What do you mean by "gold standard"? Is it because it's more effective for severe sleep apnea?
From my perspective, the dental appliance is easier to use, and is better for traveling. I also tried a CPAP but couldn't get the hang of it.
It's also super creepy that CPAPs all seem to have a cell modem that spies on you. (OK, that info also helps the doctor, but still.)
I know a couple other people who are having problems with CPAP, and the doctor has not even made them aware of the dental appliance. They're surprised when I tell them there's an alternative.
And one of these people is a doctor himself! I feel like sleep apnea is being treated very poorly given how common it is, probably for economic reasons.
I know everyone wants to say this about their pet cause -- but it does seem like an "epidemic". The "epidemic" of weight gain seems to be an obvious reason for this. FWIW my BMI is now normal (less than 25, 166-169 at 5'9"), and I still need the dental appliance and to sleep on my side. Either one alone doesn't cut it.
I've also been meaning to write a article about "Why AHI is wrong", which is basically because outliers determine outcomes and AHI doesn't measure outliers. It's a "count". It has a lot of the fallacies that Nassim Taleb talks about in his books.
The AVERAGE minute of sleep doesn't matter; the WORST minute of sleep matters. The worst minute can ruin your whole night's sleep (or at least a REM's cycle worth of sleep), or it can cause you to have a heart attack and die.
My AHI is 6 or 7, and most doctors have dismissed that as not important. However my sleep quality has improved greatly with all these remedies. Several minor health problems have cleared up all at once.
The thing that motivated me to get treated was that I crushed a tooth in my sleep, which many doctors don't realize is related to sleep apnea (but my dentist did thankfully). But I think of all the people who did NOT happen to crush a tooth and are undiagnosed. I guess it's one of those things that kills you over 20 years and used to be called "getting old". But really it was amazing to me how many problems can have the same fundamental cause.
FWIW I highly recommend this book about the "sleep breathing paradigm". It's written by an ENT who has observed a lot of these things in his practice. A key point is that he actually looks at your airway and sees if your tongue obstructs your airway when lying down. I went to 2 ENTs and neither of them did that. They don't understand the mechanism behind sleep apnea! It's geometry and gravity.
This book is not popular, which is a shame. Don't judge a book by its cover :) It's a bit dense but that will be fine for HN readers.
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