Broken System = Patients Suffering!

When is this story going to get old? Perhaps when I stop experiencing it on a weekly basis! What makes this story even more concerning is that the SYSTEM Is Not Actually Broken… It Was Built This Way!

My practice is limited to the management of Sleep Disordered Breathing (SDB), Snoring and Sleep Apnea with an Oral Appliance (OA), that’s all I do. Aside from my online presence, I do not promote my services to the General Public, with 90% of my patients coming from referrals and 10% from those that find me online. The referrals mostly come from Sleep Specialists, Family Physicians, ENT’s, Cardiologists, Dentists, Hygienists, Industry and patients.

On a weekly basis I see patients for a consultation that have been struggling with Continuous Positive Airway Pressure (CPAP) for years. It is not uncommon to hear that this struggle is 5 years or more in duration, during which they either have worn their CPAP for only part of the night, or simply not at all. Many have tried various MASKS, some have had their PRESSURE reduced and some have even purchased a second, more advanced machine with an AUTOMATIC feature that alters the pressure as needed. ALL TO NO AVAIL.

I always begin my consultations by asking the following question, “So tell me about your journey?”. Of course, before I even walk into the room, I have reviewed their Baseline Sleep Study, any available physician correspondence and their medical history. So, I usually know most of what they are going to tell me when I ask the question. But I am interested in hearing their version of the events, and what I usually hear is disappointing on so many levels…

Basically, they are told…

…CPAP is “Gold Standard”; which is true.

…CPAP is the only therapy that is guaranteed to work; which is true.

And that’s it! The patient is then dismissed to live happily every after with CPAP. Often, alternatives are not mentioned, and if they are mentioned, they are portrayed in a very negative manner. For example, when an Oral appliance is mentioned, most often they are told…

…Oral Appliances don’t work for everyone; which is misleading.

…Oral Appliance will ruin your Jaw; which is not true.

…Oral Appliances will ruin your teeth; which is not true.

… I don’t believe in Oral Appliances; which is apparently OK for a Physician to say. (I guess "Opinion" TRUMPS Evidence Based Guidelines!)

According to the American Academy of Sleep Medicine 2015 Guidelines, Oral Appliances can be considered a “Standard of Care” for All Severities of Sleep Apnea (Mild, Moderate or Severe), when the patient cannot tolerate CPAP or simply prefers an Oral Appliance to CPAP. From my experience with patients, they almost ALWAYS hear these words from me for the first time, at their consultation.

So, the question remains, “Why is this the case?”.

Quite frankly, CPAP works great, IF you can wear it throughout your sleep period. However, the literature tells us that only 1/3 of patients are able to wear their CPAP all night. The next 1/3 of patients start off with good intentions but then remove it after a few hours, and the remaining 1/3 cannot tolerate wearing it at all.

It seems to me that CPAP effectively manages 1/3 of patients. The advice currently given to patients potentially leaves 2/3rds either under-managed, or un-managed. The lack of physician follow-up for CPAP patients helps to ensure that they remain as such. After all, why would a patient that has failed using their CPAP bother going back to the physician? …the physician already provided the ONLY therapy that will work, CPAP. So, since the physicians don’t follow up, the patient status remains under-managed, or un-managed.

A comprehensive review of the literature tells us that CPAP Adherence has not improved over the last 20 years. So, it seems that the current SYSTEM IS BROKEN, and PATIENTS ARE SUFFERING. The unfortunate thing here is that in fact, the SYSTEM Is Not Actually Broken… It Was Built This Way!

Yes, Oral Appliances have a success rate, however, we currently have tests to objectively establish if an Oral Appliance will effectively manage the problem. I have managed extreme levels of Sleep Apnea well over 100 events per hour with an Oral Appliance, after first establishing that an Oral Appliance would work using the MATRx Plus Theragnostic Test.

Yes, an Oral Appliance alone may not eliminate the problem 100%, However, by implementing adjunctive therapy such as weight loss or controlling sleep position, many patients can be well managed. So, an OA is either the "journey to wellness", or for certain patients, an OA is the beginning of the "journey to wellness" which will come with the implementation of adjunctive therapies.

Regarding Oral Appliance Side Effects, it is important to note that Oral Appliances are well tolerated by patients with the literature showing us that over 90% of patients wear their Oral Appliance long Term and all Night Long. Of course, this would not be the case if the "nonsense" about Oral Appliances ruining jaws and teeth were true. In fact, we cannot cheat physics, the literature shows us that both “CPAP Masks strapped to the face”, and “Oral Appliances worn in the mouth” have side effects associated with them. Thankfully, these side effects are both benign and minimal, and insignificant relative to the medical problem that is being managed.

If you are a patient that is experiencing difficulty with CPAP, ask your dentist about the possibility of using an Oral Appliance.

If you are a Dentist that has yet to become involved, GET INVOLVED! Your patients will be eternally grateful!

John VivianoComment