Dr. Smith: At the same time? Yes, it’s called combination therapy, and allows a CPAP user to have the pressure reduced to make it easier to use. They can also be used alternately when they are hunting, on airplanes, etc.. Of course, the right type of mask would need to be used, and preferably one of the nasal cone type that does not place any retrusive forces on the maxilla.

Another use for combination therapy is if you would like to prevent any potential occlusal (bite) changes with the mandibular advancement devices. If someone wears a MAD during the week, and CPAP on weekends, for example, they will get no bite changes.

Dr. Smith: Yes, a MAD is great for UARS (upper airway resistance syndrome), and if it solves this, it will more than likely solve the snoring. I love UARS cases, because they are almost always slam dunks! (even though insurance won’t help them)

Dr. Dmith:
1. From Sleep and Breathing (When we remove obstructions and anatomically reorient the mandible, we can be surprised at the benefits)

The aim of the present study was to investigate the effect of a mandibular advancement device (MAD) for the treatment of sleep apnea (SA) on plasma brain natriuretic peptide (BNP), left ventricular ejection fraction (LVEF), and health-related qualify of life (HRQL) in patients with mild to moderate stable congestive heart failure (CHF). Seventeen male patients aged 68.4±5.5 with an apnea–hypopnea index (AHI) 10 were equipped with an individually fitted MAD. SA was evaluated using a portable respiratory multirecording system before and after the initiation of treatment. Eleven patients completed follow-up and were evaluated after 6 months of treatment. The AHI reduced from 25.4±10.3 to 16.5±10.0 (p=0.033) compared to baseline and mean plasma BNP levels decreased from 195.8±180.5 pg/ml to 148.1±139.9pg/ml (p=0.035). SA-related symptoms, e.g., excessive daytime sleepiness, were also reduced (p=0.003). LVEF and HRQL were unchanged. We conclude that SA treatment with a MAD on patients with mild to moderate stable CHF appears to result in the reduction of plasma BNP levels. Further studies to investigate if the observed reduction in BNP concentrations also result in improved prognosis are warranted.

2. From articles like this one, it becomes clear that a) Obstructions that create a decrease in respiratory motor output will b) decrease respiratory drive, leading to c) CSA. Therefore, anything that removes obstructions, such as a MAD, can improve CSA.

3. Additionally, OSA leads to arousals, which leads to hyperventilation, which leads to hypocapnia, which leads to a decreased respiratory drive, which leads to CSA. So, control OSA with a MAD, and you can lessen the likelihood of CSA manifestation.

Dr. Smith: Yes, there is more and more literature coming out showing that not only can mandibular advancement devices improve obstructive sleep apnea, but they can have a positive effect on central sleep apnea as well.

From articles like this one, it becomes clear that a) Obstructions that create a decrease in respiratory motor output will b) decrease respiratory drive, leading to c) CSA. Therefore, anything that removes obstructions, such as a MAD, can improve CSA.

Additionally, OSA leads to arousals, which leads to hyperventilation, which leads to hypocapnia, which leads to a decreased respiratory drive, which leads to CSA. So, control OSA with a MAD, and you can lessen the likelihood of CSA manifestation.