This is a difficult question to answer. It will vary depending on where you live.
The team at SomnoMed UK is extremely passionate in their belief that every person diagnosed with obstructive sleep apnoea should receive treatment. This includes those who are unable to tolerate CPAP. You will have read about the serious and sometimes life-threatening side effects caused by untreated OSA. Treatment is essential.
Unfortunately, the current reality is that there are still a limited number of NHS sleep services who have funding to provide MADs. This means that many patients must pay privately. At SomnoMed we are working very hard to prove the efficacy and cost effectiveness of MADs. This is to ensure that no one with sleep apnoea is left untreated on the NHS.
The new NICE (National Institute for health and Care Excellence) guidelines for the treatment of obstructive sleep apnoea were published on 20th August 2021. The guidance clearly states that for those people with mild, moderate or severe OSA, who can’t tolerate or don’t want to use CPAP, a MAD should be considered as an effective alternative treatment in the NHS.
So we hope that in the future all NHS sleep services will offer MADs as an alternative to CPAP where appropriate.
If you have already received a diagnosis of OSA then you will have most likely been prescribed CPAP. However, if you have tried CPAP and are unable to cope with it the question is, what next?
Cost to you = supplied free by NHS
If you are one of the lucky ones and your NHS service offers MADs as an alternative, then the sleep team will organise for you to have one made. This part of the process will involve a dental specialist who will check your oral health and take impressions or scans of your teeth to ensure a perfect fit for your MAD. Your SomnoDent MAD will then be made in our laboratory and within a couple of weeks your dental specialist will be ready to fit it for you.
At your fitting appointment the dental specialist will discuss adjustment of the device and also the optimal cleaning and care to ensure it lasts for several years.
Cost to you = approximately £1000 with a 2 year warranty (this price is subject to change dependant on dentist fees). The device should last at least 3-5 years if cared for correctly.
If your NHS sleep service is unable to offer you the alternative of a MAD then the next step is to find a private dentist with an interest in dental sleep medicine who will provide a SomnoDent MAD. You can find a list of dentists in your area by clicking the link.
The dentist will assess your suitability for a MAD. They will check your oral health and take impressions or scans of your teeth to ensure a perfect fit for your MAD. Your SomnoDent MAD will then be made in our laboratory and within a couple of weeks your dentist will be ready to fit it for you. At your fitting appointment the dentist will discuss adjustment of the device and also the optimal cleaning and care to ensure it lasts for several years.
Although we charge a fixed fee to the dentist, the final price you pay for the device can vary. This is dependent on the additional dentist’s fees and will be affected by things such as number of appointments required, any complications, the technology they use etc. Check the cost with the dentist before you go ahead.
Every NHS sleep service in the UK will offer CPAP to those patients with moderate to severe sleep apnoea and, in specific cases, mild sleep apnoea. This is because CPAP is recognised worldwide as the gold standard for severe sleep apnoea as it is extremely effective in reducing a very high AHI (over 30) down to normal levels. However, research shows that the compliance rates for CPAP have been consistently low (around 50% of those prescribed CPAP abandon the treatment after just a few weeks) despite many improvements in the machine and masks over the years. There are many reasons why people abandon their CPAP treatment including discomfort, noise, inability to fall asleep, drying of the airways etc.
Although CPAP is excellent at reducing AHI, this only occurs during the period the CPAP is being worn, there is no overflow effect into the rest of the night once removed. The current definition of compliant is as little as 4 hours per night, but surely to be fully effective it needs to be worn all night, every night? So what is happening to your AHI the rest of the night and what is the cumulative effect?
On the left, the graph shows the effect CPAP being worn for 4 hours per night, the minimum amount of time required to be considered compliant with treatment. On the right is the effect of wearing a SomnoDent for 8 hours. Research has shown that because our devices are bespoke and fitted so accurately, they are comfortable enough to wear all night.
The result is that despite CPAP reducing this person’s AHI from 25.6 to 4.5 while the CPAP is worn, for the rest of the night they are untreated, and their AHI quickly increases back to 25.6!
The MAD reduces that same AHI of 25.6 to 11.1, but in this case for the whole of the night.
The cumulative effect is that CPAP reduces the number of apnoeas (breath holds) to 120 during the night and the MAD to 96 during the night, making the MAD more effective.