In my mind, it’s not about which option is better, but customizing your treatment plan based on a systematic process that starts with CPAP, and making sure to go on to other options if CPAP is not working. Unfortunately, too many people give up after trying only CPAP. Ultimately, there is no gold standard.

What’s your feeling on this admittedly controversial topic?

I received an email from Dr. Park where he talks about the need to pursue other options if CPAP is not your "gold standard" (my paraphrase).  He talked about tracheostomy as a cure, improvements people have experienced with surgery (40% is better than nothing if CPAP does not work for you) and dental devices.

My feeling about this topic is that we all have (or most of us) a limited amount of time and money.  Being successfully treated for SDB, or OSA can be time consuming and expensive.  It's hard to explore all the alternatives as it is time consuming, and especially in the case of dental devices where insurance coverage is iffy, expensive.  I have an appointment to explore the ENT route, but because of all I've read would be reluctant to pursue any of the UPP procedures because they are irreversible and do have limited success.  I have not yet gotten my XPAP titrated correctly, but have now changed doctors and am starting from scratch.  So we are talking about a tremendous commitment to our health in terms of time, money, and energy. Many of us have other chronic illnesses and have become used to the fact that they forever require maintenance doctor visits and medicine.  For me it has been simplest, though not easy, to choose one modality to treat my OSA and try to stick with it until I'm successful.  I just put on a mask every night.  I'm 100% compliant as it has made a positive change in my life.  Even if my results are only a 40% improvement this is an improvment over no treatment.  I have been one of the lucky ones with good tech support, a mask that fits and works, and the willingness to wear it every night.

I can understand the frustration of someone who has never dealt with chronic illness and is not used to intervention of some type on a daily basis (those with MS, fibromyalgia, copd, chronic back pain, migraines, psychiatric problems, High Blood Pressure, obesity, etc. are used to extensive, unending follow up care).  I have to choose what I can afford, have time to pursue, and can live with.

The problem with dental devices is do they work, or are they enough of an improvement to justify their use exclusively? Is a certified dentist available to me? Few of us could probably get the sleep tests necessary to determine their individual success.

The same with surgery- those precious sleep studies are expensive and usually cannot be repeated several times a year. Is there a good, OSA knowledgeable surgeon available? I guess we could rely on subjective and objective criteria- do I feel better and does my partner see an improvement in my snoring/apnea?

For me the investment in time, energy and money is best left in one area- XPAP, until proven otherwise which can takes years of treatment and studies to prove.  Of course, the data capable machine for those compliant with XPAP does give objective measure of success on a nightly basis.  My current machine is not, so I'm rather in the dark about my success at present.  Luckily for some few of us the subjective and objective criteria are met with XPAP- feeling better and acceptable AI and AHI.  I think for those people it is the Gold Standard.