Oral appliance user -- should i go to cpap??

[steeve]

Hello all, and Thanks ahead for your help. I am a newbie as this is my first post. Just found this site and have learned a few things. To my question--- I have been using the silent nite appl. 3.5 weeks and while my wife does say it helps with the snoring [ I now PURR] I've not noticed much improvement in energy level and still wake up often with a headache. Should I give it more time or just go ahead to the CPAP.. Anyone have any insights, suggestions it would be much appreciated. THANKS Steve

[SleepyToo2]

Did you have a sleep study before you got the Silent Nite? If not, how do you know how severe your sleep apnea is (given that you are still "purring," otherwise known as snoring)? The only way you can tell if the appliance is working is with a before and after sleep study. You will also need a before and after sleep study with a CPAP - you alone cannot just decide to go to a CPAP. A sleep study can help diagnose about 70 different sleep disorders, of which sleep apnea is just one. You need professional help with your "purring."

[Starlette]

Hey there Steeve.

I have the same dental appliance as you. Should say on my personal information. The dental appliance and the xpap work as a tag team. All the dental appliance does is move your jaw forward to allow more airway, but it doesn't "cure" you. The xpap "gives" you the necessary therapy for the OSA.

Starlette

[steeve]

Thanks for your replies and yes I did have a sleep study done. After which my Dr. informed me I had 80 + interruptions and my oxygen level dropped below 80% several times. Don't remember exact numbers but as I told him, the numbers didn't mean much to me just WHAT CAN WE DO TO FIX IT???? He suggested that the oral appl. would work in about 75% of the cases and cpap 100%. Thinking the mouthpiece to be the lesser of the two evils that is what I opted for. As I said earlier not getting the hoped for results I now wonder if I should have went with the machine. Not being a severe case, my pressure setting is "8", I hoped the mouthpiece would work. Am I expecting too much too soon? I was really looking forward to not feeling beat all the time and was truly relieved with the diagnosis, thinking yeah I may feel like doing something again. One call to the Doc and I can have a RX for cpap Thanks to all Steve

[snelson924]

i'm definitely a newbie, but i've had WICKED headaches for years in the mornings. My o2 was down to 84% and I was having 33 interruptions. I've been on an APAP for just 3 nights and haven't woken up with a headache since I got it. BUT I've crashed around mid-afternoon and had headaches in the evenings since then. I'm hoping things are just getting shifted back towards evening and that this machine is helping.....

i say get the APAP.......

[Pugsy]

I had 80 + interruptions and my oxygen level dropped below 80% several times

The pressure needed to maintain an open airway is irrelevant to how "severe" a person's sleep apnea is.
It is just the pressure needed to hold the airway open...no more no less.

A person can need 18 cm pressure an maybe only have 10 events happening per hour...rather mild OSA and another person could have 50 events per hour and need only 6 cm pressure and their OSA is classified as severe.

So don't kid yourself. If your oxygen levels dropped below 80 %....you have a problem and it sounds like the oral appliance is not helping enough....get the machine.
Or get a sleep study using the appliance to see if the events are reduced and the oxygen stays up.

[zoocrewphoto]

A lot of dental devices are considered successful with a 50% reduction in events. So, with your 80 events per hour, they would consider it successful if you go down to 40, which is still severe. This is how they come up with a high success rate even though they aren't really very successful.

I would definitely go for the machine. I dreaded it for years and avoided the sleep study. I finally realized it was causing my high blood pressure and putting me at a higher risk for stroke. I did the sleep study, felt great the first day after the study. The next night, I was at home without a machine, and I dreamt about being angry that I had to wait for my machine. And I felt like crap the next day. I realized I didn't feel any worse than normal. I just hadn't had a good night in years to compare it to, so I didn't realize just how crappy I felt until I had a good night.

I will tell you that it is not instant magic. I don't feel great every single day. What I really notice is when I have an especially great night or an especially bad night. The really great nights have me feeling super awesome the next day. Today happens to be one of those. I slept 6 hours straight, then had a bathroom break, and then got another 2 1/2 hours of great sleep. I feel like I drank an energy drink, and I didn't even any pop. In fact, I got up at 3pm (I'm a severe night owl), and I got ready to go meet friends for a Christmas dinner. I thought we were leaving at 4pm to meet at 5pm. We ended up eating at 6:30pm. So, I was up for 3 1/2 hours with no breakfast, no pop, no energy drink, etc. And I felt great! It is now 1am, and I just ate a snack.

If I skip a night (I sometimes fall asleep watching tv and miss more than half the night before I correct the problem), then I wake up with a nasty headache. So, failure to use my machine produces instant punishment. Definitely an incentive to keep going.

The last couple months, I have had some problems with taking my mask off when I drool, cough, or get annoyed. My averages per night have been about 5 hours with the machine with another 1-2 hours per night. Even with the lower hours of usage, I feel noticeably better than I did before I started cpap treatment. I feel better. My blood pressure is better. And I don't use energy drinks much anymore. I don't feel highly energetic (except for my rare awesome days). But I don't feel dead tired either.

[49er]

Hi Steeve,

With an AHI of 80, your chances of success on a dental appliance are very slim. I say that as one who initially thought they were more effective than they really are.

As an FYI, when I was pretty desperate about my adjustment to cpap treatment not working, I called a local sleep dentist's office about his success rate in working with people with severe apnea to get the AHI below 5. This person had a great reputation.

Incredibly, his assistant was brutally honest and said they hadn't had any success in getting patients' AHI with severe apnea under 5. They were recommending the TAP Pap combination therapy which I didn't want to do for various reasons.

You made the right choice in going to cpap.

49er

[steeve]

Hello to all and Thanks so much for your responses. It really helps to know I'm walking this trail with someone who has been down it before and knows where some of the pitfalls are. Thank you so much for sharing your knowledge. I am sorry to say I think I have misled you as to where I am on this trail. As I mentioned in a previous post not knowing the lingo the afore mentioned numbers were just that; numbers: The 85 or so "episodes" was for the night 5.5 hrs. . Now am I correct in saying that is an AHI of 15.5??? My sleep Dr. definitely did not push me towards the oral appl.--- that was my choice. My morning headache is with me this morning but I do rem. a dream from last night ,something I'm not used to. So I do think the appl. has helped, just not as much as I hoped. Am I postponing the inevitable? Do I need to resign myself to the fact I will have a new sleep partner? If so , from reading here it looks as though "an APAP w/ data capability" is the way to go. I do apologize for rambling so. Sign me : Confused in TN

[Pugsy]

The 85 or so "episodes" was for the night 5.5 hrs. . Now am I correct in saying that is an AHI of 15.5???

Yes..
But what if those 15 per hour events were nearly 30 to 45 seconds long? Or longer? 15 events 10 seconds long might not sound so bad but what if they were much longer? The medical professions haven't figured out a way to incorporate event duration into severity categories.

Unless you have a sleep study done while wearing the appliance you have zero way to know how much it may have helped.

Even when I first started cpap therapy and I was seeing AHI of 8 to 10 (a lot less than without cpap) but I pretty much still felt awful. Still had the killer headaches in the AM. It wasn't until I got the AHI down to a little less than 4 that I saw the killer headaches go away.

Unless there is some other reason for the killer headaches besides low oxygen...you probably may be helped somewhat with the appliance but not enough. You could get an overnight pulse oximetry (records oxygen levels over night and you can look at the results with software) to see how the oxygen levels are doing during the night.
Lots of forum members use pulse oximeters in conjunction with their cpap therapy to help evaluate the results.

[Billy6]

The oral appliance is very effective (add the nasal strip) but let your sleep study doctor/dentist help with the decision

[steeve]

Pugsy, Thanks so much for your replies/info/sharing/caring. I had previously been told of the overnight oxygen meter by my Drs. nurse. Very much a consideration but as you said there are many variables and I'm not naive enough to think they have it all figured out. We are all individuals with somewhat different wiring. What helps one ,may or may not help another. That is definitely a good thing about this forum, input-imput? from diff. people.... Will contact Drs. office again . Thanks Again Steve

[Pugsy]

Get your doctor to order the overnight pulse ox if you don't want to buy your own (you can for about $80 and up). I have one myself. Tell him you are concerned about the continued headaches and possibility of low oxygen levels.
My DME did one early in my cpap therapy to see if my headaches were from low oxygen.
Pre cpap my O2 went to 73%...had some killer headaches. The killer headaches went away but I still had/(still have) some morning headaches but I also have a bad cervical spine. Using the pulse oximeter over night we found that my oxygen levels are fine now and since the killer headaches are gone the cpap machine is doing its job and we assume that the sometimes morning headaches I get now are related to my cervical spine.

So morning headaches aren't always caused by sleep apnea events and low oxygen but since it is easy to verify with an overnight pulse ox...why not do it? If your oxygen levels aren't sufficient you sure want to know about it...don't want to go second guessing that detail. It's kinda important.

If your oxygen levels are no longer dipping below 90% and you still have the morning headaches then the headaches may not be related to your sleep apnea but may be related to something else. You need to know so you can properly address it and/or look for other causes for the headaches.

[SleepingUgly]

You should be working with your dentist to titrate your oral appliance. I can't imagine that 3.5 weeks is enough time to know it's a bust, but then again, I don't know much about how much you can advance the bite with that device (and I've read that for some people, a middle range is better than full advancement). You already have the device, so it seems you might want to work with the dentist before abandoning it. No harm in using a pulse ox to check your SaO2 as you sleep with it, and even help you titrate it, IMO.

[archangle]

He suggested that the oral appl. would work in about 75% of the cases and cpap 100%.

Find another doctor.

Both of those numbers are WAY too high. However, CPAP has a lot higher success rate than oral appliances, especially if you don't count the patients who give up on CPAP.