Why choose a MAD over a CPAP machine?
Published on Aug 11, 2016
Dr. Pankaj P. Singh
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According to the American Academy of Sleep Medicine, sleep apnea affects nearly 22 million people. There are many treatment options, of them the most recommended are the Continuous Positive Airway Pressure (CPAP) machine and Mandibular Advancement Devises (MAD).

CPAP machines utilize a mask, six feet of tubing, and provide a steady of pressurized airflow to keep the patient’s airway from collapsing. MADs are dental appliances which offer a second option to those sleep apnea patients that are not appropriate candidates for a CPAP or have not been helped by it. These devises are specifically for those with mild-to-moderate sleep apnea.

How does the MAD work?

The MAD looks like a sports mouth guard. It keeps the airway open by forcing the lower jaw forward and down. It has been shown to be as effective as the CPAP machine in multiple studies for mild-to-moderate sleep apnea.

Benefits of the MAD over the CPAP

The first major benefit of the MAD over the CPAP is it is a simpler treatment option. CPAP machines require a power source, daily cleaning, and supply replacement on a regular basis. Masks and water compartments must be cleaned daily, tubing must be cleaned weekly or bi-weekly, and filters must be changed bi-monthly. Masks and tubing are replaced every three to six months depending on wear. The MAD is much simpler. It is fitted by a professional and may need adjustments as time goes on.

CPAPs are also restrictive as sleepers can only be, at maximum, six feet from the machine at all times. CPAPs can also be traumatizing for those that suffer from claustrophobia and cannot tolerate wearing the mask without some level of anxiety. For CPAP machines with a humidifier function, at times the machine can temporarily malfunction and spray large surges of water through the mask at the sleeping patient causing high anxiety upon waking as well interrupted sleep.

According to the New York Times, one of the biggest benefits of the MAD is that there is a “Significant reduction in apnea for those with mild-to-moderate apnea, particularly if patients sleep either on their backs or stomachs.” This is a huge benefit for habitual stomach-sleepers who often have a hard time falling asleep in a new way due to the constraints of CPAP masks which are more appropriate for back or side sleepers.

Another huge benefit of the MAD is the higher compliance rates as compared to the CPAP adherence levels. This may be smally in part to the very mobile nature of the devise, making it easy to travel and still participate in therapy.

According to a report from the University of Maryland Medical Center, MAD users have few to no complications and see a reduction in both the frequency and loudness of snoring. This is in direct opposition to CPAP machines which can actually be louder than the previously offensive snoring.

Finally, for those who have severe sleep apnea, MADs have been shown to increase efficacy of the CPAP when used together according to the Agency for Healthcare Research and Quality.


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