MAD oral appliance effective alternative to CPAP?

[sleepingbetter0209]

I have used CPAP successfully for over 2 years, but my Sleep doctor suggested I check out getting a manibular advancement device from a sleep dentist. I am mild, and he thinks I may be a possible candidate. I have heard mixed things about if they are better than CPAP. I also have TMJ, and I have heard that they can mess with the TMJ joint and make it worse when the jaw is pushed forward. Does anyone have experience with the positive or negative effects of switching to MAD device from CPAP or going from MAD to CPAP? Thank you.

[Conrad]

A 'sleep dentist'?

Never heard of such a thing.

[spitintheocean]

MADs can work well for mild OSA, but with TMJ it’s a gamble. I tried one a while back—helped a bit, but my jaw was pissed off the whole time. Definitely talk to someone who actually knows both sleep and jaw stuff (not just a random dentist calling themselves a sleep expert). If CPAP’s working and your TMJ is already an issue, I’d be cautious about switching

[sleepingbetter0209]

Thank you. I have made an appointment with a Dentist who is board certified in dental sleep medicine, an expert on sleep breathing disorders, and understands the relationship to TMJ. MY big concern is the MAD device and treatment, and if CPAP is working with me and I have 100 percent compliance and 1.2 AHI and I am waking up refreshed, why mess with something that is working? You agree?

[ChicagoGranny]

... if CPAP is working with me and I have 100 percent compliance and 1.2 AHI and I am waking up refreshed, why mess with something that is working? You agree?

Don't fix what isn't broken. CPAP is the gold standard for treatment of sleep apnea.

Gramps and I both had custom MADs made by a sleep dentist. Neither of us could tolerate that junk in the mouth.

I am mild, and he thinks I may be a possible candidate.

"may" and "possible" are each big words.

[sandman98]

i've gone down the MAD path, and although it did relieve my snoring, it caused TMJ and dental pain that just made it intolerable to wear more than 2-3 days in a row. ymmv though.
i'm now two weeks in on a trial of cpap, and i think this is WAY more tolerable than the dental device.

[robysue1]

Thank you. I have made an appointment with a Dentist who is board certified in dental sleep medicine, an expert on sleep breathing disorders, and understands the relationship to TMJ. MY big concern is the MAD device and treatment, and if CPAP is working with me and I have 100 percent compliance and 1.2 AHI and I am waking up refreshed, why mess with something that is working? You agree?

If it ain't broke, why risk breaking it?

Seriously: You have no trouble using CPAP. You say CPAP is working for you and you wake up refreshed.

There's no need to mess with a therapy that is already working and working exceptionally well for you.

[ozij]

A 'sleep dentist'?

Never heard of such a thing.

I have.

[sleepingbetter0209]

I went to an evaluation by a sleep dentist, and they wanted several thousand dollars for an MAD device and some other treatments, including laser treatments and a nasal treatment to free up breathing. They don't accept my insurance, and it would be a great undertaking. I understand it would be gratifying for anyone who has had less-than-desirable results with CPAP therapy, but I have nearly 100 percent compliance. Anyone familiar with laser treatments for airway issues and alternative nasal release treatments that are more holistic that would be a substitute for CPAP?

[Respirator99]

Why would you consider a painful, invasive and non-reversable treatment when your cpap is already doing an excellent job? I understand the desire to try a "one and done" solution rather than using cpap every single night, but the treatments you're considering should (I believe) only be a last resort when all else fails.

[sleepingbetter0209]

Thanks for your input—I totally agree that CPAP is the gold standard, and for me, it’s working very well. I’m consistently compliant, getting solid results most nights, and I don’t take that for granted.

That said, due to some specific anatomical factors—TMJ issues, a recessed jaw, nasal blockage—I’m exploring whether a custom MAD might help address things like dry mouth, mouth breathing, or suboptimal nasal airflow. I’m not looking to abandon CPAP, but rather to understand all my options for long-term management.

I’m being very cautious, especially after a recent consult that felt more like a high-pressure sales pitch than a medical recommendation. For now, I’m sticking with what’s working and only moving forward if the evidence and the provider feel right.

[ChicagoGranny]

nasal blockage

Has your nasal passage been scoped by an ENT? If not, that's your next step.

[sleepingbetter0209]

Yes i have had several nasal endoscopies and reveal blockage - deviated septum- I had turbinate reduction surgery which did seem to help but a recent ct scan of head and neck revealed total blockage in one nostril.

[lazarus]

When I was first diagnosed with severe OSA, a dentist friend of mine quickly made me a MAD to use until I could get PAP treatment going. It was a life-saver at the time.

I continued to use the MAD during and in conjunction with PAP therapy for a year or two, which helped train me to keep my mouth closed during PAP. So it was helpful at the start of my PAP journey in that way also.

Eventually the MAD started hurting my teeth and jaw, so I discontinued its use and used PAP alone. I am very happy with PAP therapy and have come to appreciate everything about it. I am glad I am not relying solely on any temporary PAP alternatives alone that generally only help about 50 percent of people reduce AHI by 50 percent.

[ChicagoGranny]

revealed total blockage in one nostril

Has your medical team made a recommendation?