Littleton, CO dentist Dr. Guy Grabiak and team celebrate case study award for long-term healthy results with their patient.

Yes, There Are Effective Alternatives to CPAP

Mar 22, 2024 | Sleep Apnea / Airway

Sometimes a snore is just a snore. Sometimes it’s a sign of obstructive sleep apnea (OSA), a potentially serious sleep disorder that affects millions. Perhaps you. Perhaps a loved one.

And it isn’t pretty.

This is the sound of the upper airway being blocked during sleep. Breathing temporarily stops. The body’s stress response kicks in to wake you up and get you breathing again. These pauses in breath – known as apneic events – can last from a few seconds to over a minute and may occur hundreds of times per night.

Yes, hundreds.

The chronic deprivation of oxygen and fragmented sleep associated with OSA do more than just make you wake up tired and feel sleepy through the day. They have far-reaching consequences on overall health and well-being. From increasing the risk of high blood pressure, heart disease, stroke, and type 2 diabetes to exacerbating mental health issues like depression and anxiety, the wide-ranging impacts of untreated sleep apnea underscore the importance of recognizing and treating this disorder.

If You Have Obstructive Sleep Apnea, CPAP Isn’t Your Only Treatment Option

For a long time, CPAP was the only real option for treating sleep apnea, and while it’s been a literal lifesaver for many, many people who need it can’t tolerate it. The mask can feel uncomfortable or claustrophobic. Having to tote medical equipment while traveling can seem inconvenient – as can the need to always have access to a power source or needing a backup battery in the event of extended outages.

There can also be negative dental consequences to long-term CPAP use. The force of air can create gaps between teeth, for instance. Or affect the bite. Even possibly contribute to dental implant failure.

Fortunately, CPAP is no longer the only option. Oral appliances, for instance, can be used to hold the jaws and tongue forward, keeping them from falling back as you relax into sleep, blocking the airway. Special appliances can even help redevelop and enlarge an underdeveloped airway, effectively treating one of the root causes of OSA.

And some of the newer options involve no appliance at all. One of these is myofunctional therapy.

Can You Really Treat Sleep Apnea with Myofunctional Therapy?

person showing tongueThink of myofunctional therapy – a/k/a “myo” – as physical therapy for the muscles of the mouth and face. It involves exercises to retrain these muscles, which can improve a person’s bite, breathing, and facial posture. The training targets the soft tissues of the face, neck, and mouth so that optimal tongue position and oral rest posture become habitual.

As you develop healthier orofacial habits, your therapist helps you become more aware of your mouth and face muscles. They’ll give you exercises to complete at home that focus on ideal swallowing, breathing, and resting patterns. Practicing these positions and movements will increase your muscle strength and coordination.

And, yes, it may even reduce symptoms of sleep apnea, according to recent research.

The most recent review of the scientific evidence was published last summer in The Laryngoscope. Through a search of the medical literature, the research team identified 7 randomized controlled trials that met their criteria, involving 310 patients in total – mostly adults.

Compared to those who received sham myofunctional therapy or no therapy at all, those who underwent “myo” showed statistically significant improvements in three key areas:

  • AHI, a measure of how many apneic events a person experiences each hour (an AHI over 5 indicates apnea).
  • Subjective sleepiness, as measured by the Epworth Sleepiness Scale, a common questionnaire used for apnea screening (you can take the test for yourself right now, if you like).
  • Minimum oxygen saturation, a measure of how much oxygen the blood is carrying.

Only one of the 7 studies analyzed focused on children, and in that case, the researchers noted that compliance was poor, and there were no improvements in AHI, minimum oxygen saturation, or snoring frequency.

But this is at odds with an earlier review, which found that myo improved AHI in children even better than it did in adults. Where AHI dropped by about 50% in adults, it dropped 62% in children. Adults also showed improvement in the other measures listed above, as well as snoring.

Finding the Right Sleep Apnea Solution for You

Of course, myo on its own may not be sufficient for everyone with sleep apnea. Often, it’s done in conjunction with oral appliance therapy and other treatments. Ultimately, the right course of treatment depends on the individual’s needs, including the severity of their OSA and its causes, as well as their preferences and tolerances.

For some people, CPAP is fine. For others, myo might be enough. Or oral appliance therapy. Or some combination of therapies.

Next time, we’ll look at another of these alternatives that’s been a real game-changer in the treatment of OSA: Vivos.

The foundation of providing safe and personalized holistic care begins by getting to know you and your goals for your oral health and overall health, both short term and long term. Dr. Grabiak will then learn about your family’s dental and medical history, along with your dental and medical history. Afterwards, we begin your exam by taking a sample of your saliva (Sillha), checking for seven different biomarkers. That same day, we will send you home with a report showing how you scored in those different biomarker categories.

The head and neck examination is often overlooked by busy clinicians but it is as crucial as an element of the oral cancer examination. Dr. Grabiak begins his exam outside of the mouth by starting with a soft tissue check of the neck and the jaw. A thorough head and neck examination is essential for detecting early skin cancers, any overdeveloped jaw muscles that may be contributing towards bruxism, and enlarged lymph nodes that may indicate an active virus or infection.

After the extraoral exam, Dr. Grabiak begins his extensive intraoral exam. During Dr. Grabiak’s exam he is evaluating the teeth, uvula, mucosal tissues, tongue, floor of the mouth, hard and soft palate, and the oropharynx. Part of this exam includes taking high-definition photos of the mouth, all at different angles so you can see exactly what he is seeing. Our hygienist will then come in and complete a comprehensive periodontal assessment. In some cases, Dr. Grabiak and your hygienist may recommend additional testing to get to the root cause of the evidence of symptoms they are seeing in your mouth. This entire process takes roughly an hour. In some cases, depending on what Dr. Grabiak and your hygienist had found during their exam we will invite you back for a follow-up appointment called review of findings.

In preparation for the review of findings, Dr. Grabiak and your hygienist will take the time to evaluate all of the data that was collected from your examination and testing to determine your specific needs. At your review of findings appointment Dr. Grabiak will sit down with you one on one to review the data that was collected from your appointment, along with any recommendations. This allows you the time to ask Dr. Grabiak any questions that you may have about your treatment recommendations and expectations from treatment.

Jeromy Mulkey

Jeromy Mulkey

Operations Manager

Jeromy received his Bachelors of Science in Finance from New Mexico State University in Las Cruces, New Mexico. He moved to Colorado in 2015 from Hannibal, New York (a small town outside of Syracuse) and that is when his career in the dental field began. Jeromy started in corporate dental as a patient coordinator and quickly progressed to office manager and then running multiple specialty practices over the next 5 years. Holistic dentistry was an exciting new challenge and Jeromy couldn't be happier with his family at Denver Dentistry. Holistic dentistry was a breath of fresh air and gave a new excitement and passion for learning of all the new sciences and technologies the Denver Dentistry team has integrated into their practice. Jeromy currently lives in Sheridan and enjoys living close to the mountains. In his free time he enjoys spending time with family, snowboarding, playing soccer and basketball, camping, and hiking. Jeromy is passionate about delivering excellent customer service and assisting the team in bringing more smiles to satisfied patients.
Chelsea White

Jazmin Contreras

Dental Hygiene Assistant

In 2020 Jazmin graduated from Colorado Mesa University at the top of her class with a degree in Kinesiology. From a young age Jazmin knew she had a passion and interest in the medical field which led her to gain various experiences in the medical field. However, when she first came to Denver Dentistry, she fell in love with dentistry and knew this was her passion. Dr. Grabiak and his team offered a unique holistic approach to the field; something Jazmin has always been highly interested in. She quickly realized this is where she was meant to be and Denver Dentistry instantly felt like home. In her free time she and her fiance enjoy traveling and participating in outdoor activities like hiking, camping, and kayaking.
Chelsea White

Chelsea White


Chelsea is a born and raised Florida girl and has now been a Colorado resident for 5 years. She has loved dentistry for a long time, and couldn’t see herself in any other profession. Knowing her career path, she went to school at Central Florida Institute to become a dental assistant with an extended program. Graduated in 2012 as a Dental Assistant and as an EDDA, she looks forward to esthetics and happiness with patients. As someone who has been in the field for almost 10 years, she strives to work as a team to meet all expectations with the patient. In her free time she loves to hike, and explore the beautiful places Colorado has to offer.

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