Discussion of Small Jaws as Cause of Obstructive Sleep Apnea

[socknitster]

Someone recently asked me how I found my orthodontist, here was my reply. It probably repeats content in the thread, so consider it a summary:

Long story short, the kind of orthodontist needed is a NON-EXTRACTION ORTHODONTIST who uses SELF-LIGATING braces. Basically, this type of ortho does the opposite of traditional dentistry. Traditional dentristry pulls teeth to make them all fit and then uses brackets to pull the teeth in, effectively making the mouth smaller in total volume. A non extraction orthodontist rarely, if ever, pulls a tooth and uses self-ligating brackets to move the teeth outward, effectively making oral volume larger, the arches wider from molar to molar and the smile wider with no dark patches at the corners of your smile--ie a toothy grin. Another type of dentist that works to achieve the same goal, is a functional orthodontist who uses retainers that push from the inside of the mouth out. My orthodontist does both methods but said my mouth was too small for functional orthodontics--my tongue is already too cramped in a small space.

I did several extensive searches to find my Orthodontist, and I believe I discuss it in the thread I link to above (edit: this thread) Damon system braces are a type of self-ligating braces. The manufacturer has a website and I searched for dentists that use them in my state. There is an association for functional orthodontics and I searched on their website for local orthos also. Also, I think there may be an association for non-extraction orthos that I searched. I found a list of about 10 within a 1 hour driving distance and went to their websites to review their credentials then made a list of 3 that I felt were the best and made appointments. The one I thought was the most qualified was the 1st appointment I went to and I liked him and his staff so I cancelled the other two.

He is always busy (a good sign) and he concentrates on adults. I've seen a woman in her late 60's to early 70's there getting treatment, as well as children and teens and other adults. He was very honest with me about what he could achieve and what the limitations would be. It will take about 2 years from beginning to end, though I'm currently a bit ahead of schedule.

BTW--in terms of numbers from my CPAP, I always have an AHI of 2 or less. Usually it's less than 1 and I'm 4 years in and still not better, which is why I'm looking outside the box. I really think there is something to the UARS and I'm going to be tested for that. But hopefully between the tonsillectomy and the braces I will be cured in a couple of years.

Jen

[tiredintenn]

Is this different from the DNA appliance or do they do the same thing? ie expand the jaws

[socknitster]

I don't know anything about the DNA appliance, as I only heard a reference of it in passing. I suspect it may be a form of functional orthodontics that uses appliances (like retainers) instead of braces. Both can achieve the same goal. In my case, there wasnt room in my mouth for an appliance. The orthodontist felt that braces were a better option for me. Do you have a link to this DNA appliance you could share?

Jen

[tiredintenn]

I don't know if I can post the link. If you google "DNA Appliance and Sleep Apnea" I am sure it will come up. I can't find any studies but I have heard good anecdotal stories. Anyone else know anything about this? It appears to be very new.

[Mike_Snodgrass]

I just posted a case study of how my dental appliance practically eliminated my OSA - might have relevant information for everyone. I think the structure of my jaw might have been a big reason for severe apnea.

viewtopic.php?f=1&t=62226&p=582498#p582498

[socknitster]

That is awesome, Mike! I'm really happy for you that it is working. Have you talked to the orthodontist about making permanent changes to your mouth so you won't have to use it forever? For example, the DNA appliance mentioned above is worn in the evenings and at night while sleeping. Your insurance might cover braces or other corrective therapies. The hardest part is finding the right orthodontist. Just food for thought. The important thing is that the therapy you have chosen now is working and dont we all love that!

Jen

[Mike_Snodgrass]

Didn't even consider that, but will look into it. Great thought - thanks!

[RosemaryB]

Wow, Jen! I haven't visited cpaptalk for ages and don't have much time now, but mainly have read this thread. I'm glad to hear that you are doing something that has so much promise! Rooster, thanks for starting this thread! Great information by you, Jen, and others.

Back along the way I was very interested in UARS since my sleep study had a lot of unexplained arousals that were not taken care of in the titration study. I even tried to get tested (regular sleep study but with UARS testing added in) but that failed since there was a balloon thing they put in my esophagus which I choked up during the night. With severe GERD I just could not tolerate it, I believe, but YMMV. Part of this study was to see if my TAP appliance was working. The study showed it was, but there was no supine sleep due to the complications and the study being very short. However, it’s inconclusive at best, since most of my apneas were during supine sleep in the original study and this study had no supine sleep since the study had limitations due to coughing up the balloon thing and not getting a very complete picture (short study, but still long enough).

I’ve been 100% compliant with cpap and/or mandibular device since then. It has been a great improvement compared to pre-cpap, but I believe there are still problems, probably relating to the UARS. The cpap seems to be significantly better than the mandibular device, but I don’t rule it out since I used it for an extended period when a close friend was hospitalized and I stayed in the hospital 24/7 with him for about 3 weeks. I did not want to take the cpap and risk some horrible flesh-eating bacteria getting into it , so I just used the mandibular device. I was worn out after that, but it’s hard to tell why, since it was a stressful experience with being awakened during the night in the hospital. I’ve also used it for a week at a time w/o cpap. My conclusion is that the mandibular device works in an emergency, but not as good as the cpap. If I can side sleep, it’s better, but I’ve had some neck problems and back sleeping is best right now. It’s a work in progress.

Not to hijack the thread, I just wanted to congratulate you on your creativity and persistence. I also wanted to say that some testing may include both apneas and UARS. My insurance paid for this test without a question. In fact, I wanted to urge people to find a place where they can get BOTH TESTS (UARS AND APNEAS/HYPOPNEAS) WHEN THEY GET THEIR FIRST SLEEP STUDY and do the research to find places near you that will do it.

I am going to research the orthodontic route. My MD first sent me for an OSA diagnosis based on my mouth/airway structure. I’m pretty old and not rich, but if some dental correction could make a difference, I’ll start saving my money and cut out luxuries, like food and shelter if need be . Seriously, I value restful sleep right along with these other things. Human needs really are “food, clothing, shelter, restful sleep.”
Also, Jen, if you haven’t already, you may want to try SAM-e. The active ingredient is used in the ATP (energy cycle) by every cell in the body. It has made a huge difference in my energy levels (and my arthritis, which is why I first tried it.) It’s the one supplement I would not be without. I take 400 mg twice a day. Though they say less, that much or more would be better for most people. Also get a brand that has been tested to have the recommended amount since some brands are not good (I used consumerlab website to determine this). You can see a difference in about a week, but it will get better over about 3 weeks, in my experience. I usually get Naturemade brand since they frequently have 2 for 1 sales at the pharmacy chains.
Also, thanks to the folks who keep this excellent forum going! I promise to report back on this thread if I am able to try the orthodontic route.

[socknitster]

RosemaryB,

Next time you get a sleep study, look for a lab that uses a nasal/oral transducer. I don't think the balloon is the most modern testing agent for this syndrome. If you are looking at UARS, you should read the thread about the teleseminar by Dr, Avram Gold and listen to the mp3 that is provided in a link in that thread. I learned loads from that thread.

I agree that you are right, probably both UARS and OSA can be present concurrently depending on position and other factors like congestion etc. My last sleep study showed zero AHI (there was nothing to record UARS, so there were many "spontaneous arousals") but my home machine regularly records an AHI of less than 1. And on the rare occasion that unwind up sleeping on my back, I sometimes wake up with a snort.

I've been away from the forum for a long time too, good to see you back!

Jen

[RosemaryB]

RosemaryB,

Next time you get a sleep study, look for a lab that uses a nasal/oral transducer. I don't think the balloon is the most modern testing agent for this syndrome. If you are looking at UARS, you should read the thread about the teleseminar by Dr, Avram Gold and listen to the mp3 that is provided in a link in that thread. I learned loads from that thread.

I agree that you are right, probably both UARS and OSA can be present concurrently depending on position and other factors like congestion etc. My last sleep study showed zero AHI (there was nothing to record UARS, so there were many "spontaneous arousals") but my home machine regularly records an AHI of less than 1. And on the rare occasion that unwind up sleeping on my back, I sometimes wake up with a snort.

I've been away from the forum for a long time too, good to see you back!

Jen

Thank you for a tip on the nasal/oral transducer. I will listen to the mp3 soon. I have new, worse insurance, but I'd still like to get some tests eventually. I'm going to work on the side sleeping again and try to lose the 15 lbs I gained during recent stressful months. It may help some. But the orthodontic stuff is intriguing. I'll educate myself on it over time and try to find a good practitioner.

[Janknitz]

short, the kind of orthodontist needed is a NON-EXTRACTION ORTHODONTIST who uses SELF-LIGATING braces

We sort of stumbled onto this type of orthodontist. Inteverviewed 4 orthodontists, and it was the last one whom we chose and this is his approach--Thank goodness!!!! 2 out of the 4 talked about extracting teeth--I ran, not wallked out of those offices.

I'd watched my friends' kids go through that palate expander that fits in the roof of the mouth with a key to adjust every day and it just looked like Mideival torture to me. I have a kid who is wonderful and puts up with a lot, but she also has some senory issues, thrust swallow, and articulation issues and that just looked like it would make her miserable. The self-ligating braces (Damon System) worked so nicely for her--no torture, no pain, and allowed her tongue work and rest naturally inside her mouth.

Socknitster's post reminds me of how lucky we were to have found the RIGHT orthodontist.

[tiredintenn]

I recently spoke with an orthodontist friend of mine about this very topic. His says this is the latest thing in orthodontia - make more space for the tongue rather than taking space away. That gives us great hope for our kids to hopefully be OSA free. I asked him if it can work for adults. He says there are many braces out there - he mentioned Damon being a brand of self-litigating braces - that can and will expand the jaws for adults. He said he has heard anecdotes how after braces the person was snoring less and sleeping better. However, there are no studies, that he is aware of, that shows the efficacy of orthodontics in the treatment of sleep apnea. I am considering getting the braces and seeing what happens. It can hurt and may help. Much less painful and invasive than MMA. I can't believe this is not being pursued as a possible cure but maybe it is just wishful thinking on my part. Any thoughts?

[roster]

His says this is the latest thing in orthodontia - make more space for the tongue rather than taking space away.

That is very encouraging to hear. Check out my sig.

[socknitster]

I have to believe that this is the beginning of future research. It is the lack of research that holds us back. Maybe I'll convince my orthodontist to write a case study.

Jen