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General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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BadBreath
 
Posts: 108
Joined: Wed Jun 27, 2007 5:40 pm
Location: Northern California
Gender: Male

Sleep Doc Visit and Opus Mod

Postby BadBreath on Tue Jul 17, 2007 3:10 pm

Hello all! I just had my 1 month follow up with my sleep doc and all is well. I took my smartcard as well as the graphs from Analyzer and he was quite impressed. At 100% compliance with a nightly average of 7.5 hours of therapy and AHI’s all below ten (half below 5) he was quite happy. And with my understanding of the numbers and the software, he said I was in the 99.9 percentile as far a patients go. I made it clear to him I owe it to my friends at the CPAP forum! I even showed him how to leave the data on the smartcard, and he was so impressed he said I should work for Resprionics LOL. I said maybe a job as a sleep technician, and to someday become registered, and he said “just say the word”. Maybe I have a new career path! When I asked for a new copy of my prescription with the mask unspecified, and copies of my sleep study including the charts, he couldn’t get them to me fast enough because he knew I would use them effectively.

As much as I liked my ball cap mod to the ComfortLite2, I just had a better fit and lower numbers consistently with the Opus mask. And with my mouth guard mod, I am able to sleep through the night on my side. I tried to improve on it in order to make it easy for anyone to modify, but I kept going back to the original setup as the best. Recently I purchased some mouth guards from Wal-Mart and ended up with a simple and effective mod after all. It is firm yet flexible and quite comfortable. There is a minor modification to the mask but it can still be used with the original headgear.

You need:

Two “Athletic Works” adult size strapped mouth guards from Wal-Mart. (98 cents each) Image

One “pin clip”, 1” long, 3/8” diameter on the large circle. (10-20 cents)Image

Elastic headband. I found one at Wal-Mart that is cloth in the front and elastic cord in the back – very comfortable – for under 2 dollars.


Here’s how:

Trim the straps on the mouth guards leaving 1-1/4” (give or take – here is where there is some adjustability). Boil both guards together according to directions, but keep them from touching while boiling. You need to leave them in a little longer so they get sticky. When they come out of the water, without cooling, align them and press the bottoms and the straps together so they stick, creating a two sided mouth guard. Once they cool a moment put them in your mouth and set, according to directions, but for both your top and bottom teeth. Now dip only the strap into almost boiling water, and when soft, remove and shape into a cylinder, taking care to keep it straight and level. This may take repeated heating to get what you want. Lastly, about 3/8” from the tip (again, give or take) you want to crimp it (again while hot and soft) so there is an indent all around. It will look like a cylinder with a ball on the end (A round cap on a fence post? A round finial on a curtain round? A …I’ll stop there).
ImageImage

Now take the pin clip and squeeze together the ends and straighten them so they are parallel to each other.
Image
You now want to bend just the very tips at the end outward very slightly.

Image


Remove the Opus mask from the headgear. There is a tab on the housing where the head gear was attached. Drill a small 1/8” dia. hole through the center of the tab, being careful to not go through the housing underneath. You do not want to compromise the air chamber. And lastly put two ¾” slots in the front center of the head band about 1” apart.

Assembly:

Slightly open the pin clip and put it around the indent in the mouth guard post just below the ball.
Image
With the ends facing up, squeeze them together and push both ends into the hole you made in the tab under the mask assembly. They should spread out once in and stay in the hole, but allow the mask housing to rotate and bend forward and back.
Image
Place the spare hose strap (that came with the mask) through the slits you made in the head band and attach the hose.
Image
Put the head band on and the mouth guard and nose pillows in. Adjust the placement of the tube on the headband so it maintains slight upward pressure on the nose pillows.

Image

The flexibility between the mouth guard and the mask allow for easy adjustment, but the rigidity between your mouth and the post, and support above from the hose, keep everything in place.


I can usually tell the effectiveness of a seal by how quickly the auto-on responds. With this setup it comes on after the first breath. I sleep through the night (except for a small break usually around 3-4am), and my AHI is usually below 5.

Now the disclaimer: I use a mouth guard anyway for teeth grinding, but my sleep doc says a mouth guard can negatively affect your numbers. Others have also pointed that a simple mouth guard can affect the structure of your mouth. All I can say is this works well for me and my situation but YMMV. Buyer beware, and you get what you pay for. Let me know if this works for anyone else out there.

Regards,

Denny

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): hose, CPAP, AHI, seal, Prescription, auto


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jabberwock
 
Posts: 219
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Location: Oakville, Ontario
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Postby jabberwock on Tue Jul 17, 2007 4:21 pm

Wow Denny, that's amazing!

Forget sleep technician; if you aren't already an engineer, I think that's what you shoud be considering... makes lots more money too :wink:

I think it's fabulous that you have been able to make modifications that allow you to be comfortable and get good therapy; I just wish I was so creative in coming up with a solution for me.

Thanks for sharing :)

Bonnie

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rested gal
 
Posts: 12889
Joined: Thu Sep 09, 2004 10:14 pm
Location: Tennessee
Gender: Female

Postby rested gal on Tue Jul 17, 2007 4:23 pm

Denny, you're the lab-rattin'-est lab rat I've seen in a long time. LOL!! :lol:

You just now got this, to go alongside the Lab Rat trophy you already won:

Image

:lol:
S9 VPAP Auto - S9 Auto - BiPAP Auto - 420E auto - Everest 2. ResScan, EncPro & SL3.
Humidifier: F&P HC 150, Aussie heated hose.
Mask: Aeiomed Headrest/homemade straps.
ALL LINKS by rested gal:
http://www.cpaptalk.com/viewtopic.php?t=17435

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momadams
 
Posts: 320
Joined: Thu May 17, 2007 7:46 am
Gender: None specified

Postby momadams on Tue Jul 17, 2007 4:28 pm

Wondering how a mouth guard could affect numbers?

User avatar
BadBreath
 
Posts: 108
Joined: Wed Jun 27, 2007 5:40 pm
Location: Northern California
Gender: Male

Postby BadBreath on Tue Jul 17, 2007 6:55 pm

Wondering how a mouth guard could affect numbers?


I believe what was implied is that the CPAP is trying to open your airways and a mouth guard that pushes backwards makes that more difficult.

For myself, I don't see it and the mouth guard actually helps prevent mouth breathing, even without the "tongue depressor" modification.

BTW my next challenge is a mod to the Oracle. I'm trying to create a seal inside the mouth to move the air further back near the throat in order to prevent nasal blowback, cheek puffing and dry mouth.


sleepjoe
 

Re: Sleep Doc Visit and Opus Mod

Postby sleepjoe on Sun Feb 15, 2009 3:38 pm

I like the unit showing the opus and the boil and bite guard.
What I have seen clinically is that most patients have a challenge with retention of those devices onto the teeth. The other problem is mouth leak. These are the problems with the CPAP Pro. Holding to lower jaw forward is important to decrease pressure. We have noted consistently less pressure with linear advancement in millimeters of an adjustmable mandibular advancement device.

The problem in every but Portland Oregon is the idea of combining these treatments is the cost. We bill insurance and don't do fee for service like a dentist office.
We also have clinically noted a high prevalence of bruxing and clenching in OSA patients resulting in wear of the teeth. A dentist would recommend a plastic guard. Why not get rid of the straps, protect the TMJ and decrease the pressure with a more custom fit device.

Combining these modalities results in less sleep fragmentation from mask leaks, pressure sores and nasal irritation from the strapped masks and of course the straps are out of the picture which is a large pain. We are now fixing a number of off the shelf masks to our leak proof custom dental devices fitted by a dental sleep medicine practice.

Joe Zelk
sleep specialist

BadBreath wrote:Hello all! I just had my 1 month follow up with my sleep doc and all is well. I took my smartcard as well as the graphs from Analyzer and he was quite impressed. At 100% compliance with a nightly average of 7.5 hours of therapy and AHI’s all below ten (half below 5) he was quite happy. And with my understanding of the numbers and the software, he said I was in the 99.9 percentile as far a patients go. I made it clear to him I owe it to my friends at the CPAP forum! I even showed him how to leave the data on the smartcard, and he was so impressed he said I should work for Resprionics LOL. I said maybe a job as a sleep technician, and to someday become registered, and he said “just say the word”. Maybe I have a new career path! When I asked for a new copy of my prescription with the mask unspecified, and copies of my sleep study including the charts, he couldn’t get them to me fast enough because he knew I would use them effectively.

As much as I liked my ball cap mod to the ComfortLite2, I just had a better fit and lower numbers consistently with the Opus mask. And with my mouth guard mod, I am able to sleep through the night on my side. I tried to improve on it in order to make it easy for anyone to modify, but I kept going back to the original setup as the best. Recently I purchased some mouth guards from Wal-Mart and ended up with a simple and effective mod after all. It is firm yet flexible and quite comfortable. There is a minor modification to the mask but it can still be used with the original headgear.

You need:

Two “Athletic Works” adult size strapped mouth guards from Wal-Mart. (98 cents each) Image

One “pin clip”, 1” long, 3/8” diameter on the large circle. (10-20 cents)Image

Elastic headband. I found one at Wal-Mart that is cloth in the front and elastic cord in the back – very comfortable – for under 2 dollars.


Here’s how:

Trim the straps on the mouth guards leaving 1-1/4” (give or take – here is where there is some adjustability). Boil both guards together according to directions, but keep them from touching while boiling. You need to leave them in a little longer so they get sticky. When they come out of the water, without cooling, align them and press the bottoms and the straps together so they stick, creating a two sided mouth guard. Once they cool a moment put them in your mouth and set, according to directions, but for both your top and bottom teeth. Now dip only the strap into almost boiling water, and when soft, remove and shape into a cylinder, taking care to keep it straight and level. This may take repeated heating to get what you want. Lastly, about 3/8” from the tip (again, give or take) you want to crimp it (again while hot and soft) so there is an indent all around. It will look like a cylinder with a ball on the end (A round cap on a fence post? A round finial on a curtain round? A …I’ll stop there).
ImageImage

Now take the pin clip and squeeze together the ends and straighten them so they are parallel to each other.
Image
You now want to bend just the very tips at the end outward very slightly.

Image


Remove the Opus mask from the headgear. There is a tab on the housing where the head gear was attached. Drill a small 1/8” dia. hole through the center of the tab, being careful to not go through the housing underneath. You do not want to compromise the air chamber. And lastly put two ¾” slots in the front center of the head band about 1” apart.

Assembly:

Slightly open the pin clip and put it around the indent in the mouth guard post just below the ball.
Image
With the ends facing up, squeeze them together and push both ends into the hole you made in the tab under the mask assembly. They should spread out once in and stay in the hole, but allow the mask housing to rotate and bend forward and back.
Image
Place the spare hose strap (that came with the mask) through the slits you made in the head band and attach the hose.
Image
Put the head band on and the mouth guard and nose pillows in. Adjust the placement of the tube on the headband so it maintains slight upward pressure on the nose pillows.

Image

The flexibility between the mouth guard and the mask allow for easy adjustment, but the rigidity between your mouth and the post, and support above from the hose, keep everything in place.


I can usually tell the effectiveness of a seal by how quickly the auto-on responds. With this setup it comes on after the first breath. I sleep through the night (except for a small break usually around 3-4am), and my AHI is usually below 5.

Now the disclaimer: I use a mouth guard anyway for teeth grinding, but my sleep doc says a mouth guard can negatively affect your numbers. Others have also pointed that a simple mouth guard can affect the structure of your mouth. All I can say is this works well for me and my situation but YMMV. Buyer beware, and you get what you pay for. Let me know if this works for anyone else out there.

Regards,

Denny

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): hose, CPAP, AHI, seal, Prescription, auto

User avatar
rested gal
 
Posts: 12889
Joined: Thu Sep 09, 2004 10:14 pm
Location: Tennessee
Gender: Female

Re: Sleep Doc Visit and Opus Mod

Postby rested gal on Sun Feb 15, 2009 9:33 pm

Very nice post, Joe. Sounds like your place and the sleep dentist are doing a good job for people.

Denny's mod might not be as good as a custom made device, but it looks like an effective, inexpensive way to work on stabilizing some masks better.

sleepjoe wrote:
We bill insurance and don't do fee for service like a dentist office.
---
A dentist would recommend a plastic guard. Why not get rid of the straps, protect the TMJ and decrease the pressure with a more custom fit device.
---
We are now fixing a number of off the shelf masks to our leak proof custom dental devices fitted by a dental sleep medicine practice.
---


That sounds great. For people with insurance.
S9 VPAP Auto - S9 Auto - BiPAP Auto - 420E auto - Everest 2. ResScan, EncPro & SL3.
Humidifier: F&P HC 150, Aussie heated hose.
Mask: Aeiomed Headrest/homemade straps.
ALL LINKS by rested gal:
http://www.cpaptalk.com/viewtopic.php?t=17435


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