Maxillary Expansion (DOME) to enable effective CPAP treatment?

[palerider]

The question that remains is why CPAP would be more effective breathing through my nose.

No clue, but this guy might know:
https://doctorstevenpark.com/tag/mouth-breathing

[sephiro499]

Dr. Park's 1st book is good place to get all of his theories. But if you don't have the time/money it is all pretty much available on his website. His podcast interviews are good and he has several just with Dr. Krakow.

His theory is that sleep apnea is a cranial facial problem. I know that I fit this definition. Maybe the OP does too? That would help you decide if dental or other surgery would benefit you. Some would say that 'he is just selling surgery' but the same could be said for other doctors selling cpap machines and mask/supplies for basically a lifetime. Dr. Park says himself he tries all conservative interventions first.

He doesn't strike me as a huckster or a self promoter. All he is selling on his site are his two books and his personal services. His podcast does not have any ads. And he really questions the long-term compliance of cpap. That was the first time I ever heard that because every doctor I've seen (since 2009) told me 'I'd feel better the next day'. So his theories and opinions were a breath of fresh air. His book says the 'official' compliance rate of cpap is anywhere between 40-80% and the long term compliance in his practice is 10-20%.

One of his arguments I heard during his podcast is that a surgical procedure, that would always exert it's benefits, better than a treatment (cpap) that while it essentially cured the OSA was only used sporadically? Of course everyone would have to make that personal decision for themselves in conjunction with their treating doctor(s).

If OP lives anywhere near Manhattan in New York an in person consult could be an option.

[harrywr2]

Nasal breathing produces a small amount of nitrous oxide that gets pulled down into your lungs. This is believed to have beneficial effects.

Mouth breathing is a major contributor to gum disease and associated problems. (Ive lost one tooth do far)

[chunkyfrog]

Nasal breathing produces a small amount of nitrous oxide that gets pulled down into your lungs. This is believed to have beneficial effects.

Mouth breathing is a major contributor to gum disease and associated problems. (Ive lost one tooth do far)

Mouth breathing dries soft tissues in the mouth.
Moisture is essential in fighting decay and gum diease.
Best not to put much stock in that nitrous oxide fad.

[fireyoni09]

I had non-surgical maxillary expansion with ALF appliances. There are a few other non-surgical options as well offered by airway-focused dentists. The effects aren't as extreme as surgery, and slower of course, but less invasive.

Do you feel better now? Were you using CPAP before and after?

[Janknitz]

I know someone who had this procedure and I can put you in touch with him if you would PM me. For him it has been a profound improvement.

Does your severity rise to the level where the benefit outweighs the burden's of this procedure? That's an important consideration because it's major surgery. Get second and third opinions.
Make sure you absolutely clearly understand what your surgeon means by "success" and make sure it aligns with your expectations--also that you have a reasonable chance of achieving it.

If it's not successful, do you understand what you may have to live with the rest of your life?

[rosie1231]

I had non-surgical maxillary expansion with ALF appliances. There are a few other non-surgical options as well offered by airway-focused dentists. The effects aren't as extreme as surgery, and slower of course, but less invasive.

Do you feel better now? Were you using CPAP before and after?

Yes, but not related to sleep honestly. The expansion helped decompress the TMJs which in turn reduced a lot of tension and pain in my face/neck/upper back. Chronic ear infections disappeared overnight and my ears felt like wind tunnels. So much improvement in sinus issues.

However, I was really disappointed that it did not solve my sleep issues. I pursued CPAP after finishing the expansion. I suspect that the issue CPAP resolves for me relates not to maxilla position but to nasal valve collapse.

[patrissimo]

1. Why would breathing from my mouth instead of from my nose render CPAP ineffective? Can anyone point me to literature backing this up?

2. Before I commit to surgery, I want to be sure that breathing from my nose during sleep will actually help me feel better. To test this, I am looking into using a chin-strap or taping my mouth during sleep, plus clearing my nasal passage as best I can without surgery, at least for long enough to reach some sort of conclusion.

I disagree that your test will work. If you are mouth breathing because of a small nasal airway, or nasal obstruction (like congestion, swollen turbinates), then trying to breathe through your nose pre-surgery will be worse airflow and worse sleep. It sounds like your doctor is suggesting to expand your nasal airway, so that you can nose breath. (I am currently in the process of palate expansion using Dr. Li's EASE procedure).

Personally I wouldn't think of it in such black & white terms. The more drag on your airway, the more your brain will go fight-or-flight and wake you up. Any surgery that successfully expands your airway (particularly any bottlenecks) and reduces the overall drag should lead to better sleep (with or without CPAP) and less arousals. Many surgeries actually don't do much to expand the airway in most people (UPPP, say). Palate expansion and MMA, on the other hand, while they are much more invasive than soft-tissue, actually serve to expand the airway in a significant way.

Hence, doing one of those procedures will usually improve your sleep.

[nee]

Yeah, my long-term plan is to do mandibular and maxillary expansion through periodontal surgery + Invisalign, followed by MMA surgery to increase the antero-posterior dimension of my airway.

The periodontal surgery ("Periodontally Accelerated Osteogenic Orthodontics (PAOO) or Wilckodontics") itself is interesting. It consists of cutting holes and slits into the jawbones, putting a bone graft and periodontal membranes over it, stitching everything back up, and starting Invisalign trays which are switched out every 3 days instead of 2 weeks. The intentional "damage" done to the jawbones brings in cells that allow for rapid expansion.

Both of these combined should "cure" me, according to the dentist and ENT and oral surgeon I'm working with. I'm only 29 years old and don't want to be dependent on any appliances for the rest of my life, so it makes sense for me. Paying for it all is another matter altogether...

[babydinosnoreless]

For anyone doing jaw enlargement surgery because you think it will get you off the cpap. Don't. I was in middle school when they cut my jaw moved it forward and put pins in place. Today I need a bilevel machine with pretty high pressure to keep my airway open. On top of still needing a bilevel machine my jaw aches every time the weather changes. There are some masks I can not wear because it puts the wrong pressure on my jaw and it hurts. I know they have come a long way with surgery since mine was done in the late 70's. But IMO no surgery is without risks and the long term ache in my jaw totally not worth it. My personal opinion is that orthodontists, dentists and oral surgeons are all a bunch of sadists and you can't trust any of them. That being said get a second opinion from someone not associated at all with the first people. It is amazing what they try to pull on people. My husband had a doctor tell him he needed a hip replacement. 2 other doctors said no way. Thank goodness they did because the problem wasn't the hip at all but in the back.

[nee]

For anyone doing jaw enlargement surgery because you think it will get you off the cpap. Don't. I was in middle school when they cut my jaw moved it forward and put pins in place. Today I need a bilevel machine with pretty high pressure to keep my airway open. On top of still needing a bilevel machine my jaw aches every time the weather changes. There are some masks I can not wear because it puts the wrong pressure on my jaw and it hurts. I know they have come a long way with surgery since mine was done in the late 70's. But IMO no surgery is without risks and the long term ache in my jaw totally not worth it. My personal opinion is that orthodontists, dentists and oral surgeons are all a bunch of sadists and you can't trust any of them. That being said get a second opinion from someone not associated at all with the first people. It is amazing what they try to pull on people. My husband had a doctor tell him he needed a hip replacement. 2 other doctors said no way. Thank goodness they did because the problem wasn't the hip at all but in the back.

As a dentist myself... oof, that stings a little bit. I'm sorry it didn't go well for you, and I'm not sure why they did that to you in middle school while you were a growing child. What was their reasoning? At that point in your life, non-surgical treatment would have worked for you. I don't know your particular situation today, but although your cranio-facial factors may now be "normal," other factors (such as being overweight) may necessitate CPAP usage.

I'm getting an opinion from Dr. Zaghi as well, an ENT based in Los Angeles who is affiliated with The Breathe Institute.

There are plenty of peer reviewed articles showing the high success rate of MMA in "curing" sleep apnea, especially in certain scenarios (such as normal weight, no medical problems, just cursed with a retrognathic jaw). Of course it's not without risks, I just have to weigh them against being in a sleep appliance for 50+ more years to get a normal night's sleep.

[ChicagoGranny]

I'm not sure why they did that to you in middle school while you were a growing child. ... At that point in your life, non-surgical treatment would have worked for you.

+1

[babydinosnoreless]

For anyone doing jaw enlargement surgery because you think it will get you off the cpap. Don't. I was in middle school when they cut my jaw moved it forward and put pins in place. Today I need a bilevel machine with pretty high pressure to keep my airway open. On top of still needing a bilevel machine my jaw aches every time the weather changes. There are some masks I can not wear because it puts the wrong pressure on my jaw and it hurts. I know they have come a long way with surgery since mine was done in the late 70's. But IMO no surgery is without risks and the long term ache in my jaw totally not worth it. My personal opinion is that orthodontists, dentists and oral surgeons are all a bunch of sadists and you can't trust any of them. That being said get a second opinion from someone not associated at all with the first people. It is amazing what they try to pull on people. My husband had a doctor tell him he needed a hip replacement. 2 other doctors said no way. Thank goodness they did because the problem wasn't the hip at all but in the back.

As a dentist myself... oof, that stings a little bit. I'm sorry it didn't go well for you, and I'm not sure why they did that to you in middle school while you were a growing child. What was their reasoning? At that point in your life, non-surgical treatment would have worked for you. I don't know your particular situation today, but although your cranio-facial factors may now be "normal," other factors (such as being overweight) may necessitate CPAP usage.

I'm getting an opinion from Dr. Zaghi as well, an ENT based in Los Angeles who is affiliated with The Breathe Institute.

There are plenty of peer reviewed articles showing the high success rate of MMA in "curing" sleep apnea, especially in certain scenarios (such as normal weight, no medical problems, just cursed with a retrognathic jaw). Of course it's not without risks, I just have to weigh them against being in a sleep appliance for 50+ more years to get a normal night's sleep.

It didn't start or stop in middle school. I was put in retainers at 5-6, I only had one or two teeth fall out naturally they pulled the rest. By the time I was in high school they had me in headgear 24-7 and then yelled at me for over-correcting for following what they told me. They used rubber bands, headgear, retainers and braces to torture me through my entire childhood. Oh did I mention the gum surgery because I was allergic to the metal ? The years of non stop harassment for not cleaning my teeth right when it turns out I was allergic to that metal.

This rant was not directed at you personally. I think it is always a good practice to get 2nd opinions before major any surgery.

As for weight causing OSA, I'm pretty sure that is an old fashioned and debunked theory, but let me assure you that I wasn't overweight when I was being tortured with all the dental work.

[nee]

It didn't start or stop in middle school. I was put in retainers at 5-6, I only had one or two teeth fall out naturally they pulled the rest. By the time I was in high school they had me in headgear 24-7 and then yelled at me for over-correcting for following what they told me. They used rubber bands, headgear, retainers and braces to torture me through my entire childhood. Oh did I mention the gum surgery because I was allergic to the metal ? The years of non stop harassment for not cleaning my teeth right when it turns out I was allergic to that metal.

Pulling out all the teeth caught my attention. Our baby teeth being in place for as long as possible are what guide our adult teeth to come in properly. I have a feeling all of your problems started when those primary teeth were taken out before their time.. It sounds like you were the victim of badly managed treatment. I assure you there are many of us who are becoming aware of the benefits/consequences of dental treatment in airway development, and we're even screening infants now for any signs of trouble.

This rant was not directed at you personally. I think it is always a good practice to get 2nd opinions before major any surgery.

No offense taken. And agreed.

As for weight causing OSA, I'm pretty sure that is an old fashioned and debunked theory, but let me assure you that I wasn't overweight when I was being tortured with all the dental work.

How has it been debunked? If my understanding is correct, higher fat content in the soft tissues of the oropharynx can reduce oxygen intake during sleep. This is why people's snoring/apnea can improve with weight loss. I'm welcome to any studies showing otherwise as I'm always looking to learn more.

I do also believe that craniofacial anomalies predispose us to OSA, which in turn causes obesity via hunger hormone dysregulation. For years I have had difficulty making progress at the gym and controlling my weight, and now that I am managing things with a mouth appliance + CPAP, I'm finding it much easier to regulate what I eat and make progress at the gym.

[babydinosnoreless]

It didn't start or stop in middle school. I was put in retainers at 5-6, I only had one or two teeth fall out naturally they pulled the rest. By the time I was in high school they had me in headgear 24-7 and then yelled at me for over-correcting for following what they told me. They used rubber bands, headgear, retainers and braces to torture me through my entire childhood. Oh did I mention the gum surgery because I was allergic to the metal ? The years of non stop harassment for not cleaning my teeth right when it turns out I was allergic to that metal.

Pulling out all the teeth caught my attention. Our baby teeth being in place for as long as possible are what guide our adult teeth to come in properly. I have a feeling all of your problems started when those primary teeth were taken out before their time.. It sounds like you were the victim of badly managed treatment. I assure you there are many of us who are becoming aware of the benefits/consequences of dental treatment in airway development, and we're even screening infants now for any signs of trouble.

This rant was not directed at you personally. I think it is always a good practice to get 2nd opinions before major any surgery.

No offense taken. And agreed.

As for weight causing OSA, I'm pretty sure that is an old fashioned and debunked theory, but let me assure you that I wasn't overweight when I was being tortured with all the dental work.

How has it been debunked? If my understanding is correct, higher fat content in the soft tissues of the oropharynx can reduce oxygen intake during sleep. This is why people's snoring/apnea can improve with weight loss. I'm welcome to any studies showing otherwise as I'm always looking to learn more.

I do also believe that craniofacial anomalies predispose us to OSA, which in turn causes obesity via hunger hormone dysregulation. For years I have had difficulty making progress at the gym and controlling my weight, and now that I am managing things with a mouth appliance + CPAP, I'm finding it much easier to regulate what I eat and make progress at the gym.

Sorry I don't have any studies for you all I know is what I've read in this forum and other places.

https://elementshealthspace.com/4-myths ... ea-busted/

I wasn't overweight until a few years ago when my thyroid quit working correctly. Since being on the bilevel machine I've lost almost 50 lbs and have more energy than I've had in years, even before I gained any weight. In fact it was the thyroid going wonky is what led to the sleep apnea diagnosis but I'm pretty sure I've had sleep apnea for years. I've always snored and had bad sleep.