Yes, for some people. Combined therapy means wearing a custom oral appliance and using CPAP (or another form of positive airway pressure, PAP) at the same time. It is usually considered when one treatment alone isn't working well enough, such as when CPAP pressure feels too strong or an oral appliance leaves some breathing events uncontrolled. It is not a do-it-yourself adjustment: your sleep physician and dentist plan it together and confirm the result with follow-up testing.
A quick refresher on obstructive sleep apnea
In obstructive sleep apnea (OSA), the soft tissues of the throat relax and collapse during sleep, narrowing or blocking the airway.[1] Common signs include loud snoring, gasping awake, daytime tiredness, trouble concentrating, and morning headaches.[2] Untreated OSA is linked to heart and blood vessel problems, including high blood pressure, atrial fibrillation, and stroke.[3] If you notice these signs, don't put off an evaluation. See understanding sleep apnea for more.
How each treatment works
| CPAP | Custom oral appliance | |
|---|---|---|
| How it keeps the airway open | Gentle air pressure through a mask | Holds the lower jaw slightly forward, which brings the tongue and nearby tissues forward |
| Who manages it | Your sleep physician sets and adjusts pressure | A qualified dentist fits and adjusts the appliance; your sleep physician confirms results |
| Common challenges | Mask fit, leaks, dryness, pressure discomfort | Jaw or tooth discomfort, bite changes; may not fully control more severe OSA |
National guidelines support custom, adjustable oral appliances for adults with OSA who can't tolerate CPAP or prefer another option, with follow-up sleep testing to confirm they work.[4] See oral appliance therapy and how oral appliances work.
Why combine them?
The two treatments open the airway in different ways, so together they may do what neither does alone. Combined therapy may be worth discussing if:
- CPAP works, but the pressure you need feels uncomfortable
- Mask straps, leaks, or fit make CPAP hard to use every night
- An oral appliance has improved your sleep apnea but hasn't fully controlled it
- Your sleep apnea is more severe, and your care team wants more than one way to keep the airway open
Some setups pair a standard CPAP mask with an oral appliance. Others connect a custom mask directly to the appliance, which removes head straps.[5]
What the research shows
The evidence is promising but still limited, mostly small studies.
| Study | Who was studied | What happened | Keep in mind |
|---|---|---|---|
| El-Solh et al., 2011[6] | 10 adults who couldn't tolerate CPAP and still had events on an oral appliance | Adding an oral appliance lowered the CPAP pressure needed from about 9.4 to 7.3 cm H₂O. Remaining events fell from 11.2 to 3.4 per hour, and daytime sleepiness scores improved | Small pilot; three nights; no control group |
| Prehn & Swick, 2017[5:1] | Chart review at one dental sleep center; 75 patients using a custom mask attached to an oral appliance | About 78% of those reached were still using it years later; patients most often cited comfort and no straps | Retrospective; single center; did not report how well breathing events were controlled |
Taken together, these suggest combined therapy can help selected people who struggle with one treatment alone. They don't show it is right for everyone, and results need to be confirmed with testing.
Important safety points
- Don't change your CPAP settings on your own. If an oral appliance is added, your sleep physician decides whether and how pressure should change.
- Keep using prescribed therapy until you and your medical team agree on a new plan.
- Expect follow-up testing. A sleep study, or data from your CPAP device reviewed by your physician, shows whether the combination is working.
- More severe sleep apnea needs careful assessment. Your diagnosis, sleep apnea severity, teeth, jaw, and overall health all affect what's appropriate.
Combined therapy in Raleigh, NC
At RespAir Sleep in Raleigh, Dr. DeSaix provides the dental part of combined therapy: evaluating whether your teeth and jaw are suitable for an appliance, then fitting and adjusting it. She coordinates with your sleep physician, who manages your PAP therapy and confirms results. Bring your sleep study and a list of your CPAP concerns so your care team can assess suitability, compare treatment options, and plan how to check the result.
Our office is open Monday–Thursday, 9 am–3 pm, and Friday by appointment. See insurance and costs for payment options and medical insurance information; our team can review your specific benefits.
Contact us to talk through whether combined therapy could fit your situation.
This article is general education, not medical advice. Your medical and dental care teams can explain what applies to you.
National Heart, Lung, and Blood Institute. What Is Sleep Apnea? ↩
National Heart, Lung, and Blood Institute. Sleep Apnea: Symptoms ↩
Yeghiazarians Y, Jneid H, Tietjens JR, et al. Obstructive sleep apnea and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2021. Summary from the American College of Cardiology. ↩
Ramar K, Dort LC, Katz SG, et al. Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: an update for 2015. J Clin Sleep Med. 2015;11(7):773–827. ↩
Prehn RS, Swick T. A descriptive report of combination therapy (custom face mask for CPAP integrated with a mandibular advancement splint) for long-term treatment of OSA with literature review. J Dent Sleep Med. 2017;4(2):29–36. ↩ ↩
El-Solh AA, Moitheennazima B, Akinnusi ME, Churder PM, Lafornara AM. Combined oral appliance and positive airway pressure therapy for obstructive sleep apnea: a pilot study. Sleep Breath. 2011;15(2):203–208. ↩