Question for those using a Mandibular Advancement Device:

After it is adjusted properly and your apneas are reduced, have any of you found that it loses effectiveness after a while and you have to advance it further?

Reason I ask is that I started using one, and it was extremely effective for a few weeks and I felt a lot better. But then it wasn't effective any more and I am tired again.

I am wondering if my airway has adjusted to it and therefore it needs to be adjusted further forward...?

tiredman wrote:I started using one, and it was extremely effective

Let me ask you a question. How did you know it was extremely effective?

As a general rule, MADs are not very effective for obstructive sleep apnea. I went to some considerable expense to have one made and it turned out to be useless for me. It's hard to pull the lower jaw forward far enough to open up the sleeping airway.

ChicagoGranny wrote:

tiredman wrote:I started using one, and it was extremely effective

Let me ask you a question. How did you know it was extremely effective?

As a general rule, MADs are not very effective for obstructive sleep apnea. I went to some considerable expense to have one made and it turned out to be useless for me. It's hard to pull the lower jaw forward far enough to open up the sleeping airway.

I felt rested the first day after I started using it, and for a few weeks after that. I hadn't felt that way in a long time.

Also, the data from my autopap indicated that my AHI had reduced significantly, compared to before using the device. (I had low AHI in the first place but it went down to less than 1 with the dental device)

I stopped using the autopap, and just used the dental device, and felt just as rested as I had with the S9 + dental device. I continued feeling great for a few weeks with just the dental device, and then started feeling tired again.

I have not had a chance to try again with the auto pap as I left it at my parents house, but will have it back in a few days.

Let me see, you used a mad and your machine and things were good. You stopped using your machine using only your mad and now your feeling bad again. I would think you should go back on your machine and stop using the mad. I bet you would start feeling better again. Meaning the mad was a waste of your monies.

mike1953 wrote:Let me see, you used a mad and your machine and things were good. You stopped using your machine using only your mad and now your feeling bad again. I would think you should go back on your machine and stop using the mad. I bet you would start feeling better again. Meaning the mad was a waste of your monies.

I should clarify--I used a machine for about a year without the MAD and it helped a little but not much. I used the machine with the MAD for one night to see what the data was with the MAD. I felt great. I then used the MAD without the machine for several weeks without the machine and felt great, but then I started feeling tired after those few weeks.

I would really like to know if further advancement of the device is necessary after a given amount of time in some cases? I can and might go back to my DDS, but it would be helpful to first get some feedback from those who have used these devices successfully.

Not to be a party pooper but I think you will be hard pressed to find many who have been successful on the MAD.I was diagnosed with mild SA and was prescribed a MAD, over time it was adjusted as far as my jaw would allow it to go. I had another sleep study and the SA had progressed to severe SA. I've been on CPAP for a little over a month and I have my life back!

Most ortho docs will adjust the device out as far as it can go without discomfort so there may be no more room for adjustments to be made. You should have a sleep study done to see if the device truly has helped or is of no help at all. Wishing you the best with your SA.

tiredman wrote:I would really like to know if further advancement of the device is necessary after a given amount of time in some cases?

tiredman, This is Gramps.

I have a MAD, Granny has a MAD and they don't work for either of us.

I read a lot about MADs before I had one made and over the years since I have read a ton of stuff about MADs. In all of that reading I never read that a successful initial adjustment later needed further forward adjusting.

Now it is known that obstructive sleep apnea is a progressive condition due to airway muscles becoming "flabbier" as we age. But this would take more time than the few weeks you describe. In other words, I don't think your airway muscles became flabbier after just a few weeks.

By what logic do you think your MAD would need forward adjustment after a few weeks?

I am trying to answer that question and one possibility would be that your airway has swelled due to inflammation from a cold or reflux condition. Have you had an upper respiratory infection or reflux?

The other possibility is placebo effect. Maybe you were excited about not having to use CPAP and feeling better was all in your mind. You know the placebo effect in humans is very powerful?

ChicagoGramps

A better solution, and more permanent one, to jaw advancement would be in going to an orthodontist and getting an expander (e.g., Crozat). I am undergoing orthodontia with an expander on the bottom jaw; I first started with the expander on top and bottom jaws. My lower jaw has come forward significantly, out of my airway.

Tiredman,

What type of dental appliance are you using? Certain ones can be advanced further but I don't know if that will help with your situation or not. Might be a question to ask your dentist instead of asking strangers on an internet board.

By the way, I am wondering if dental appliances act like pap machines in a way. Perhaps it is still treating your apnea but you feel like cr-p. Let me explain because I can see folks rolling their eyes.

One night, I had 4 hours of sleep on the pap machine and I felt like a million dollars. Got tasks done I hadn't accomplished in years.

Another time, I got 5 hours of sleep with a lower AHI and felt like I hadn't slept at all. My energy was zilch. I haven't heard of people with dental devices experiencing a similar situation but I do wonder.

Also, could you have other medical issues interfering that might not have anything to do with the effectiveness of the device. Just wondering.

Unfortunately, as other people have mentioned, it is tough when you can't really measure the effectiveness of the appliance. Anyway, ask your dentist what is going on.

49er

ChicagoGranny wrote:

tiredman wrote:I would really like to know if further advancement of the device is necessary after a given amount of time in some cases?

tiredman, This is Gramps.

I have a MAD, Granny has a MAD and they don't work for either of us.

I read a lot about MADs before I had one made and over the years since I have read a ton of stuff about MADs. In all of that reading I never read that a successful initial adjustment later needed further forward adjusting.

Now it is known that obstructive sleep apnea is a progressive condition due to airway muscles becoming "flabbier" as we age. But this would take more time than the few weeks you describe. In other words, I don't think your airway muscles became flabbier after just a few weeks.

By what logic do you think your MAD would need forward adjustment after a few weeks?

I am trying to answer that question and one possibility would be that your airway has swelled due to inflammation from a cold or reflux condition. Have you had an upper respiratory infection or reflux?

The other possibility is placebo effect. Maybe you were excited about not having to use CPAP and feeling better was all in your mind. You know the placebo effect in humans is very powerful?

ChicagoGramps

Gramps thanks a lot for your response.

I thought the MAD might need adjustment after a few weeks because it seemed to lose effectiveness. (If indeed it was the MAD that was making me feel better.)

I did not have a cold but reflux is possible as I tend to eat a little too late. 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. I'm not ruling out placebo as it's always a possibility but I don't think it is a factor in this case as the data from my auto pap showed lower AHI with the dental device. (Though I was certainly excited to not use the autopap!)

I myself am not 100% convinced that the MAD was the thing that was making me feel better (as most of those commenting here believe as well), however, the purpose of posting here is to at least like to make sure that it is adjusted properly. I am addressing one thing at a time in an effort to figure out what helps and what doesn't.

Logies101 wrote:Not to be a party pooper but I think you will be hard pressed to find many who have been successful on the MAD.I was diagnosed with mild SA and was prescribed a MAD, over time it was adjusted as far as my jaw would allow it to go. I had another sleep study and the SA had progressed to severe SA. I've been on CPAP for a little over a month and I have my life back!

Most ortho docs will adjust the device out as far as it can go without discomfort so there may be no more room for adjustments to be made. You should have a sleep study done to see if the device truly has helped or is of no help at all. Wishing you the best with your SA.

Thank you for your post!

49er wrote:Tiredman,

What type of dental appliance are you using? Certain ones can be advanced further but I don't know if that will help with your situation or not. Might be a question to ask your dentist instead of asking strangers on an internet board.

By the way, I am wondering if dental appliances act like pap machines in a way. Perhaps it is still treating your apnea but you feel like cr-p. Let me explain because I can see folks rolling their eyes.

One night, I had 4 hours of sleep on the pap machine and I felt like a million dollars. Got tasks done I hadn't accomplished in years.

Another time, I got 5 hours of sleep with a lower AHI and felt like I hadn't slept at all. My energy was zilch. I haven't heard of people with dental devices experiencing a similar situation but I do wonder.

Also, could you have other medical issues interfering that might not have anything to do with the effectiveness of the device. Just wondering.

Unfortunately, as other people have mentioned, it is tough when you can't really measure the effectiveness of the appliance. Anyway, ask your dentist what is going on.

49er

49er--I am using a Somnodent device. Going to the DDS to adjust each time is like $150 so I have been adjusting it myself. My jaw can go a little more forward and might try adjusting a little further.

You raise an interesting issue. My AHI with a PAP is relatively low and yet I often wake up feeling unrested. I attributed it to me having a very sensitive nervous system and being affected by even a few apneas per hour. However you state that with even lower AHI sometimes you feel worse. When I have my PAP back I will see what the data is--if my MAD use is still giving me even lower AHI than with the PAP and I am still feeling tired then something else must be at play, as might be in your case.

tiredman wrote: 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.

tiredman wrote: 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.

tiredman wrote: 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?

tiredman

I should also ask you about sleeping positions. OSA is usually worse when sleeping on the back. Your CPAP may control it fine while on the back. If it doesn't, you might try sleeping on the sides and checking the results.

If you changed the positions while using MAD sans CPAP, you would need to account for that variable in your analysis of how you feel.

tiredman wrote:

49er wrote:Tiredman,

What type of dental appliance are you using? Certain ones can be advanced further but I don't know if that will help with your situation or not. Might be a question to ask your dentist instead of asking strangers on an internet board.

By the way, I am wondering if dental appliances act like pap machines in a way. Perhaps it is still treating your apnea but you feel like cr-p. Let me explain because I can see folks rolling their eyes.

One night, I had 4 hours of sleep on the pap machine and I felt like a million dollars. Got tasks done I hadn't accomplished in years.

Another time, I got 5 hours of sleep with a lower AHI and felt like I hadn't slept at all. My energy was zilch. I haven't heard of people with dental devices experiencing a similar situation but I do wonder.

Also, could you have other medical issues interfering that might not have anything to do with the effectiveness of the device. Just wondering.

Unfortunately, as other people have mentioned, it is tough when you can't really measure the effectiveness of the appliance. Anyway, ask your dentist what is going on.

49er

49er--I am using a Somnodent device. Going to the DDS to adjust each time is like $150 so I have been adjusting it myself. My jaw can go a little more forward and might try adjusting a little further.

You raise an interesting issue. My AHI with a PAP is relatively low and yet I often wake up feeling unrested. I attributed it to me having a very sensitive nervous system and being affected by even a few apneas per hour. However you state that with even lower AHI sometimes you feel worse. When I have my PAP back I will see what the data is--if my MAD use is still giving me even lower AHI than with the PAP and I am still feeling tired then something else must be at play, as might be in your case.

Thanks Tiredman for letting me know. Yup, I wouldn't want to pay $150 to see the dentist for an adjustment either.

Good luck with your testing and getting the situation resolved. I am exploring some other issues but as you and everyone else on this boards knows, getting answers is easier said than done.

49er