Dental Device... EMA or Dorsal?

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glyphix
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Dental Device... EMA or Dorsal?

Post by glyphix » Fri Nov 20, 2015 11:18 pm

Anyone have any strong feelings between EMA or Dorsal Dental Devices? From what the dentist said they normally recommend Dorsal for men.

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49er
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Re: Dental Device... EMA or Dorsal?

Post by 49er » Sat Nov 21, 2015 4:38 am

glyphix wrote:Anyone have any strong feelings between EMA or Dorsal Dental Devices? From what the dentist said they normally recommend Dorsal for men.
Not sure under what context you are asking this question but if you click on the dental device link in my signature, you will find that dental appliances that are adjustable have the best success rate. I do wish I could find an updated study as this one is from 2011 but I still think it has alot of useful information.

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glyphix
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Re: Dental Device... EMA or Dorsal?

Post by glyphix » Sat Nov 21, 2015 10:40 am

Thanks! Some context... I have mild apena... (avg 8/hr though they say 63/hr in rem... but ox never goes below 88 and only below 90 for 1 minute in my study) I have monitored ox at home with and without CPAP and basically never go below 90, and avg in mid 90's.

I snore a lot... never had fatigue... that is until I started using CPAP... then had LOTS of fatigue... quit CPAP for a week... felt better... back on CPAP 3 days... so far so good... so maybe CPAP will work out.

Both the ema and dorsal I was shown were adjustable. So just curious if people had any personal preferences or horror stories or great successes with either.

EMA had the rubber bands attaching the two. Dorsal had hard plastic fins that were not attached but that had adjustable blockers on the top to keep the fins (and lower jaw) from going back to far.

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Re: Dental Device... EMA or Dorsal?

Post by ChicagoGranny » Sat Nov 21, 2015 11:02 am

glyphix wrote: Some context... I have mild apena... (avg 8/hr though they say 63/hr in rem... but ox never goes below 88 and only below 90 for 1 minute in my study) I have monitored ox at home with and without CPAP and basically never go below 90, and avg in mid 90's.
Have you had an analysis of the severity of your condition when you sleep on your sides and/or stomach (avoiding backsleeping)?

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Re: Dental Device... EMA or Dorsal?

Post by glyphix » Sat Nov 21, 2015 12:01 pm

ChicagoGranny wrote:
glyphix wrote: Some context... I have mild apena... (avg 8/hr though they say 63/hr in rem... but ox never goes below 88 and only below 90 for 1 minute in my study) I have monitored ox at home with and without CPAP and basically never go below 90, and avg in mid 90's.
Have you had an analysis of the severity of your condition when you sleep on your sides and/or stomach (avoiding backsleeping)?
I don't think I could ever sleep on my stomach. I did have a fully monitored sleep study. (Hooked up with elecrodes all over head and legs, and video camera on my with video and audio monitoring, etc.). Looks like I had a higher index supine

Total Index for Apnea Events: 0.2/h
Total Index for Hypopnea Events: 8.1/h
Total Index for Apnea/Hypopnea Events (AHl) REM: 67.2/ h
Total Index for Apnea/Hypopnea Events (AHl) NREM: 6.1/h
Total Index for Apnea/Hypopnea Events (AHl): 8.3/h
Total Index for Apnea/Hypopnea Events (AHl) Supine: 18.0/h
Total Index for Apnea/Hypopnea Events (AHl) Non Supine: 3.5/h
Total Index for Respiratory Events (RDl): 8.8/h
Lowest Sp02 w/a Respiratory Event: 89
Lowest Heart Rate w/a Respiratory Event: 71
Greater Heart Rate w/a Respiratory Event: 98

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Re: Dental Device... EMA or Dorsal?

Post by ChicagoGranny » Sat Nov 21, 2015 4:24 pm

glyphix wrote:Total Index for Apnea/Hypopnea Events (AHl) Non Supine: 3.5/h
Do you have a summary report that shows how many minutes in each sleep stage you slept in while in non-supine positions? And what your AHI or number of events was in each of those stages?

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Re: Dental Device... EMA or Dorsal?

Post by glyphix » Sun Nov 22, 2015 2:24 pm

https://drive.google.com/file/d/0B5xtPx ... cslist_api

You can see full PDF here.... scroll down to get past the summary of changes. Basically I blocked out my name everywhere and so the first part just shows a summary of all the places I did that. But if you keep scrolling down you will see page by page the full 10 plus page report

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Re: Dental Device... EMA or Dorsal?

Post by ChicagoGranny » Sun Nov 22, 2015 4:39 pm

glyphix wrote:https://drive.google.com/file/d/0B5xtPx ... cslist_api

You can see full PDF here.... scroll down to get past the summary of changes. Basically I blocked out my name everywhere and so the first part just shows a summary of all the places I did that. But if you keep scrolling down you will see page by page the full 10 plus page report
During the study, you spent only 12.5 minutes in REM sleep. Your AHI during this time was 67.2. Obstructive sleep apnea is typically more severe in REM when the muscles of the body are at maximum relaxation.

12.5 minutes of REM sleep is a short amount of time in REM for one night. It would seem if you had been able to achieve a normal amount of REM, your apnea condition would at least have been rated moderate and most likely severe.

There was not enough data in the summary to make a determination as to whether positional therapy (non-supine) sleeping would adequately treat your condition. My guess is that it would not.

With your sleep study results, I would not recommend treatment with a mandibular advancement device (MAD). My recommendation would be CPAP - the gold standard treatment for sleep apnea.

Now do note this is a CPAP forum, and it is frequented by people who are highly successful with CPAP treatment. You will not find many fans of MADs here. Both Gramps and I own custom-made MADs, and both of us found them to be intolerably uncomfortable and not at all effective.

Good luck whatever you decide, and if you go with CPAP, remember you have many expert patients here who have dealt with solving many different CPAP problems.

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Re: Dental Device... EMA or Dorsal?

Post by glyphix » Mon Nov 23, 2015 11:11 am

Thanks... I have 2-3 weeks of ox data with a home pulse oximeter, and about half of that with a CPAP.... Both with and without CPAP I am not really dipping below 90... It feels like to me my blood ox is the MOST important number... Hyponeas or Apnea's and the count of these seems like a secondairy measure to me. If my blood ox is staying OK, why do those things even matter.... that (and the fact that when I first start CPAP is when I started to get fatigue) is why I was leaning towards dental device.

But just curious... am I looking at this backwards? Do the other events really matter that much if blood ox is staying fine.

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Re: Dental Device... EMA or Dorsal?

Post by ChicagoGranny » Mon Nov 23, 2015 11:27 am

glyphix wrote:Do the other events really matter that much if blood ox is staying fine.
There are people who have normal blood-oxygen levels all night long, but are very ill due to the frequent awakenings caused by sleep-disordered breathing (apnea).

Looking at your sleep study, the profile looks poor - insufficient slow-wave sleep, insufficient REM and too many awakenings. This is a road map to poor health or worse. Sleep deprivation is a deadly condition. Sleep quality and quantity have major impacts on our health.

Consequences of sleep deprivation - heart disease, stroke, hypertension, metabolic syndrome, diabetes, obesity, anxiety, depression.

Why did you go through the trouble of a sleep study in the first place? Right. You knew something was bad wrong. Now that you know what that something is, don't slip into denial.

I encourage you to seek good therapy. CPAP would be my choice.

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Re: Dental Device... EMA or Dorsal?

Post by glyphix » Mon Nov 23, 2015 11:44 am

Thanks! I appreciate the feedback! To be clear... I did the sleep study because my snoring annoyed my wife. I never had fatigue before the sleep study. For the first 2 weeks I was on CPAP I had terrible fatigue many days. It seemed clear the CPAP was giving me even worse sleep. I guess having air forced in my face and a mask strapped to me were interfering with my sleep even more than the apnea's were.

Don't get me wrong I'm not giving up on CPAP... I plan to give it a fair shot and workwith the settings... either finding the right constant pressure or right variable min/max, etc..... but it seems reasonable to give a dental device a try... Perhaps just having my jaw constantly held in a position vs a machine forcing air down my throat when it closes will micro-arouse me less? I figure if I feel better with the dental device and can have less interrupted sleep then I should be good.

I guess my point is I don't think I am in denial... I am just trying to understand the facts so I can make informed decisions... because my first two weeks with CPAP I felt fatigued and sleep deprived when I had NEVER felt that way before... It sounds like you are saying even if ox is fine I could be being micro aroused... (perhaps why CPAP made me feel fatigued even though ox was fine... perhaps it was arousing me) and some things/symptoms/evidence to look out for would be "heart disease, stroke, hypertension, metabolic syndrome, diabetes, obesity, anxiety, depression"... that's helpful... If I am doing the dental device and start to have problems with those things I should certainly re-evaluate!!

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Re: Dental Device... EMA or Dorsal?

Post by HoseCrusher » Mon Nov 23, 2015 2:12 pm

Oxygen saturation is one thing. Pulse rate spikes are another. Arousals can cause a spike in pulse rate. This causes stress hormones to be released that cause health issues. Your body can deal with a few occurrences, but being repeatedly bombarded takes its toll.

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Re: Dental Device... EMA or Dorsal?

Post by glyphix » Mon Nov 23, 2015 2:40 pm

thanks... my pulse does not seem to spike a lot... atleast I don't think so... what do you think qualifies as a spike?

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Re: Dental Device... EMA or Dorsal?

Post by HoseCrusher » Mon Nov 23, 2015 8:34 pm

Pulse rate spikes show up as pulse rate events.

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Re: Dental Device... EMA or Dorsal?

Post by glyphix » Mon Nov 23, 2015 9:24 pm

HoseCrusher wrote:Pulse rate spikes show up as pulse rate events.
It looks like sleepyheads default for flagging pulse events is 5bpm diff in 8 seconds... either
1. that's a completely unreasonable default setting...
2. my pulse is crazy...
3. my pulse ox device is crap (CMS50D)

By that criteria i have like 50+ pulse "events" per hour. (even before falling asleep) And completely uncorrelated with other events (OA, HA, o2 drop, etc)

For example... here is about a 15 minute period with nothing but pulse events recorded... and there are like 15+... everything else is plenty steady.

Image

Is my pulse really that crazy or should I be using more stringent criteria to flag pulse events? (perhaps 15bpm in 20 seconds?)

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