Clinicians move beyond disease burden to address ‘treatment burden’—the strain patients can experience related to managing their OSA.

By Sree Roy

Sleep physicians are well versed in treating the disease burden of obstructive sleep apnea (OSA), a burden that can include excessive daytime sleepiness, disruptive snoring, impaired concentration, reduced quality of life, and elevated risks for cardiovascular disease, metabolic dysfunction, and motor vehicle accidents, among other manifestations. Less consistently addressed, however, is the parallel burden patients carry: the day-to-day labor of living with and managing OSA therapy.

OSA patients can feel a significant “treatment burden”—a newer phrase encompassing the workload of managing a chronic illness that can include learning about the diagnosis, the learning curve of a new device, maintaining equipment, the varied immediate and long-term financial costs, and so much more.

Scheduling and attending doctor appointments, adjusting to therapy side effects, making lifestyle changes, and navigating the costs of replacement device parts can exceed a patient’s coping capacity, outweighing the perceived benefits of treatment and even leading to nonadherence, according to a study of 18 OSA patients on CPAP.¹ For some, the work of being a patient feels like a second job, one they can “quit” by ignoring appointment reminders and eventually burying their therapy in a bedroom closet.

The research highlights that even patients who are “compliant” by insurance standards can suffer from a hidden burden. Relationship strain, for instance, remains a significant factor; some patients continue to sleep in separate bedrooms to avoid the noise of a machine. Financial barriers can also persist, as the cost of masks and replacement parts can lead patients to use worn-out equipment that increases the likelihood of therapy failure, according to the study.¹

Thankfully, patients, clinicians, and other experts are discovering ways to alleviate the treatment burden for OSA, lightening the load in hopes of nudging patients toward easy, long-term adherence. Many of these strategies only have limited (or anecdotal) evidence but may be worth trying if they resonate with you and your patients.

Empowering Patients in Therapy Selection

One way to reduce treatment burden is to give patients real agency in choosing their therapy. That means presenting all viable options clearly and neutrally, then allowing the patient to decide what best fits their anatomy, lifestyle, preferences, and tolerance for day-to-day work.

During her consult visits, Suzanne Thai, DDS, founder and owner of DFW Sleep Solutions, walks patients through the benefits and tradeoffs of available therapy modalities, not just the oral appliances her practice manages. “The win comes from when patients choose whatever therapy they choose,” says Thai, a recent TEDxSouthlake speaker. “So if they say, ‘I want a CPAP,’  I tell my team that’s a win.”

For patients who pursue oral appliance therapy, instead of selecting a device on behalf of the patient as she initially did, Thai now limits the field to appliances for which the patient is an appropriate candidate (an array that frequently includes those by Panthera, ProSomnus, and SomnoMed), then lets the patient choose. In Thai’s experience, when patients select their device, they are more likely to use it. When the choice is made for them, though clinically sound, resistance and nonadherence are more common. “When they pick it, they do better,” Thai says.

Communication gaps between providers can undermine even well-chosen therapies. Fragmentation between, for example, sleep physicians and dentists, can increase follow-up visits, prolong titration, and add to patient workload.

Some sleep software platforms can help connect the dots. For example, sleep diagnostics company Cadwell has attempted to address this problem by building new fields into its software. For patients on oral appliances, sleep techs have fields to document anterior-posterior advancement in millimeters, along with transverse and vertical dimensions, if any, directly in polysomnography reports. Specific fields are also available for high-flow nasal cannula and sleep apnea neurostimulator settings.

James Blevins, product manager for sleep diagnostics at Cadwell, says, “What are patients willing to accept? If you only have one pathway of treatment, then you end up with untreated patients, which I think is worse than having a bigger toolbox and the ability to treat them in the best way that they will accept….Our perspective is to improve the clinical users’ documentation around whatever therapy they want,” Blevins says.

Integrated Practice Models

Another approach to reducing treatment burden is the creation of multidisciplinary centers that simplify the OSA patient journey. Kent Smith, DDS, DABDSM, founder and CEO of Star Sleep & Wellness, operates a model that includes boarded sleep physicians, nurse practitioners, physician assistants, and dentists across eight locations.

“We try to do everything in-house if we can. Patients want that,” Smith says. A patient might meet with a nurse practitioner for an initial consult, undergo a sleep study interpreted by an in-house sleep physician, and then have a follow-up telemed appointment with a dentist or physician to decide on treatment—whether that be CPAP, an oral appliance, or a surgical intervention like hypoglossal nerve stimulation (for which Star Sleep does refer out).

“There are not many avenues of treatment that we can’t help the patient with in our offices,” Smith says. This integration reduces the logistical burden on the patient, who otherwise might have to coordinate between three different offices to get a diagnosis and a path forward.

A key component of this approach is Star Sleep’s “recovery team,” staff members assigned to follow patients after therapy initiation. Often, the team member is the same assistant who handled the device delivery, reinforcing continuity and trust. Patients are told to expect follow-up outreach, typically by email or text, utilizing secure messaging platforms like Weave.

Without proactive outreach, Smith has found that patients may quietly abandon therapy. Regular check-ins help prevent that silent dropout and keep patients engaged. “That’s our best way of ensuring the patient gets maximum care,” he says.

Patient-to-Patient Reassurance

Star Sleep has also found an unexpected way to reduce treatment burden and improve early engagement: group device delivery sessions. These workshops are used for both CPAP and oral appliance delivery and are designed primarily for efficiency, but they have delivered an unanticipated benefit—peer-to-peer reassurance. “They get to hear everybody else’s opinion when they try on their device, so that can be helpful,” Smith says.

Patients receive their devices in a small-group setting, where they can see others trying on CPAP masks or oral appliances at the same time. That shared experience, Smith says, helps normalize the process. Patients realize they are not alone in navigating a new therapy.

To run these sessions, Star Sleep typically assigns two or three team members to a workshop, rotating the team across different locations. Brief periods of downtime—when a team member is assisting another patient—create space for informal patient-to-patient conversation. Educational videos also play on a screen during the workshop to reinforce key points.

Smith intentionally stays out of these sessions, preferring not to influence the dynamic or make patients or staff feel self-conscious. The workshops, he says, work best when they remain peer-oriented and team-led, making patients feel comfortable as they take their first steps into therapy.

Many of the practice’s five-star reviews online, he notes, trace back to these workshops—something he did not anticipate.

Accessibility and Habit Stacking

To encourage ongoing therapy adherence, DFW Sleep Solutions’ Thai provides her cell phone number to patients and uses voice texts and video messages to answer questions between appointments. “I think if anything, they are so cognizant of not taking up my time that they only text if they absolutely need it,” she adds.

Thai also helps patients decide where to “habit pair” or “habit stack” to assist oral appliance users in managing the burden of morning repositioners.

“I help them attach it to a habit that they already do daily, and it makes it so much easier,” Thai says. “I’ll say, ‘What do you usually do about an hour after you wake up?’ And they’re like, ‘I shower.’ Perfect. I’ll tell them, ‘I want you to do it every time you shower.'” By integrating the treatment task into an existing routine, the mental load of remembering the exercise or morning device is lessened.

Emphasizing Lived Treatment Benefits

Research suggests that patient-perceived improvements—such as more refreshing sleep and the cessation of snoring—are among the motivators for continued device use.¹

Thai does this by asking patients to define success in their own terms. For some patients, success means reduced snoring; for others, fewer nighttime awakenings or improved daytime energy. Whatever the answer, Thai returns to those benchmarks at every follow-up.

To reinforce progress, her practice uses standardized questionnaires at each visit. The results allow clinicians and patients to directly compare before-and-after outcomes. Thai describes routinely highlighting these “wins” during appointments—showing patients how nightly awakenings dropped from five to zero or how self-reported energy levels climbed. By anchoring follow-up conversations to the patient’s original goals, the benefits of therapy become concrete.

Raghu Ghuge, MD, MBA, president and CEO of the Sleep Medicine Institute of Texas, uses imaging to help patients understand both their disease and their potential response to therapy. During consultations, cone beam computed tomography scans are used to compare airway dimensions with and without an AIOMEGA oral appliance (the oral appliance brand that Ghuge founded), emphasizing any expected increases in airway volume. “A picture is worth a thousand words to patients,” Ghuge says.

Also, according to Ghuge, patients using AIOMEGA devices have not required morning repositioners. Removing that daily step, he says, reduces treatment burden.

Spreading the Word

What’s more, Ghuge regularly conducts training sessions for local dentists and hygienists, teaching them how to screen for OSA. “I firmly believe that we need to break the silos between dental medicine and regular medicine,” Ghuge says. “Not just for sleep apnea, but for teeth grinding, acid reflux, and so many other conditions that can be seen by the dentist.”

In 2025, he visited about a dozen dental offices to educate them about OSA care and management. He hopes to scale his lessons into an online course.

As the industry enters 2026 and beyond, the lens may change to a more holistic view of the patient experience. By improving documentation, increasing provider accessibility, leveraging technology, and offering a broader toolbox of therapies, clinicians can help ensure that the treatment for sleep apnea doesn’t become as exhausting as the disorder itself.

Reference

1. Chou MSH, Ting NCH, El-Turk N, et al. Treatment burden experienced by patients with obstructive sleep apnoea using continuous positive airway pressure therapy. PLoS One. 2021 Jun 7;16(6):e0252915.

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Learn More:

Oral Appliance Titration PSGs: How Sleep Techs and Dentists Work Together for Patient Outcomes

Rethinking What Counts as ‘Well-Treated’ Obstructive Sleep Apnea

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