Sleep apnea can be a debilitating condition. Sufferers experience a low sleep quality and can experience a wide range of symptoms. These include morning headaches, daytime fatigue, frequent visits to the bathroom, depression or irritability, or poor concentration.
The CPAP Solution
Effective therapy for sufferers of sleep apnea is the use of continuous positive airway pressure (CPAP) machines. A CPAP machine increases air pressure in the throat. A CPAP mask that covers the nose and mouth is a full-face mask. A mask that covers the nose only, which is generally more comfortable, is known as a nasal mask.
What About MAD’s?
One popular snoring therapy is a Mandibular Advancement Device (MAD), which reduces air resistance in the back of the throat by moving the lower jaw forward.
The best-selling MAD available is the Zyppah, which is heavily advertised on radio, TV and has increased market share over the last few years. The Zyppah is billed as a solution to snoring – but does not have FDA approval yet for obstructive sleep apnea (OSA).
A MAD is cheap, silent, and easy to purchase. It appears to be a good solution to help snorers. The attraction is then immense for consumers to purchase and use a MAD.
However, can a MAD such as Zyppah be used to treat OSA?
What Medical Research Says
Multiple clinical trials have compared the effectiveness of a MAD to that of CPAP for the treatment of sleep apnea.
Despite the relatively large number of trials, there is much uncertainty around the subject. Most studies involved research using one type of MAD with limited functionality.
Other trials are now old, and in many trials, the number of patients used was few. In several studies, especially those involving long-term research, patients didn’t follow through with the treatment, making the data less accurate. Patients found both the MAD and the CPAP therapy to be too unpleasant.
Placebos just as effective as MAD devices?
In this study carried out by a team of Swedish researchers, half of the people used a custom-fitted MAD, while the remaining half used a placebo mouthpiece. After the study, more than half of those who had used the placebo said they would like to keep it because it had been effective. Those who had used the real MAD did show a little more improvement than those using the placebo device, but the data is somewhat skewed in that many of the people in the study suffered from mild to no sleep apnea. It was also conducted using only one MAD device. For this reason, the reliability of the results is questionable.
In another study published in the European Respiratory Journal it was concluded that, while MAD devices were an effective alternative to CPAP machines, they were not quite as effective as the CPAP machines in reducing the symptoms of sleep apnea. As with other studies, a lot depended on whether the patients followed through with the CPAP therapy. Due to the discomfort they experienced during the therapy, many patients did not follow through.
Other research articles, such as this one, support the contention that MAD devices can replace CPAP machines as a therapeutic option, but that they are only effective for patients suffering from mild cases of OSA. And, some patients experienced worsened symptoms as a result of the use of the MAD device. Most patients preferred the MAD device to the CPAP machine.
In this medical review, patients wearing a MAD spent less time in stage one sleep (the stage between wakefulness and sleep) and more time in slow-wave (deep) sleep. They also experienced an increase in REM or rapid eye movement sleep. They woke up less often during the night and felt more alert during the day. This concluded that MAD’s could be beneficial for mild sleep apnea. It did not find MAD to be effective in the treatment of more severe cases of sleep apnea.
Conclusions
While patients preferred sleeping with MAD's, CPAP machines were still more effective for people who suffer from severe cases of sleep apnea.
Positive MAD Reviews
Snoring mouthpieces promise to reduce snoring. Consider our review of Zyppah, in which we list the pros and cons of the product. Our conclusion is that “…it will be the perfect fit for a lot of snorers.” Compared to other mouthpieces we found it relatively comfortable and effective and other reviews of Zyppah concurred with our experience.
Is a MAD as effective as a CPAP machine? No.
While Zyppah and competing products are cleared by the FDA to reduce snoring, they have not been FDA cleared for sleep apnea. Zyppah, therefore, is not a replacement for CPAP.
If a patient suspects they suffer from sleep apnea, it is most advisable to do a sleep study.