I Can’t Wear My Cpap. Now What?

CPAP — which stands for continuous positive airway pressure — is the most commonly physician-prescribed treatment for obstructive sleep apnea (OSA). A CPAP machine uses a special mask that covers the nose and sometimes the mouth as well. A compressor pump is attached to the mask through a hose to keep your airway splinted open during sleep so you can breathe. Some patients, however, simply cannot or will not tolerate CPAP because it solves some problems but creates others they weren’t experiencing before beginning OSA treatment. We use the term “CPAP Intolerance” to describe this situation.

Signs Of Cpap Intolerance Include:

  • Nasal congestion and irritation of the lining of the nose
  • Eye or sinus irritation from the blowing air and mask leaks
  • Bloating in your stomach from swallowed air
  • Headaches from the mask and strap pressure
  • Continued drowsiness because of an inability to wear the CPAP for more than a few hours

Thankfully, CPAP isn’t the only treatment option for patients who struggle with OSA. Since 1996, the American Academy of Sleep Medicine has recommended that a professionally made oral appliance should be considered as a first-line therapy for patients with mild or moderate OSA as well as those with severe OSA who have tried CPAP therapy without success. With oral appliance therapy, our patients from all over Kitsap, King and Pierce Counties are enjoying an alternative that allows them to get the full night’s rest they deserve.

Oral appliance therapy uses a comfortable, custom-made, two-piece mouthpiece that is designed to reposition your tongue and throat muscles by advancing the lower jaw. Not only will this help you sleep better, but it will also treat your snoring, which will make your bed partner much happier! In many cases, couples who were forced to sleep in separate bedrooms are once again able to sleep in the same bed.

If you have tried to treat your OSA with CPAP and have experienced side effects that make you unable or are unwilling to use it, give us a call. At Center for TMJ & Sleep Solutions NW, we have helped many patients with OSA find relief.

Oral Appliances

What is an oral appliance and how does it work?

If you have mild to moderate OSA or if CPAP has not worked for you, an oral appliance may be the better therapeutic option.

An oral appliance is a non-surgical OSA treatment that consists of a custom-fitted device (somewhat resembling a retainer or mouth guard) that you wear while you sleep. There are over 100 types of oral appliances approved for treating mild to moderate OSA. While in use, it keeps your airway open by sliding your lower jaw forward to create more room for your tongue and any excess soft tissue at the back and upper part of your throat.

Types Of Oral Appliances

Mandibular Advancement Devices

Our office uses all of the devices listed below to treat snoring and obstructive sleep apnea. Which one is right for you depends on a number of factors. After examining you and your imaging results, your doctor will explain which device best suits your needs and why.


This type of appliance is named for the distinctive fins that protrude upward from the lower appliance. All surfaces are smooth acrylic against your cheeks, lips and tongue, and it is easily adjustable.


The SUAD appliance allows more lateral movement than most of the appliances and is specially made with extra cast metal components for our patients who aggressively grind their teeth at night. The thermoflex material usually requires heating in warm water to soften it slightly before attempting to place it over your teeth.


The OASYS is the only dental device that is FDA approved as a medical device in two separate classifications: (1) as a mandibular repositioner for treatment of snoring and sleep apnea and (2) as a nasal dilator for improved nasal breathing. It pulls the lower jaw and tongue forward to prevent the tongue from blocking the airflow, strengthening the throat against collapse during sleep.


The NARVAL appliance is made of nylon and is quite thin yet durable, which allows maximum tongue space. The amount of mandibular advancement is adjusted by changing out the attachment arms, which are available in a wide variety of lengths.


This design allows for a lot of side-to-side movement and is a good choice for people who grind their teeth or simply want more ability to move. It is also one of the approved designs for patients with Medicare and works well in a variety of patients. As a result, it is one of the most popular devices in use today.

What are the benefits of an Oral Appliance?

  • Helps you breathe without interruption while you sleep
  • Eliminates snoring and other OSA symptoms, like headaches
  • Significantly improves your overall health and energy level
  • Easy, convenient, and comfortable

Research shows that oral appliance therapy is an effective treatment for snoring and obstructive sleep apnea, and many patients find the oral appliance more comfortable than a CPAP mask. Additional benefits of an oral appliance include easy portability, no associated noise, and they are easy to care for. An oral appliance is an optimal choice for patients who travel often or enjoy outdoor activities.

Did You Know? 80% Of Moderate To Severe Cases Go Undiagnosed.

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Wake Up To Better Sleep

Your complete guide to understanding sleep apnea

Receive a copy of Dr. Kushner’s book, Wake Up to Better Sleep, at your first appointment.