My CPAP Can Harm Me. What Can You Do?

by Steve Carstensen, DDS, D.ABDSM

“Stop using your CPAP device and contact your physician or DME provider for next steps.“ On June 14, 2021, Philips issued a safety recall for most of their CPAP/BiPAP line based on breakdown of internal parts that could release particulates and certain chemicals into the
airstream.

Stop using the machine that people put up with because it significantly improves their quality of life and/or addresses a vital medical problem? Philips had no suggestion for what to put in place other than ‘work with your physician.’

“Stop using your CPAP device and contact your physician or DME provider for next steps.” This represents a tremendous opportunity for dentists to help

This represents a tremendous opportunity for dentists to help patients breathe better the first night without CPAP. Why dentists? Why not switch to a safer brand of PAP? Since Philips is one of two major PAP manufacturers, and since this recall came as a surprise to the industry, the other companies had to quickly pivot and ramp up their production and supply. However, in the American Academy of Sleep Medicine’s webinar on June 21, 2021, they stated, “CPAP supply is nearly exhausted. Prioritize severe sleep apnea and complex patients.”

Philips has put millions of PAP devices into people’s homes over decades. That many calls to sleep docs and DME providers alone would overwhelm the system. There’s no answer for most people demanding a solution to their risky sleep related breathing disorder.

Into that gap steps the dentist trained in fitting mandibular advancement devices. We have at our disposal professional interim devices we can fit tonight and assure our patients their airway will be supported. We can order custom oral appliances from our manufacturing partners to address airway collapse in the long term, sans harmful particulates or ‘certain chemicals.’

How do we become the saviors of the day? Let’s step back a bit and examine how patient flow works in your dental practice. The ADA has suggested every dentist, all 199,486 (as of 2018), screen their patients for sleep related breathing disorders (SRBD). If you’ve not started that yet, please look into how simple it is to add a few questions to your health history. You can ask:

• Do you snore or has anyone told you that you do?
• Have you ever been diagnosed with a sleep breathing problem and been prescribed CPAP?
• Do you feel sleepier in the day than you think you should?
• Has anyone ever mentioned you stop breathing during sleep, or observed you choke or gasp?
• In the morning, do you ever feel you’re not rested, despite enough time in bed?
• Do you get up more than once during the night to use the restroom?

Dentists are using questions like these, along with validated tools such as STOP-BANG or Epworth Sleepiness Scale, to identify people at risk for SRBD and sending them for further evaluation by a sleep physician. That’s excellent practice, but there is more to be done.

Ken Berley, DDS, JD, uses a ‘Snore +’ method of understanding his patient’s status. If they report snoring plus one other ‘comorbidity’ such as hypertension, anxiety, diabetes, GERD, or one of another 18 signs, symptoms, or reported history, it generates a heightened sense of urgency to make sure patients are safe while they pursue additional evaluation.

What if your patient reports enough factors that you are worried for their safety – they are afraid they would be sleepy driving, for example. If they say they are afraid to go to sleep without their Philips CPAP because they fear stroke, heart attack, or not waking in the morning? If they enjoy sleeping in their master bedroom instead of the guest room down the hall? Are you going to simply assure them and help them make an appointment to see the sleep doc, even if that’s weeks or months away? Is that your best doctor behavior?

Professional interim mandibular advancement devices, made in the office by your trained team, give your patients the solution they seek, tonight.

There are choices – Amazon lists ‘over 1,000 results for anti-snoring.’² There are many professional devices such as Apnea Guard (Advanced Brain Monitoring), Alpha (SomnoMed), Moses Express (Moses Appliances), Silent Nite (Glidewell), SnoreHook (ChairsideSplintStore.com), and myTAP by Airway Management (www.tapintosleep.com).

The myTAP has advantages other devices don’t have: a silicone mouth shield to promote nasal breathing and vertical shims to vary the tongue space to fine tune airway support. The thin arch forms are shaped over the teeth and can be refitted an unlimited number of times by reheating. The device can be relined in a simple process, ensuring excellent retention. Dialing in the patient’s mandibular protrusion and vertical jaw position while improving nasal breathing allows the astute clinician to address patient’s SRBD with precision. Immediately, tonight.

If your dental practice is like most, you have 1000, 1500, 2500 patients in your care. Statistics indicate over 25% of them have some form of SRBD, and many probably have history of CPAP use. Reaching out to your patient base with a message of support and an offer to take action today is a powerful value statement of your commitment to health.

Another excellent feature of professional interim devices is they require no doctor time to fabricate – the dentist simply needs to order them. Trained team members take over and heat, shape, fit and counsel the patients about their use. In my practice experience, this energizes the team, provides new education, opportunities to help patients, and reinforces the values of the office.

If you provide myTAP or another device for undiagnosed patients while waiting for additional medical evaluation, or if your patient cannot use their CPAP, there is currently no medical or dental benefit coverage for the devices, coded E0485 in insurance terms. These are cash-pay services, simplifying your collection systems.

The Philips CPAP recall provides the ethical dentist with many marketing opportunities. First, to your patients who need help tonight. How will you do that? Email blast? Social media posts? Automated text or voice messages? Can your software help?

To your medical colleagues – offer to help the physicians who diagnose SRBD and prescribe CPAP – keep in mind, they don’t have other brands to turn to. Give them a face-saving solution, and you will build loyalty.

To physicians, dentists, and health care professionals not directly involved in sleep care: they might not have thought of your office when discussing sleep issues with their patients. Providing your expertise, fact sheets, and giving them answers to FAQ will enhance your reputation as the go-to in your community.

What about the general public? Do you, the dentist, offer services directly when the recall announcement says, “Consult your physician and DME Provider?” Of the millions of Philips CPAPs delivered to patients, more than half are unused.³ Your message might prompt those diagnosed, untreated people to consider an alternative that appeals to them. Make yourself known and give them hope.

We want every breath, every night, to be the best possible for every patient. The Philips recall is another reminder that no part of health care has all the answers. Trained dentists have been and will always be part of the solution. Do your part. Help people, today.