CPAP - Pain Or Promise??



What does "Gold Standard" mean?   It usually means it is the best--everything else is less effective.  So what is the "Gold Standard" for getting rid of an infection in your foot??  Most people would say it is antibiotics.  But the infection can return after several rounds of antibiotics.  Is there a way to make 100% sure that the infection will never return?  Of course, and it is amputation.  So we would have to say that amputation is the "Gold Standard" for a foot infection!  Would you like to start with the "Gold Standard"?   Of course not!

Just like amputation, CPAP (which has been called the Gold Standard) may not be the right treatment to start out with.  Since 1980 much has changed in the medical world.  We are seeing breakthrough treatments for health issues coming at an amazing pace.  What was originally thought to be the ultimate Gold Standard treatments are dropping from their thrones to be replaced by simpler, less invasive, less expensive new breakthroughs.

When CPAP first came on the scene it really was the only viable treatment for obstructive sleep apnea.  Hence is was called the Gold Standard… it was the only successful treatment that avoided painful surgery that hadn't really helped many get rid of their sleep apnea long term because the tracheotomy could not be used long term.  Simply put, for most people CPAP worked if the patients could tolerate it but it did have its issues.  It's not the Gold Standard anymore; it's just another method of treating obstructive sleep apnea.

There have been numerous studies on CPAP compliance.  Being CPAP compliant is defined as wearing the device 4 hours a night for at least 5 nights a week.  That is, of course, less that 50% of the time which means that for over 50% of the time there is no treatment being used and the apenic events continue to happen.  There have been studies that reveal startling results.  Some studies have revealed that less than 30%  of CPAP users don’t meet even those minimal requirements of CPAP compliance.

They were either removing the CPAP mask early or deciding to skip a night altogether.  The health effects of not treating sleep apnea can be devastating.  We have seen many, many patients who do not even know how dangerous it is to sleep without the "machine " on.  Let’s take a look at what is determined as compliance and what real sleep needs are to maintain productivity and health.  If we take an average number of 7 hours of sleep a night to be healthy we would be sleeping 49 hours in a week.

To get real benefit from those hours of sleep they would need to be free from apnea episodes that drastically drop blood oxygen levels. If we were using CPAP we would have to wear the device 7 hours a night, each night.

If you factor in what is considered as CPAP compliance, 4 hours a night, 5 nights a week.  5 out of 7 nights per week is 70%.  But really athat turns out to be in that week, a total of 20 hours of treated apnea out of 49 hours!  That's only 41% of the time, not 70%.  And that is considered 100% compliant.   But it gets even worse when you consider how many people, 70% of CPAP users don’t even get that 20 hours.


As I said before, we have come a long way since 1980.  There have been many different ideas to treat sleep apnea since then.  Some have appeared and faded away fast and some have taken hold and have revolutionized the treatment for snoring and sleep apnea.

One of the greatest innovations to treat sleep apnea is the oral appliance… I don’t mean the ones you see on the internet for  under $100.00.  Most of those disappear soon after the company receives a letter from the FDA telling them to stop selling an unapproved device.  You must know that even if a device is FDA approved, that only means that it is safe--it does not mean that it works!!  Also many of the companies that make these cheap devices are from outside the US and not subject to the legal penalties US companies are.

The basic alternative to CPAP is an oral appliance that is properly fitted by a qualified, experienced dentist, and adjusted to position your lower jaw just right to keep your tongue from closing off your airway while you sleep.  The oral appliances work great for someone who can’t or won’t use CPAP.  They are comfortable enough to be worn all night to get a full 7 hours of non-snoring sleep every night.

The procedure to obtain an oral appliance is simple and painless and you can be sleeping comfortably in just a few short weeks.  If you live in the Spokane, Coeur d'Alene, or Post Falls area, you are fortunate to be close to the Northwest Treatment Center for Snoring & Sleep Apnea.  Call today at (844) 447-6673 to schedule your free consultation with Dr. Don Johnson, a Dental Sleep Specialist.



The inside of the reservoir, tubing, and masks of the CPAP get a biofilm on the surface.  A biofilm is defined as a growth of a mixture of microbes on a surface.  The HEPA filter on the CPAP does not prevent a biofilm from forming on the inside of the reservoir, mask, or tubing.  Below are pictures of various things which have been cultured from CPAP masks and tubing.  As you can see, there are many microbes on the equipment even after cleaning.

Picture #1

Picture #2


In 1980 an interesting thing happened.  A doctor named Colin Sullivan from Australia came up with the idea that positive pressure, applied to the airway, might bring down blood pressure and stop obstructive sleep apnea.

The first test was done on a patient that had such severe sleep apnea that the doctors were about to perform a tracheotomy (cutting a hole in the throat and creating a passage for air that bypasses the airway above the throat).

Neither the patient nor his family were pleased with the tracheotomy idea.  When they were presented with the option of trying a non-invasive experimental treatment they decided to try it.  The doctors then got him ready to go to bed with a unique twist. They used rapid setting silicone sealer to connect and seal two tubes in his nostrils.

They let him go to sleep while monitoring him.  Once he started to have episodes of obstructive sleep apnea (blocked airway), they applied air pressure to his nostrils.  At first nothing changed, but as they increased the air pressure something surprising happened. He began to breathe normally and soon was in REM sleep.

They dropped the pressure and the apnea came back.  Because it was an experiment they put the poor fellow through numerous cycles of REM sleep and sleep apnea interruptions.   Finally they tried one last experiment, how long would he sleep?

Once they stopped “playing” with him he slept for 7 hours. He woke up feeling alert and rested saying he couldn't remember such a great night’s sleep. Sadly he probably did not have a great night sleep the next night as the experiment was over.  CPAP was discovered!!