Can dental nightguards worsen apnea symptoms?

[Dyssomniac]

For some time now I've been using a System One machine and F10 full-face mask, and my AHI for the night is generally less than 1. By far, sleeping position seems to be the most important factor. If I go onto my back, the AHI goes up quickly, the machine pressure increases and I wake up long before it gets to any point where it can control the symptoms. But if I stay on my side, symptoms are quite low, usually a few isolated RERA or hypopnea events here or there. Most nights I use a Rematee sleep positioner to help ensure that I stay on my side.

A few years ago (before CPAP therapy) I got a custom nightguard made by a dentist due to some mild to moderate TMJ symptoms I was experiencing at the time. The symptoms seemed to subside on their own and did not return, so after a few weeks I stopped wearing the nightguard. Recently, I was curious to see if wearing the nightguard would do anything helpful to my airway that might help with the RERA or hypopnea events. The nightguard is the type that covers all of the upper teeth. Although I hadn't worn it in a while, the fit still seems reasonably good.

I therefore tried sleeping last night with the nightguard, as well as the Rematee sleep positioner. I was surprised to see my AHI for the night was over 6. Much of this seemed to be from a half-hour time period between 3 and 3:30 a.m. when I was getting a fairly heavy combination of CA and hypopnea events.

Now, my sleep-clinic tech had noticed some time ago that even when I wear a sleep positioner, I sometimes manage to contort around where I sleep with my face up, so it's possible that the poor AHI was related to sleep position and not to use of the nightguard. I'll try the nightguard again for a few nights, but I'm curious about others' experience with them. Can they actually worsen apnea symptoms? Or, conversely, does anyone find that nightguards of this type seem to help with AHI?

[LSAT]

Can dental nightguards worsen apnea symptoms?

Based upon what you said....obviously they can.

[ChicagoGranny]

If I go onto my back, the AHI goes up quickly, the machine pressure increases and I wake up long before it gets to any point where it can control the symptoms. But if I stay on my side, symptoms are quite low

The situation is the same for Gramps and me. We also used devices to force us off our backs. But a few years ago we switched to using soft cervical collars and we can now sleep on our backs (or sides) without requiring a very high pressure. Example of collar - http://www.amazon.com/Carex-Health-Bran ... cal+collar

Can they actually worsen apnea symptoms?

You said the problem was only for 30 minutes and many of the events were centrals. Assuming you slept most of the night without the problem, my guess would be that the nightguard is not causing the problem.

Can you describe the night guard? In what position does it hold the jaws? Is it for TMJ relief? Is it for protection from teeth grinding?

[Chilipepper]

I am brand new to this forum, and I wear the same kind of nightguard... one made by my dentist... and it doesn't seem to affect my AHI.

[Sir NoddinOff]

I wear a night guard that I mold myself called the Doctor's Teeth Guard. I've used them for 2.5 years. If I don't wear it my AHI goes up slightly. I think it helps advance my lower jaw and keep it in the proper position... of course, everybody is different in the way they sleep.

[chunkyfrog]

A night guard designed to alleviate TMJ may be different from those intended to address OSA.
So it might be more a matter of the wrong tool for the job.
I believe that some OSA night guards have had a detrimental effect on TMJ.
Not all night guards are alike, nor would be professional or patient application.

[SewTired]

Yes, dental guards can worsen apnea but I don't know why or how it works. My brother had very mild apnea and got dental guards primarily because he was grinding his teeth at night. His apnea worsened dramatically. He stopped wearing the dental guards. This was in the late 80s when most doctors didn't know about apnea and he certainly did not call it that but I now know that it was apnea. In his particular case he started sleeping on his side and within a few years he didn't have a apnea at all so whatever was causing that issue went away. Oh, and the teeth grinding ? He now wears dentures as a result. My brother was subject to major allergies, so that may have been the situation.

[Dyssomniac]

Thanks for all the comments, very interesting. Some specific replies:

ChicagoGranny: The cervical collar sounds like something I should at least try. It looks, however, as though they come in various widths. Do you need a medical provider to tell you what size to use, or do you just take a shot at what seems like an appropriate size?

As for my night guard, it was made by a specialist dentist to address TMJ issues I was having at the time. It covers all of the upper teeth. It doesn't appear to me that it changes the jaw thrust (forward or backward) in any way, it just keeps the teeth from closing together fully. Obviously it was made for TMJ, not apnea, but I figured that since I had it, it might be worth trying in case it did anything beneficial to the airway.

Also, a note about the half-hour episode from last night when I was wearing the night guard. When I said it was a mixture of CA and hypopnea, I was referring to what SleepyHead calls "clear airway," not central apnea.

Chilipepper: Thanks for the note about your night guard not affecting your AHI, that's interesting to know.

Sir NoddinOff: Also interesting to know about your experience with yours.

Chunkyfrog: Good point about the different kinds of night guards. I didn't think that my TMJ night guard would necessarily help, but since I have it, I thought it was worth trying.

SewTired: Interesting about your brother's experience. I noticed that my father was a teeth-grinder, and I'm told that I do this occasionally, but the TMJ symptoms seemed to resolve on their own, and never came back. Sleeping on my side by itself takes care of so much of my apnea that my sleep doctor said I might not have to use a machine. However, my impression is that I'm getting some definite benefit out of using the APAP, so I continue to do so.

[Dyssomniac]

Just a side note -- in my profile, I've selected to show that I use a "PR System One REMStar 60 Series Auto CPAP Machine." For many months this appeared at the bottom of my postings along with my mask, humidifier and "Additional Comment" about my pressure setting and SleepyHead use. When I look at my posts today, however, the line about the CPAP machine is missing, though the others are there. I verified that it's still selected in my profile. Is this a known glitch?

[RogerSC]

Just a side note -- in my profile, I've selected to show that I use a "PR System One REMStar 60 Series Auto CPAP Machine." For many months this appeared at the bottom of my postings along with my mask, humidifier and "Additional Comment" about my pressure setting and SleepyHead use. When I look at my posts today, however, the line about the CPAP machine is missing, though the others are there. I verified that it's still selected in my profile. Is this a known glitch?

Interesting pressure range. Have you looked at your data to see where your pressure goes at night? If you can narrow the range, you can sometimes get better results, since a cpap takes some time to react to sleep apnea events. For example, if your pressure has fallen to say 6, and it needs to get to 12 to stop an OSA event, it may not be able to get there in time to stop that event.

Just a thought, sometimes when you look at nightly pressure graphs you see wide swings, and those take time. My pressure range was narrowed down by looking at the graphs and figuring out what range was really being used to stop apnea events.

[Dyssomniac]

Roger, good points about the pressure range. When my machine was originally given to me, it was set for 4-20. Everyone here agreed that 4 seemed very low, and the effect felt minimal to me. After some experimentation, I've found that somewhere in the 5 to 6 range seems to work best for me sleeping on my side. Recently I've backed it off a bit to 4.5, but I plan to bring it back up a bit. Anything over 7 or 8 is uncomfortable to me, even after using the machine for about 9 months. At this level it wakes me up, and my first impulse is to check my sleep position and reset the machine to bring it back down. I know that many people here subscribe to the theory that you should set the pressure to whatever it needs to be to avoid apnea events, regardless of sleeping position. Since I do well sleeping on my side, but really dislike higher pressures, I've preferred to follow that approach.

[Pugsy]

When I look at my posts today, however, the line about the CPAP machine is missing, though the others are there. I verified that it's still selected in my profile. Is this a known glitch?

Known glitch. Seems to work for some people and not others and I don't know why.
I have the same PR S1 60 series Auto CPAP chosen (as experiment) in my profile and it isn't showing up for me either but the humidifier does.

When this happens I suggest people just make a brief note in the comments section of the equipment profile.
Something like PR S1 model 560 is sufficient...we all know which one it is.

[Dyssomniac]

Thanks, Pugsy, duly edited.

[ChicagoGranny]

ChicagoGranny: The cervical collar sounds like something I should at least try. It looks, however, as though they come in various widths. Do you need a medical provider to tell you what size to use, or do you just take a shot at what seems like an appropriate size?

Size is not so critical. I will guess 3-inch height for you. Very small people may need 2.5-inch size.

One other tip, my experience is they do not have to be tightened snugly to be effective - no choking . You just need something to keep your chin up. The collars help hold the neck in the best position to help prevent airway collapse.

something I should at least try

It's a cheap trial.

[cflame1]

I use a TMJ night guard nightly... no issues with my AHI unless I don't wear it