Calling all CPAP haters

It might seem counterintuitive, but Dr. Ira Shapira wants to increase public awareness of sleep apnea though his new Web site, ihatecpap.com. The Chicago-based dentist is not anti-CPAP, he says, but the machines simply don't work for everyone. By reaching out to those patients who have been “lost to sleep medicine,” he figures he can get them treated, either through an oral appliance or, with better education, back to CPAPs.

HME News: Your Web site has a catchy name.

Dr. Ira Shapira: We are trying to make an emotional appeal to the 60% or 70% of sleep apnea sufferers who don't use their CPAPs. I get a lot of people who haven't used it for years. Some of the newer research says if they like CPAP in the first few days, they will like it forever; if they don't, they are never going to use it. It doesn't matter if you change their masks or switch them to BiPAP.

HME: Why aren't people using their CPAPs?

Shapira: They can't fall asleep with it on or they don't like the noise or the humidity. It can be the mask itself. Almost nobody I see does a good job of cleaning their CPAPs. They end up with biofilms that lead to sinus infections or bronchitis. Sometimes they just don't realize how serious the problem is. If I get someone with severe apnea, if we put it in terms they can understand, they will get back on it.

HME: Who is a good candidate for an oral appliance?

Shapira: If they have mild to moderate apnea and we can get them healthy with just the appliance, we'll stick with that. If they need CPAP, we'll put them on CPAP. It's not like oral appliances are wonderful. They're more comfortable and some people tolerate them better.

HME: Can people use both?

Shapira: I see people who like CPAP and they only come in for the appliance because it's a pain to travel or go camping. The appliance is a complementary therapy to begin with. Between half and two-thirds of patients, once they've worn the appliance and get good results, will switch to the appliance.

HME: Do you also fit patients with CPAPs?

Shapira: We work with sleep labs, pulmonologists and neurologists who refer patients. CPAP fitting gets referred back to the labs and I don't do any in-house screening. I'd rather see every patient have a full sleep study.

HME: Is it strange for a dentist to treat sleep disorders?

Shapira: It doesn't seem strange to me. The National Heart, Lung and Blood Institute considers sleep apnea to be a TMJ disorder. Dentists have treated it with appliances for years. Now we look at it as, Are we fixing the jaw or opening the airway? It's very similar.