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CPAP Intolerance: FAQs

Since CPAP is “the gold standard,” can I expect similar benefits from oral appliance therapy?

To be effective, CPAP must be used. However, our review of the sleep medicine literature suggests that as many as 80% of the people who try CPAP cannot tolerate it and, therefore, do not use it. If you are CPAP intolerant, you can enjoy the benefits of recuperative sleep, and greatly improve your quality of life and life expectancy, by using a properly fitted and calibrated oral appliance like the ones we provide to patients in our practice.

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What is a CPAP Intolerance Affidavit?

A CPAP Intolerance Affidavit is a document, which you must sign, that signifies that you have put forth a good faith effort to use CPAP but find it intolerable to use on a regular basis. This affidavit also lists the reason(s) why you have been unsuccessful using CPAP and clearly states your wish to pursue an alternative method of treatment – that is, oral appliance therapy. Many insurers require CPAP Intolerance Affidavits in order to provide reimbursement for covered benefits, and we are happy to make these affidavits available to our patients as warranted. To view a copy of our CPAP Intolerance Affidavit, click here.  

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Am I a candidate for oral appliance therapy in addition to, or instead of, CPAP?

We cannot answer this question until you have completed an examination in our office. However, we can tell you Dr. Bailey adheres to practice parameters of the American Academy of Sleep Medicine, which specify that “oral appliances are indicated for use in patients with mild to moderate OSA (Obstructive Sleep Apnea); who prefer them to CPAP (Continuous Positive Airway Pressure) therapy; or who did not respond to, are not appropriate candidates for, or who fail treatment attempt with CPAP.”

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Do physicians recommend oral appliance therapy for patients who are CPAP intolerant?

Yes. Oral appliance therapy is recommended by the American Academy of Sleep Medicine (AASM) for patients who are CPAP intolerant as well as those who snore and/or have been diagnosed with mild-to-moderate Obstructive Sleep Apnea. The AASM has a combined membership of nearly 12,000 accredited member sleep centers and individual members, including physicians, scientists and other health care professionals. Likewise, Dr. Bailey has developed a network of highly-respected, board-certified sleep physicians that we work with on a regular basis.

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Will an oral appliance replace my CPAP machine?

We cannot answer this question without reviewing your dental/medical history and completing a clinical examination in our office. However, we can tell you that Dr. Bailey has achieved excellent results for patients by combining CPAP treatment with oral appliance therapy. In other cases, Dr. Bailey has found that snoring and mild-to-moderate Obstructive Sleep Apnea may be managed effectively with oral appliance therapy alone. Dr. Bailey has also had great success managing severe sleep apnea with oral appliances, too.

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Can I use an oral appliance if I have been diagnosed with severe sleep apnea?

You are not alone; fear not. We see many patients in our practice who have been diagnosed with severe Obstructive Sleep Apnea. For these patients, an oral sleep appliance can be an effective adjunct or alternative treatment option. And it is endorsed by the American Academy of Sleep Medicine. As with all of our patients, once your oral sleep appliance is delivered we will monitor your condition and conduct routine assessments for signs and symptoms of worsening OSA. Our office will also communicate regularly with your physician, which is an important aspect of good patient care.

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If I cannot tolerate my CPAP, will I have the same problem with an oral sleep appliance?

This is not likely because CPAP machines and an oral sleep appliances work in very different ways. A CPAP machine works by blowing air down the throat to keep your airway open while you are sleeping. In essence, it works like an “air splint.” By contrast, the oral sleep appliances we provide to our patients maintain airway patency in a number of ways, including: repositioning your lower jaw, tongue, soft palate and uvula; stabilizing your lower jaw and tongue; and increasing the muscle tone of your tongue.  

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What is the benefit of combination therapy – that is, using my CPAP and an oral sleep appliance together?

We work with physicians who have prescribed combination therapy for their patients on a regular basis; the results have been excellent. Using a CPAP machine and an oral sleep appliance at the same time can be very effective and it can also help you better tolerate the CPAP. In brief, the oral sleep appliance reduces the amount of pressure needed for your CPAP to be effective. It can also eliminate the need for straps. Last but not least, the oral appliance can be disconnected from your CPAP machine and used separately. This can be a significant benefit, particularly if you travel frequently for business or pleasure and do not want to take your CPAP along with you on your trip.

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Is there a particular oral sleep appliance for patients that are CPAP intolerant?

No, one size does not fit all. We use a number of different oral sleep appliances in our practice, each of which has strengths and limitations. Dr. Bailey’s care, skill and judgment enables her to select the best oral sleep appliance for you based on the cause(s), severity and complexity of your sleep-disordered breathing problem. Once selected, to ensure that it is effective, Dr. Bailey will also custom-fit it and calibrate your oral sleep appliance to precisely to you

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Do health insurance companies provide coverage if I am CPAP intolerant?

Health insurance policies vary greatly; however, we have found that most insurance companies do provide coverage to patients who are CPAP intolerant. Ultimately, it is the patient’s responsibility to pay for the treatment we provide in our office while insurance reimbursement for covered benefits is paid directly to the patient.

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Are all dentists sufficiently trained to provide treatment to patients who are CPAP intolerant?

Per the American Academy of Sleep Medicine, oral appliances should be fitted by qualified dental personnel who are trained and experienced in the overall care of oral health, the temporomandibular joint, dental occlusion and associated oral structures. Dr. Bailey has invested the necessary time and dedication to the study of dental sleep medicine, craniofacial pain and temporomandibular disorders to ensure that she is fully versed in all of these areas of dentistry. She also completes continuing education courses and participates in tier advancement programs to ensure that her knowledge and skills remain current.

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1401 Hospital Drive, Suite 102, Hurricane, WV 25526 USA
Jeanne K. Bailey, DDS Sleep, TMJ and Craniofacial Pain Treatment Center in West Virginia (304) 757-7428 (304) 757-3535 wvsleepandtmj@frontier.com