Latest & Greatest Oral Appliances

[brain_cloud]

Esteemed OSA Geeks and Freaks,

Longtime 100% compliant cpapper here (since Oct 2009).

Also, longtime sufferer of ingested air or aerophagia, whatever you want to call it. I've struggled with this from day one. Finally decided just to live with it, and perhaps I can do that. But first I'm going to try an alternative, although the likelihood of it succeeding is not super high. But I'm hoping that just maybe, a good oral appliance, in conjunction with strict positional discipline (to wit, avoidance of supine sleeping), just may deliver effective therapy. Or, if it doesn't quite get the job done, it still may allow a large enough lowering of pressure so that I could use my machine without the annoying air-in-the-guts.

So then, what are the very best oral appliances out there? I know this is a cpap forum, but still some of y'all dabble in the oral appliance game, surely? We're just brainstorming here--no recommendation is too outre or recherche. And while I don't exactly want to throw a shit-ton of money at this, I will spend several thousand if that is what is required to get high quality.

Anyhoo, I've talked enough. Now it's your turn.

Paul J.

[Goofproof]

If you really have used XPAP for a long time, and have done your research, you should know be now XPAP treatment is the Gold Standard Treatment.

Your present quest, is only a devirgment from your treatment, one would think you would be past that. Jim

[kteague]

I have seen people post on here about using a dental device with their CPAP. Guessing that those who have successfully transitioned to using only the oral device aren't hanging out here. Good luck finding someone with knowledgeable input. I did a focus group last year on some new devices coming out, but of course they didn't let us know any names. Let us know how this effort works out for you. Especially if you gain any measure of success. Would be nice to have more stories on record.

[chunkyfrog]

Please share your findings.

[ChicagoGranny]

what are the very best oral appliances out there?

They are not exactly "out there". You have to go inside an authorized dentist's office and have them fitted and fabricated.

The two "best" are (in alphabetical order):

- SomnoDent Fusion http://somnomed.com/dentists/somnodent- ... nt-fusion/

- TAP III Elite http://tapintosleep.com/breathing-devic ... ap-custom/

Of course, see a dentist you trust. Depending on the condition of your teeth and your anatomy, he may recommend a different model.

Gramps and I both have devices. I spent $1600 for mine and he spent a bit more for his. Both devices reside comfortably in the dark of a drawer in the bedroom chest.

CPAP rocks!

[brain_cloud]

If you really have used XPAP for a long time, and have done your research, you should know be now XPAP treatment is the Gold Standard Treatment.

Your present quest, is only a devirgment from your treatment, one would think you would be past that. Jim

If I'm reading the chart below correctly, it seems to say (since my AHI is 72) that there is a 35% chance of getting to AHI < 5 using an adjustable oral appliance. This is from the study in 49er's signature. Not great odds but not hopeless either.

A guy with his head under the sink is bound to be a pessimist.

[brain_cloud]

I have seen people post on here about using a dental device with their CPAP. Guessing that those who have successfully transitioned to using only the oral device aren't hanging out here. Good luck finding someone with knowledgeable input. I did a focus group last year on some new devices coming out, but of course they didn't let us know any names. Let us know how this effort works out for you. Especially if you gain any measure of success. Would be nice to have more stories on record.

Hi Kathy (and chunkyfrog), yup I'll measure and chart and graph and we'll see where it goes. Cheers.

Paul J.

[H.C]

I've used an appliance for over 20 years, and will write about my experiences. But I'm going to bed now.
Thanks for starting this thread.

[49er]

If you really have used XPAP for a long time, and have done your research, you should know be now XPAP treatment is the Gold Standard Treatment.

Your present quest, is only a devirgment from your treatment, one would think you would be past that. Jim

If I'm reading the chart below correctly, it seems to say (since my AHI is 72) that there is a 35% chance of getting to AHI < 5 using an adjustable oral appliance. This is from the study in 49er's signature. Not great odds but not hopeless either.

A guy with his head under the sink is bound to be a pessimist.

Thank you for clicking on the link in my signature. As an FYI, the sleep medicine dentist I corresponded with from the now defunct ASAA board pretty much had the same statistics regarding the TAP appliance for severe sleep apnea.

You also might look into combination treatment using the tap appliance and pap therapy which might serve your needs in lowering the pressure.

http://www.austinapnea.com/combination_ ... tment.html

Finally, you might also want to do a search of the forum archives for tips on dealing with aerophagia(sp?) if you haven't already.

Best of luck to you.

49er

[MeToo]

I've thought about this as well. My pressure needed to be increased incrementally as time passed (as judged by my autopap's diagnostics). At a pressure of 11-12, I had constant aerophagia. I was strongly considering getting a dental appliance to lower the pressure and thereby lower the aerophagia. I have an Activa mask and I wondered about the mask fitting the upper lip with the dental appliance under it. Pillows would seem to be better with an appliance.

End note: I decided to have another sleep study and the technician said my pressure needed to be LOWERED to a fixed 8 cfm (the doc agreed after looking at the sleep report for a measly 2 seconds). I had been trusting my apap diagnostics, which was telling me my 95% pressure was at the higher end of my pressure range, so I would increase the pressure range only to have the diagnostics tell me (over months and years) to increase my pressure. I was originally titrated at 9 and over the course of about 7 years or so (I eventually bought an apap based on reading this forum -- thanks all!) my apap indicated that my pressure should be increased from 9 to 11 -12. So after sleep study, I set my Airsense 10 to 8 cfm and it seemed okay but I occasionally felt like I was choking. I engaged autopap function and set pressure range 8-9 and again my diagnostics say that my 95% should be closer to 9. I'm not sure what the Hades is going on here and not sure whether to trust sleep study our my machine. My AHI is around 2.2.

If you decide to try the appliance, please keep us posted.

[Cardsfan]

I have a $500 dental device. It is very uncomfortable to have my jaw in that position all night long. I figured it was doing more harm that good having my jaw forced into that unnatural position for 8 hrs a day.
The only time I would wear that dental device is if my cpap machine was unavailable. (broken, no electricity) Plus, I don't trust that the dental device is even working. I know my cpap is working, and it doesn't cause me jaw pain.

My dental device came from my dentist, he said normally they sell for around $3,500. -

[ChicagoGranny]

I'm not sure what the Hades is going on here and not sure whether to trust sleep study our my machine. My AHI is around 2.2.

It seems you are trying to titrate yourself using the summary data, which includes averages, off of the machine display. You are also relying on the "95% statistic" which is a poor statistic for titrating.

Most of the seasoned people on here will tell you to download the free Sleepyhead software so you can see what is going on breath by breath and do a much better self-titration.

Good luck,

[Pugsy]

I engaged autopap function and set pressure range 8-9 and again my diagnostics say that my 95% should be closer to 9. I'm not sure what the Hades is going on here and not sure whether to trust sleep study our my machine. My AHI is around 2.2.

95% numbers of anything (leak or pressure) just mean that for 95% of the time we were AT OR BELOW that number for 95% of the night. People tend to forget the "or below" part of the definition and think that's where they are at for pretty much all night.
95% are easily skewed by just a short time period where higher happens and they aren't the hold grail of numbers that people think they are. Sometimes they can be a good indicator of where a person might want to set the machine in cpap mode and sometimes they are way off.

95% numbers can be higher during REM sleep or when sleeping on our backs and thus they can vary a lot from night to night as we might be having more or less REM sleep or more or less time sleeping on our backs.

Like CG says...it's not the best number to be basing therapy pressure needs on unless we are looking at them in extremely long term...like 6 months or so. Night by night they just can change to easily.
When I was using APAP I might have 95% pressure of 18 cm one night and the next night maybe 11 cm.
Long term I was probably around 12 cm.

[SewTired]

I have a $500 dental device. It is very uncomfortable to have my jaw in that position all night long. I figured it was doing more harm that good having my jaw forced into that unnatural position for 8 hrs a day.
The only time I would wear that dental device is if my cpap machine was unavailable. (broken, no electricity) Plus, I don't trust that the dental device is even working. I know my cpap is working, and it doesn't cause me jaw pain.

My dental device came from my dentist, he said normally they sell for around $3,500. -

My dentist won't even deal with dental devices for apnea. He's seen too many cases of folks developing TMJ from them. He has a cpap himself.

[ChicagoGranny]

If I'm reading the chart below correctly, it seems to say (since my AHI is 72) that there is a 35% chance of getting to AHI < 5 using an adjustable oral appliance.

The 8 Reasons Why Dental Appliances May Not Work For Your Sleep Apnea

http://doctorstevenpark.com/podcast-8-t ... leep-apnea