Twin Cities News Segment - Diagnosis and Dental Appliance

http://www.myfoxtwincities.com/story/20 ... -treatment

Interesting clip, I think we all agree there needs to be better awareness. I wish they would have done a better job saying that the CPAP is the best and tolerated by many. I do wonder if the device he got is better than the surgical options that only reduce AHI by 50% though. I probably couldn't do an appliance since I have been diagnosed with TMD.

Wow! I heard him say there are 80 different brands of oral appliances. That is amazing how many companies have jumped into this!

KrisasMan wrote:http://www.myfoxtwincities.com/story/20 ... -treatment

Interesting clip, I think we all agree there needs to be better awareness. I wish they would have done a better job saying that the CPAP is the best and tolerated by many. I do wonder if the device he got is better than the surgical options that only reduce AHI by 50% though. I probably couldn't do an appliance since I have been diagnosed with TMD.

This is my latest understanding of the research on dental appliances and I will not swear that I am 100% accurate but here goes. In corresponding with the sleep medicine dentist on the apnea support board, the Tap III is the most effective dental appliance for apnea, particularly for severe cases. I have seen another citation that says the same thing.

The success rates provided have been 75% for mild, 60% for moderate, and 40% for severe. Initially, I thought that meant if the AHI got below 5. But in clarifying with Dr. Luisi, success results are counted if the AHI is reduced by 50%.

Of course, I questioned that and he provided me a citation that showed that if the AHI is reduced to the mild range, that folks don't have that much of a greater chance of a stroke and heart attack than normal people. I didn't read the citation because I just didn't have the brain power to do so.

And to be honest, I am kind of skeptical about it. I mean, if you're stopping breathing even at the high end of the mild apnea spectrum, that are lot of breathing pauses.

Anyway, I previously believed that a dental appliance was a definite option if you had mild or moderate apnea. I have changed my mind to say that this is true only for mild apnea.

However, having said that and feeling like I have tried everything to make apap work to no avail (I am not ready to give up yet) and knowing that there are plenty of other people in my position, I don't think we can simply throw statistics at people and say you have to stick with cpap come heck or high water. Even Steven Park says there are many people who are simply cpap intolerant.

But if people's odds aren't good with dental appliances, then they need to do what they can to increase the odds of success. Personally, I would chose a sleep medicine dentist who pretty much limited his/her practice to dental appliance/TMJ work. I would be suspicious of the provider who seemingly is doing this on the side.

I do not know what the success rate is for various surgical options. I thought it was under 50% but I could be totally wrong.

Since this guy has a severe case, I hope he will post updates to let people know how his dental appliance is working. That would be very encouraging to people who who have a severe case of apnea who can't tolerate the cpap.

Finally, I realize your mileage will vary and there are exceptions to every rule regarding studies.

49er

I cannot imagine that putting a bunch of metal and plastic in your mouth that pulls the lower jaw forward and leaving it there all night is more comfortable than a soft mask blowing at a low pressure.

To each his own.

Do they make dental appliances for patients who have dentures--and sleep with them out?
--Not me; for a friend. . .

chunkyfrog wrote:Do they make dental appliances for patients who have dentures--and sleep with them out?
--Not me; for a friend. . .

Hi Chunkie,

The sleep dentist on this board says you need 8 natural teeth par arch.

http://www.apneasupport.org/dr-luisi-ta ... 28566.html

49er

At 25 left after dental mal-whatever, I would barely qualify; my friend has zero.

When I changed dentists in 2009 and at my first appointment, he found out that I had both TMJ and sleep apnea. He recommend a dental appliance to me called the Silent Nite which helps with both issues. I've been using it for the last 3 - 4 years. You've find information on it on this website. http://www.ihatecpap.com/oral_appliance.html . With with regards to sleep apnea, the main purpose of a dental appliance is bring your lower jaw forward to allow more of a passage way to breathe and prevent the back of your throat from collapsing. That's it. Therefore, the xpap and dental appliance work in partnership in dealing with OSA. It won't "prevent" the different events from occurring, just allows more open passage way for the oxygen to pass. It's comfortable for me to use. However the pins have broken time to time.

Starlette

Was TMD/TMJ an issue with your appliance? Does it reduce your xPAP pressure?

I have moderate osa. I've had two dental appliances. Both times the dentists told me that my insurance would pay for it. Both times I had big out of pocket expenses. The second time they paid a small portion, the first time, nada. I even called the ins company in advance the second time to make sure they'd pay. I forgot to ask if they paid the full amount less a small copay. So be wary if you expect the ins to pay. I don't have a lot of money and the payments were a real burden.

My experience was that they were far, far less effective than a cpap. My sleep got worse and worse, but not back to pre-cpap levels. I really didn't notice how much my sleep was suffering until it went way downhill. If I'd continued I might have found "bottom" but I went back to the cpap. I <3 cpap!! Good rest is one of life's wonders to me.

The first one, a TAP III broke and could not be fixed unless I went to a sleep dentist. The first dentist kind of disappeared and never answered my calls. He was from out of state and I had to drive to another city to get this done. That's why I found a second dentist who could fix it. But it seemed that it was not made properly (my jaw did not come far enough forward). Since the second dentist had a better reputation and was local, I went with her opinion and got the second device. It was the pink one that looks like vampire teeth upside-down, but I don't remember the name. I do think she did a better job fitting me and adjusting it, etc.

However, the checking how it works is not very scientific. Lots of questionaires given by an assistant. No regular sleep study, for instance. I'd only advise it if there were a proper sleep study in a good clinic as a follow up. This dentist wanted to do an in-home study, not the same thing at all. Because I knew a lot about sleep studies (thanks to cpaptalk) I realized it was not a good followup and declined it, since I'd have to pay her for it. My level of sleep deprivation was obvious.

I have moderate OSA. If I had mild it might have worked, I don't know. I was hoping to use it for travel, camping, power outages, etc. even if it were somewhat less effective. But it is way less effective, though probably better than nothing. I'd wear it if the power went out and I'd used my backup battery up. I'd sleep on my side wearing a backpack device. It would help some, but not near as good as cpap.

Also, if someone absolutely won't use their cpap, it might help a bit. But two close people in my life started off not able to wear cpaps, really seemed they absolutely wouldn't use them. They finally came around to it and now can see the huge changes using cpap. If they'd opted for a dental device rather than toughing it out, they would not be as healthy.

I can see using them in conjunction with a cpap in some cases. At first I wore mine in conjunction with a cpap. This was as I was getting used to it.

It's hard to tell if it caused any tmj problems. I already had them. There is some pain as one adjusts the device, but I went very slowly and it was ok. More slowly than they recommend, btw. I sometimes had pain, but then I sometimes had pain before using the device.

Bottom line. It didn't work for me. I really wanted it to. I spent a lot of time and money. It was too expensive as an experiment.