Oral Appliances for OSA?????

curtcurt46 · Post by **curtcurt46** » Tue Jan 22, 2008 9:56 am

I know this is primarily about cpap use and OSA, but I was curious about anyone having success with an oral appliance similiar to the TAP device. If you are out there please give your experiences. Of particular interest is how you were able to determine success or failure.

Thanks,

Curtcurt46

socknitster · Post by **socknitster** » Tue Jan 22, 2008 10:02 am

I have heard several success stories with TAP. I have one myself but got it just days before discovering I was pregant and the thought of using it right now is just too overwhelming. After baby is sleeping through the night blah, blah, I will be returning to the device to give it a fair try. It seemed very confining and hard to get out of my mouth, but I could probably get used to it if I could get off cpap! An awkward object in my mouth would be easier than the hose. My concern is that it won't address my tongue falling back which i now beleive is my real problem.

jen

rested gal · Post by **rested gal** » Tue Jan 22, 2008 10:08 am

Below is a link that goes to many topics about the TAP oral appliance.

Quite a few people are using that successfully to treat their OSA. Of course it's always best to have a follow up PSG sleep study with the appliance in place to be sure it is getting the job done.

Many discussions about the TAP are at the dental sleep forum of talkaboutsleep.com

Clickable LINKS to surgery, turbinates, Pillar, TAP experiences
viewtopic.php?t=2836

oceanpearl · Post by **oceanpearl** » Tue Jan 22, 2008 10:12 am

I obtained one of the dentist fitted devices a couple of years ago and it was a total waste of 1800.00, of which I paid 20%

Velbor · Post by **Velbor** » Tue Jan 22, 2008 10:47 am

Since I use BOTH an oral appliance and CPAP, I think I may legitimately respond on this forum. I would also dare to refer you to a competitor forum, http://www.talkaboutsleep.com which has a sub-board specifically devoted to dental sleep medicine.

I was diagnosed with OSA in 1997. After abortive attempts to use CPAP, directed by my family physician, using what today would be considered primitive equipment, and no humidification, in 1999 I finally was referred to an oral/maxillofacial surgeon who was both doctor and dentist. I was evaluated as being a good candidate for success with an oral appliance (a very critical key step in the process) and a Klearway appliance was made for me. http://www.klearway.com

I have been using the Klearway since then, and continue to do so. It was easy to get accustomed to, and I sleep with it throughout the night. I can talk, I can drink water. It's easier than CPAP equipment to care for, and much simpler for travel. Subjectively, my body responded so well that I looked forward to its use, and I rarely considered sleeping without it. I felt markedly better, more awake, more alert, less sleepy. My wife heard less breathing noise from me, and much less no-breathing / gasp-start-breathing noise. Efficacy has been documented by several repeat sleep studies.

I've been using the Klearway for almost 9 years. I'm on my 4th appliance - they're custom-made, "durable" and well made, but teeth shift and normal dental work needs to be done and they're subject to considerable stresses in the mouth, so they do need periodic replacement. Insurance (BCBS) has covered all of them fully.

As my teeth have aged along with the rest of my body, it was considered prudent several years ago for me to return to CPAP one day weekly, to give my dental structures a periodic "break". I now use CPAP twice weekly, effectively, easily and comfortably, with my Klearway on the other 2 and 3 night stretches. I must say that I feel "different" on the mornings after CPAP than I do on the mornings after my appliance. I'd be hard pressed to call one "better" or "worse" than the other - they're simply different, probably related to differing details of sleep architecture. I enjoy and look forward to the different feelings of the switch-off, but if I had to choose just one, I'd go with the appliance, no contest.

By the way, I've found it impossible to use both therapies together. With the appliance in my mouth, I have no control over my cheeks on CPAP, and the air blows them out like puffballs.

Side effects, yes. Some jaw discomfort early on, but I haven't had that for years. Unquestionably my bite has changed. But the trade-off between that and not breathing / not sleeping is a no-brainer. My experience with an oral appliance has been very positive, and I'd encourage its exploration as an alternative to CPAP when medically appropriate.

curtcurt46 · Post by **curtcurt46** » Tue Jan 22, 2008 11:02 am

Velbor,
Thanks for the very informative report on your experiences. It will be very helpful in determining how I proceed. I was particularly interested in your using both, though at different times.

socknitster · Post by **socknitster** » Tue Jan 22, 2008 4:28 pm

Yes, Velbor, I also very much appreciate your very thorough post. My doctors want me to use both the cpap and the oral device at the same time during the adjustment period and I just can't see that happening. The TAP really opens the mouth up and I just can't see how I could keep the air from coming out of the mouth. They do make some kind of dam to try to prevent that. But, I don't know--just sounds like too much going on!

I am seriously going to give this a good try after the baby is here and sleeping well. Too dangerous to experiment right now, but this could really be the answer for me in the future. I went from an upper pressure of 14-16 down to 10-11 after my tonsilectomy. It seems to me that if the TAP works, it could get me off cpap.

It is heartening to hear that it has worked for others.

What is your cpap pressure and your original AHI from your first sleep study, Velbor? Just curious!

Jen

jskinner · Post by **jskinner** » Tue Jan 22, 2008 6:02 pm

I use a Klearway in combination with CPAP. If I was starting over again I would start with a mandibular advancement device first. Its much more comfortable to sleep with then CPAP. Used alone helps quite a bit but is not as good as CPAP.

Slinky · Post by **Slinky** » Tue Feb 05, 2008 10:04 am

Thank your for that information about the Klearway, Velbor. It does sound more comfortable than some of the dental options I've read about. I know you are pretty savvy so you really had my curiosity up WHY the combinatin of Klearway and CPAP but not on the same nights.

And we appreciate that you specifically mentioned that PSGs had confirmed the Klearway's efficacy for you as there are those that try something other than CPAP and then swear they are "cured" w/o ever having a PSG to confirm the "cure".