Snoring Mouth Guards or CPAP?

When did the phrase “As Seen on TV” become the gold standard barometer of a quality product? I just heard a commercial on satellite radio with a bold message to “get rid of your CPAP and fix your snoring and sleep apnea with a mouth guard”. If you are willing to believe this I have a relative that is a Nigerian prince that needs your help moving money out of Nigeria and is willing to pay you a hefty sum.  Anyone that has ever been spammed with that email gets the joke. The truth is too many people are being fooled by opportunistic companies emerging on the market to promote a remedy that’s supposedly going to help you get rid of your CPAP machine.

While I should be happy that apnea awareness continues to grow, I am dissatisfied with some of the irresponsible marketing some companies will lead you to believe will benefit your sleep health.  It kind of reminds me of the thousand of weigh loss dietary supplements that all claim to produce results.cpap-versus-mouthguard

These companies are very clever in their advertising and I give them kudos for that. Since they can’t come out and say that their product will treat or help your sleep apnea, they do that in a roundabout way by saying “get rid of your CPAP” by using their product. Here in lies the problem; if you are on CPAP (continuous positive airway pressure) that means you have a major likelihood that it is being used to treat sleep apnea. So how do they get around this? Simple, just say your product treats snoring and imply it treats apnea by telling someone to get rid of their CPAP machine.  Brilliant, but that kind of advertising is irresponsible and the equivalent to telling someone to put a band-aid on a gun shot wound.stock-footage-boxing-mouthpiece-dental

So unless you plan on boxing 12 rounds in your sleep leave the mouth guard in your gym bag and put your CPAP mask back on.

Over-the Counter Doesn’t Always Save Time and Money

Some of the worse perpetrators of “quick fix” sleep medicine sell of mouth guards or sprays (yeah, I just said sprays and anybody in their right mind would believe that; right?). You may say “Hey Jason, aren’t you a little biased when it comes to this” and I would say “yes, I don’t want to see any apnea sufferer that needs CPAP be scammed out of money for a product that will not be effective and is potentially harmful”. Just to be clear I am not speaking directly about oral appliances, the kind you are fitted for mandibular repositioning and adjusted by a dental professional but rather the “over the counter” direct to consumer, as seen on TV junk you see advertised on radio and on sensationalized Facebook ads. Sleep physicians or those that practice dental sleep medicine should be consulted first if you feel you may be a qualified candidate.

I Knew A Guy Once

I have a friend that had a sleep study conducted and it revealed that he had a severe case of sleep apnea.  So what determines level of severity?  The levels of sleep apnea are described as the number of times per hour that a person stops breathing or has a partial blockage that causes a drop 3% or greater drop in oxygen level. A mild case of sleep apnea would be a person that has apneas that occur 5 to 15 times per hour on average, a moderate case would be 15 to 30 times per hour and a severe case is an average of 30 or more per hour. My friend’s apnea index was 72/hour and I was floored when he told me that he received his CPAP machine but wasn’t going to use it. He opted instead to go through a slew of oral appliances (currently more than 80 on the market) until he found one he liked. Now mind you I am a registered polysomnographic technologist and have been since 2003 so I couldn’t bite my tongue on this one and had to offer up my professional opinion on his decision.

My friend, we will call him “Mark” for the sake of the story, had a follow up appointment scheduled with his sleep physician and he was going to cancel. I pleaded with Mark to see his doctor in follow up and if he wouldn’t believe what I was telling him then maybe he would believe it directly from the horse’s mouth. After Mark’s follow up appointment the doctor has convinced him to undergo another sleep study, this time using his “mouth guard” to see if apnea was still present. Before his overnight stay at the clinic I made a little side bet with Mark that the results would reveal that he still had severe apnea present. He took this bet and skip all the boring details I will say that he owes me a round of golf at our local course. I must say that I do feel a little guilty about this since I have read case studies and know that oral appliances are only about 20% effective in treatment of sleep apnea sufferers like him. Though some studies have shown that people with an AHI (apnea/hypopnea index) less than 10 have a 52% success rate (Sleep, Vol. 29 2006 Oral Appliances for Snoring and Obstructive Sleep Apnea: A review)

Why Mouth Guards Won’t Help Typical Apnea Sufferers

Sleep apnea is a result of a blockage in the airway (apnea being the Greek word “without breath”) and this blockage can occur for a multitude of reasons that commonly include the following:

  • Enlarge tongue or uvula (that little punching bag in the back of your throat)
  • Excessive tissue in the airway wall that relaxes when you fall asleep and collapses (most common)
  • Neurological causes (these will produce central apnea)

Many different factors can and will contribute to the presence and severity of disordered breathing such as:

  • The position you sleep (i.e. on your back will be the worst)
  • Medications such as opiates that produce central apnea
  • Maintaining a healthy weight or BMI
  • Co-Morbid conditions (heart failure, stroke)

Bottom line is don’t trade in your CPAP mask for some gimmick with good advertising otherwise your sleeping with something in your mouth that may be doing absolutely nothing.