trying to sleep, you might think twice about the suitability of C-PAP. If you simply can’t sleep on your back, this should give you reason to question if C-PAP will be workable. If constant travel is part of your life style, C-PAP may prove difficult or impractical.

It’s important to recognize that if you have serious concerns about C-PAP or have failed to remain compliant with C-PAP you have very effective alternative treatment options. One of the most common alternative and successful alternative treatments is oral appliance therapy.



The Exhausted Caveman: A Sleep Fable

Imagine a caveman who climbs into his cave bed after a hard day of dinosaur hunting. He falls asleep quickly. He has a nightmare about a saber tooth tiger chasing him and his blood stream is filled with cortisol and adrenaline. His heart rate accelerates dramatically. His blood metabolism changes for the worse and he awakens for an instant only to fall back to sleep. Imagine that this same saber tooth tiger dream occurs another hundred and fifty times that night and every night with the same physiological results.

The morale of the story:

If a real saber tooth tiger doesn’t kill the caveman, the one that keeps chasing him out of a good night’s might!


Are you living like the exhausted caveman? Is sleep apnea your saber tooth tiger?