CPAP – continuous positive airway pressure – is widely regarded as the gold standard treatment for obstructive sleep apnoea (OSA). For many patients it works well, and the benefits are significant. But for a considerable number of people, tolerating it night after night is a different matter. Patients report a range of difficulties – from mask discomfort and nasal congestion to difficulty exhaling against the air pressure – and these are the reasons so many people quietly stop using their machine and go back to sleeping badly.
Here at The London Lingual Orthodontic Clinic, Dr Asif Chatoo combines specialist orthodontic training with expertise in sleep medicine – and he sees many patients who have tried CPAP and are looking for a different approach.
Why CPAP Compliance Is Such a Common Problem
CPAP works by delivering a continuous stream of pressurised air through a mask worn over the nose or mouth during sleep, keeping the airway open. In theory, it’s highly effective. In practice, adherence is a well-documented challenge – studies consistently show that a significant proportion of patients either abandon CPAP altogether or fail to use it for the recommended number of hours each night.
For partners, the disruption doesn’t always end there – the noise of the machine can be as disruptive as the snoring it’s designed to address.
None of this means CPAP is the wrong treatment – for severe sleep apnoea in particular, it remains the most effective option available. But recognised clinical guidelines support mandibular advancement devices as an effective alternative for patients with mild to moderate OSA when CPAP has not worked or cannot be tolerated.
Mandibular Advancement Devices as an Alternative to CPAP
A mandibular advancement device (MAD) is a custom-made oral appliance that fits over the upper and lower teeth and gently holds the lower jaw in a slightly forward position during sleep. This keeps the airway open, reducing snoring and – in cases of mild to moderate obstructive sleep apnoea – preventing the airway from becoming repeatedly blocked.
Mandibular advancement devices are among the most well-researched treatments for sleep-disordered breathing. They are small, silent, and unobtrusive – and because compliance tends to be significantly higher than with CPAP, many patients find they deliver better real-world results.
Why Custom-Made Matters
Not all mandibular advancement devices are equal. Over-the-counter devices are available, but they lack the precision of a custom-made appliance fitted by an experienced clinician. The fit has a direct bearing on how comfortable the device is to wear and how well it works – and a device that isn’t comfortable is unlikely to be worn consistently.
This is where the expertise of a specialist orthodontist makes a real difference. Dr Chatoo has a detailed understanding of how the teeth, jaw, and bite work together, which means a device can be fabricated and adjusted to a level of precision that reflects both clinical knowledge and a thorough understanding of your individual anatomy.
How Dr Chatoo Can Help
Dr Chatoo offers a carefully selected range of mandibular advancement devices, including the Somnowell and Prosomnus, and will take the time to talk through the options and recommend the device that’s right for you. Where a diagnosis of sleep apnoea has not yet been established, or where further investigation is needed, Dr Chatoo works collaboratively with sleep physicians and other medical colleagues to ensure patients are assessed and treated in the right way.
Every device is custom-made and fitted by Dr Chatoo, with follow-up appointments included to check on progress and make any adjustments needed. You’ll be looked after by the same small, dedicated team throughout.
Book a Consultation
If you’ve struggled with CPAP and would like to explore whether a mandibular advancement device could help, we’d be delighted to hear from you. Consultations are with Dr Chatoo at our Harley Street practice.
