What CPAP does
Continuous positive airway pressure (CPAP) uses a small machine to deliver pressurized air through a mask. The pressure splints the airway open during sleep, preventing collapses. CPAP is the gold-standard treatment for moderate to severe obstructive sleep apnea, it works exceptionally well when used consistently.
The challenge: many patients struggle with CPAP tolerance. Mask discomfort, claustrophobia, noise, dry mouth, and equipment maintenance lead to lower adherence than the medical community would like.
What oral appliances do
A mandibular advancement device (MAD) is a custom-fitted oral appliance, similar to a sports mouthguard or orthodontic retainer, that holds the lower jaw slightly forward during sleep. By advancing the mandible, the appliance opens up the airway at the back of the throat.
For mild to moderate obstructive sleep apnea and for simple snoring, oral appliances are highly effective. They're small, silent, portable, and don't require a power source, which makes them dramatically easier to actually use every night.
When CPAP is the right call
We recommend CPAP (typically through a sleep physician) when:
- Sleep study shows severe obstructive sleep apnea (AHI > 30)
- There's significant oxygen desaturation during apneic episodes
- Underlying heart disease or stroke history requires maximum therapy
- Central sleep apnea is the diagnosis (oral appliances don't help)
- Previous oral appliance trial wasn't effective enough
When oral appliances are the right call
Oral appliances work especially well for: mild to moderate obstructive sleep apnea, primary snoring without significant apnea, patients who can't tolerate CPAP, and patients who travel frequently. The American Academy of Sleep Medicine recognizes oral appliances as a first-line treatment for these cases.
Combination therapy
Some patients use both, CPAP at home, oral appliance when traveling. Some use a CPAP machine at lower pressure thanks to oral appliance support. Treatment doesn't have to be either/or, and we coordinate with your sleep physician to design the right approach.
Getting started
Bring your most recent sleep study to your consultation. We evaluate your bite, tongue posture, and airway anatomy, then take impressions or a digital scan. The custom appliance is delivered 2–3 weeks later, and we'll adjust the advancement over a few visits to find the right balance between effectiveness and comfort.
Combining oral appliance with CPAP
It's not always one or the other. Several patients we see use a combination approach with their sleep physician's coordination:
Oral appliance during the night, CPAP only on bad-symptom nights or during travel, flexibility for patients who travel often. Oral appliance plus a lower-pressure CPAP, the appliance opens the airway enough that CPAP pressure can be dialed down, making it more tolerable. Oral appliance during the night, positional therapy (side-sleeping aid) added, useful for patients whose apnea is positional. Bariatric or surgical evaluation if neither approach alone is working. We coordinate directly with your sleep physician and primary care doctor to make sure everyone's on the same page about your treatment plan and how it's adjusting over time.
Questions about your specific case?
Every patient's mouth is different. The article above covers the general principles, for a personalized recommendation, schedule a consultation with Dr. Sidhu.