Question for those using a Mandibular Advancement Device:

[tiredman]

I'm not sure if my eating later coincided with decrease in sleep quality but I will try eating earlier and see if that helps.

There is some basic advise here on home remedies - http://www.mayoclinic.org/diseases-cond ... n-20025201.

Bed risers at the head of the bed are great, we both use them - http://www.amazon.com/s/ref=nb_sb_noss_ ... bed+risers

Practicing good sleep hygiene helps CPAP patients. Just google it and read a few sources. Ignore the ones that are more complicated. Keep it simple.

I have been adjusting it myself. My jaw can go a little more forward and might try adjusting a little further.

Yes, that is how we make adjustments.

My AHI with a PAP is relatively low

Just how low is your AHI with CPAP only? What was your diagnosis from your sleep study? Do you have any other health problems?

I'm sorry for not responding sooner. A lot has been going on and being tired has made it difficult to keep up, though today I am feeling better.

My AHI from my last sleep study was 8.6. My Resmed S9 measures an AHI from 3-8. Measured with the PAP one night wearing the MAD it was 0-1. I am not overweight, and am otherwise healthy. I have a fast metabolism and very sensitive nervous system. My ENT says that I have a large palette which he thinks is causing the OSA. When wearing my PAP I sleep on my back. I cannot sleep on my side due to severe aerophagia in that position. I have found that sleeping in my back with the MAD gets the best results, contrary to recommendations.

Thanks for the recommendation about GERD. I am going to try some of those things including raising my bed a bit.

[BrooklynCPAPer]

I was successfully treated with a MAD for almost three full years. MY AHI went from 8 during my baseline in-lab sleep study to 0 with the MAD in a second follow-up in-lab study. It did need to be adjusted periodically by the sleep dentist and any new fillings or crowns also required a trip to her so she could check the fit. We went both forwards and then backwards slightly if my jaw ached.

My sleep dentist charge a single fee ($3,000 that I'm very lucky and grateful to have had insurance that paid) and any adjustments she could do in her office were included in that price. I had mine adjusted for various reasons probably 5-7 times. For me, the impetus to start CPAP was some weight gain and severe jaw pain last year - the MAD didn't help matters once the jaw pain started but it also wasn't the root cause of the pain either. That was brought on my poor posture and extreme job stress (which is probably why we need insurance that covers things like $3,000 medical devices).

I'm adjusting fine to CPAP but I probably will try a MAD again at sometime in the future too.

[tiredman]

I was successfully treated with a MAD for almost three full years. MY AHI went from 8 during my baseline in-lab sleep study to 0 with the MAD in a second follow-up in-lab study. It did need to be adjusted periodically by the sleep dentist and any new fillings or crowns also required a trip to her so she could check the fit. We went both forwards and then backwards slightly if my jaw ached.

My sleep dentist charge a single fee ($3,000 that I'm very lucky and grateful to have had insurance that paid) and any adjustments she could do in her office were included in that price. I had mine adjusted for various reasons probably 5-7 times. For me, the impetus to start CPAP was some weight gain and severe jaw pain last year - the MAD didn't help matters once the jaw pain started but it also wasn't the root cause of the pain either. That was brought on my poor posture and extreme job stress (which is probably why we need insurance that covers things like $3,000 medical devices).

I'm adjusting fine to CPAP but I probably will try a MAD again at sometime in the future too.

Interesting, we have some things in common. How tired were you at an AHI of 8? I have the same baseline AHI and am often very tired, though I know 8 is relatively low. You must have been tired enough to seek treatment.
What position were you sleeping in with the MAD?

[gsbuck]

I used a MAD for a while, specially ordered by dental doctor who specialized in sleep problems. It was supposedly the "top of the line" device per the doctor.
It hurt my upper teeth pulling the lower jaw forward, so I returned it to him. He made one himself for me and I used it until it wore out. Have not been back to him as I didn't see any change anyway.
I started CPAP last summer, but have not had the wonderful experience others have reported of feeling like they got a good nights sleep. I do have Restless Leg Syndrome also, and think that may keep me from sleeping soundly. I have found out many of the things I took to help me sleep actually aggravate the RLS. Wondering if the cpap is worth using until I find relief from the RLS.

[BrooklynCPAPer]

Interesting, we have some things in common. How tired were you at an AHI of 8? I have the same baseline AHI and am often very tired, though I know 8 is relatively low. You must have been tired enough to seek treatment.
What position were you sleeping in with the MAD?

Tiredman - I was completely wiped out. I was going to the gym in the morning before work so I got up around 5 or 5:30am. By 11am, I was already nodding off at my desk and that was after a large iced coffee. My caffeine usage kept going higher just so I could keep from getting canned from work. Some nights I went to bed as early as 9pm to get a full eight hours of rest and it still didn't matter.

I think I was mostly on my back during the second study that showed the MAD was working but I'd have to read a copy of that study to know for sure. I went to sleep on my back and woke up on my back but I'm a fairly active sleeper so that doesn't mean I didn't do 360s during the night (sleep techs love me for my entertainment value, I'm sure)

I wish you the absolute very best with whatever treatment path you continue on and glad you brought this topic up for us to have a look at.

[Julie]

Have you ever been tested sleeping in any other position but your back? I really question from your results whether or not you could have positional apnea, i.e. whether or not it mostly goes away when you're not on your back... in which case you wouldn't need Cpap and have no aerophagia. I also wonder if you've tried the various tricks many of us use to prevent aerophagia?

[ChicagoGranny]

I think I was mostly on my back during the second study that showed the MAD was working but I'd have to read a copy of that study to know for sure.

If you do read the study, know that sleep stages matter a lot. For instance, if you slept on your back and did not have any REM sleep, you cannot assume the MAD is effective. Generally, sleep apnea is worse during REM because muscles are at their maximum relaxation.

The crew here is good at helping people understand studies.

[VVV]

I do have Restless Leg Syndrome also, and think that may keep me from sleeping soundly.

Sorry to get off the OP's topic, but I want to insert a word of advice. I knew I had RLS for many years and I don't like unnecessary drugs and refused to take any. Eventually the sleep doc talked me into taking something. Wow, it made a big difference in my sleep quality with hardly any undesirable side effects. Now there is the realization that I should have starting taking them years earlier.

If you decide to take something ask your doctor if she uses a protocol for which drugs to take. My doctor uses a protocol and starts patients on the same drug every time. If the drug turns out to be ineffective for an individual or causes unwanted side effects she moves up on the protocol list to the next drug. The first two I tried were not good for me. The third one is a charm. It is an old, generic drug - $36 per year.

Good luck.

[BrooklynCPAPer]

I think I was mostly on my back during the second study that showed the MAD was working but I'd have to read a copy of that study to know for sure.

If you do read the study, know that sleep stages matter a lot. For instance, if you slept on your back and did not have any REM sleep, you cannot assume the MAD is effective. Generally, sleep apnea is worse during REM because muscles are at their maximum relaxation.

The crew here is good at helping people understand studies.

Very good point - thank you! I'll pull a copy out and have a look to see the sleep stage breakdown because now I'm curious and it will be another good learning opportunity for me. Once I started using the MAD though, I also could make it through the day without feeling drained so I was happy. I think the MAD's can be a good option for some but I also realize that the cost and insurance coverage is quite variable and I was lucky to have the options I did!

[donewithbeingtired]

Removed to separate thread

[ChicagoGranny]

Also apologies if its bad etiquette to jump in on this thread, I can start another if its easier for all.

Yes, this is off topic for this thread. Copy this post and paste it in a new thread. You will get better results that way and tiredman's thread will not be junked up with people trying to help you.

Maybe a title for your new thread is something like "Need Help Optimizing Therapy".

(I do think your therapy can be optimized without the need for a MAD.)

[BrooklynCPAPer]

I think I was mostly on my back during the second study that showed the MAD was working but I'd have to read a copy of that study to know for sure.

If you do read the study, know that sleep stages matter a lot. For instance, if you slept on your back and did not have any REM sleep, you cannot assume the MAD is effective. Generally, sleep apnea is worse during REM because muscles are at their maximum relaxation.

The crew here is good at helping people understand studies.

Very good point - thank you! I'll pull a copy out and have a look to see the sleep stage breakdown because now I'm curious and it will be another good learning opportunity for me. Once I started using the MAD though, I also could make it through the day without feeling drained so I was happy. I think the MAD's can be a good option for some but I also realize that the cost and insurance coverage is quite variable and I was lucky to have the options I did!

Closing the loop on this one.....I did go back and read my study with the MAD. I spent 15% of my time in REM (50 minutes) out of a recorded sleep time of about 325 minutes. And to correct myself from earlier, my AHI was 1 and not 0 with the MAD. Close enough for me.

[tiredman]

Have you ever been tested sleeping in any other position but your back? I really question from your results whether or not you could have positional apnea, i.e. whether or not it mostly goes away when you're not on your back... in which case you wouldn't need Cpap and have no aerophagia. I also wonder if you've tried the various tricks many of us use to prevent aerophagia?

I have only been tested on my back however I have slept in all positions and none seem to make any difference, although I did feel better for a while when I was sleeping on my back and side with the MAD, though I am tired now in those positions, so it could have been something else.

What are some tricks for avoiding aerophagia? I get it within 15 minutes of putting my mask on if I am on my side, before even falling asleep. It is extremely painful and I don't want to risk it happening again. But I do want to be able to sleep on my side with clap. I have read about tilting your bed, lowering pressure, anything else that you have found helpful? I am not sure that I can avoid it, given how extreme it is in my case. But I would like to try.

[tiredman]

Interesting, we have some things in common. How tired were you at an AHI of 8? I have the same baseline AHI and am often very tired, though I know 8 is relatively low. You must have been tired enough to seek treatment.
What position were you sleeping in with the MAD?

Tiredman - I was completely wiped out. I was going to the gym in the morning before work so I got up around 5 or 5:30am. By 11am, I was already nodding off at my desk and that was after a large iced coffee. My caffeine usage kept going higher just so I could keep from getting canned from work. Some nights I went to bed as early as 9pm to get a full eight hours of rest and it still didn't matter.

Sounds like me. Thanks for sharing your experience--it's interesting and insightful to hear from someone in a similar situation. Glad you are doing better!

[tiredman]

I think I was mostly on my back during the second study that showed the MAD was working but I'd have to read a copy of that study to know for sure.

The crew here is good at helping people understand studies.

Chicago Granny, thanks for your responses. I know this response was to BrooklynCPAPer, but you've got me thinking that posting my sleep study here is probably a good idea. I will do so in a new thread.