Help! - I am trying to quit.

[Ganesha]

Hi All,

I have been successfully using my CPAP machine for two months. I am 100% compliant and don't have any major issues with the therapy. My numbers have been good. But the lifestyle change brought on by CPAP therapy are an adjustment. So I have been investigating alternatives.

My dentist fitted me with a Silent Nite oral appliance. I have not tried it yet because I don't have a way to measure its effectiveness. I record the data my ResMed unit gives me every morning. I couldn't think of a way to do that with a dental appliance.

Then I had an idea. If I switched my machine from CPAP to APAP and established a baseline then I could add the oral device into the mix and see if it kept the APAP pressure to the minimum. My prescribed pressure is 8. The sleep study said 95% of my apneas were controlled at 7. So I set the APAP range from 4 to 12. So far my average pressure is just under 8. I plan to get at least another week of data before starting the appliance.

If the APAP pressure stays at 4.0 with the appliance in then it is probably keeping my airway open. If I see this consistently then I would go for another sleep study using just the appliance to confirm my findings.

All of this makes me nervous because I do not want to compromise my therapy. I have a heart condition which may have been contributed to by OSA. Using a CPAP machine is preferable to dying of a heart attack. But if I can get the same results from another method I would go for it.

Does anyone have experience with oral appliances? Does my plan make sense?

All comments welcome.

Mark

[elader]

sounds wacky to me. Buy a cheap recording pulse oximeter and take a baseline for a couple of days on cpap and then try the device without cpap.

Do any of us know how an apap would behave with someone who is not suffering from apnea?

[robertmarilyn]

If the APAP pressure stays at 4.0 with the appliance in then it is probably keeping my airway open. If I see this consistently then I would go for another sleep study using just the appliance to confirm my findings.
Mark

The pressure isn't going to stay at 4 no matter what! My APAP was locked in by my doctor on 4-17 and I felt like I couldn't breath on until the pressure got up to 8. I have a feeling a normal, non sleep apnea person would still push the pressure up to about 8. But I am no expert...I just know that it feels like you are trying to breath in a paper bag with the pressure starting at 4...it does not feel nice

mar

[BleepingBeauty]

Hi, Mark.

In theory, your plan seems to make sense (to me, as a layperson). But I'd be very wary of going there, especially if I had a heart condition. I have no idea what your machine would do if the dental device actually did accomplish its task, or how you would fare through the night if, indeed, the pressure stayed really low, like at 4. (I agree with mar on that; 4cm makes me feel like I'm suffocating. I've adjusted my ramp so that it now starts at 8.5cm.)

Hopefully, others with more knowledge than I will chime in here with more info and advice. Sounds like you're considering this with a great deal of caution, and I think that's a good thing.

[Julie]

I can only say that dental devices have not been shown to be anything like as effective as Cpap, though may keep snoring down, and in your case in particular, I would not want to quit using what is known to be the best available device around so far. I think there's a lot more room for you to tweak Cpap before giving up on it for a very new and really unproven thing.

[kteague]

Mark, it sounda like you are making a reasonable effort to do this safely. Especially with having heart problems, I agree with caution being a good approach. Also that adding an oximeter to the mix could add a layer of information important to your process. I agree that these efforts should be just a pre-screen before having a sleep study with the device. Here are my concerns...

Wondering how your data is looking early in the night with that APAP range starting at 4? Seems to me you could be starting your night at a disadvantage. And what is your mask's minimum pressure for proper venting? Data from the screen is not going to be enough to give you the best info for what you are trying to do. What if you showed an AHI of only 5 for an 8 hour night, but of those 40 events, nearly all are clustered early in the night while trying to get to a therapeutic pressure? That 4 starting point may just muddy the waters, as even with a starting point of 6, I still had to occassionally open my mouth and take a deep breath to catch up.

I read in an early post that your apnea was diagnosed as moderate. How low did your desats go and how long were your events? Just wondering how much fire you're playing with.

In thinking about caution, how does it sound to start at your usual fixed pressure with the oral appliance in place and an oximeter, and each week, drop your pressure a point? At least you'd be sliding downhill rather than falling off a cliff.

Let us know how this goes. I'd like to hear if you are able to use the oral device successfully.

Kathy

[5aces]

I would love to ditch the hose too.
In reviewing dental devices,the consensus seemed to indicate that dental appliances were best used to treat 'mild' to 'moderate' OSA.

Got to live with 'severe' OSA for now and keep the blower...

[drubin007]

another lay person chiming in here...

Something simple but has not been mentioned as of yet...

going to a sleep lab and having them watch you sleep with the dental appliance is great, and with a bad ticker it would
be the safest means of getting the answers.... But, that is only 1 night. We all have good nights and bad nights, if we are on a hose or not. Would 1 night at a sleep lab with wires to your head, fingers, and legs give you a true representation?

We all go to the sleep lab (I have been there twice, once without and the again with cpap) and my number was set to 9 for OSA. I am still in the "tweaking" of my settings, and will be creating a new post shortly with my numbers looking for feedback...

Sorry, think I got off topic there. What I am saying though is I would not think 1 night in a sleep study would give you a real good idea of the long term effects of the appliance. Finding your baseline in your enviroment is great, and with a bad ticker you do need to be careful though.

[Ganesha]

How low did your desats go and how long were your events? Just wondering how much fire you're playing with.

In thinking about caution, how does it sound to start at your usual fixed pressure with the oral appliance in place and an oximeter, and each week, drop your pressure a point? At least you'd be sliding downhill rather than falling off a cliff.
Kathy

Thanks Kathy - That sounds like another good approach. I also like your point about clustered apneas giving a false sense of security due to averaging. It looks like I need to get a data card reader to really see the full picture.

My sleep study AHI was 23.1. Oxygen destaturations went down to 87.

5aces - Sorry about the 'severe' diagnosis keeping you tied to the hose. My 23.1 puts me in the 'moderate' range.

I also agree with Drubin007 that data from a sleep study does not represent reality (although it is the best we have).
One observation does not give a statistically significant sample. I would love to get sleep study information every night at home. Except for the goop in my hair.

Mark

[Wulfman]

Consider the possibility that you are/were in the early stages of developing sleep apnea. I'm sure none of us went from "normal" to "severe OSA" overnight. If that's the case and you're younger than many of us who didn't realize what we had until it became severe and debilitating, consider yourself "lucky" that it was caught in the earlier (mild) stage.

My therapy has become so much a part of my life now that I can't imagine sleeping without it. In fact, I CAN'T sleep without it.


Den

[Ganesha]

Den,

Thanks for the input. I do consider myself lucky.
First, that my wife insisted I get a sleep study (she's an RN).
Second, that the OSA condition was detected before it got worse.
Third, that getting my apnea under control can prevent a heart attack.
And, last but not least, I consider myself lucky to be a part of this group.

Mark

[roster]

....... What I am saying though is I would not think 1 night in a sleep study would give you a real good idea of the long term effects of the appliance. Finding your baseline in your enviroment is great, ..........

Yes!!

The same is true for a CPAP titration - one night in a strange sleeping environment just doesn't get the job done. You need to take that night's prescribed pressure and use it as a starting point in your own home titration with patient software.

[frustratedmary]

I was diagnosed in the fall with mild sleep apnea. My sleep doc recommended an appliance. I went to a prostadontist and had one made. My insurance did not cover it. I worked with it for 6 months with no progress. I finally had my throat scoped and found my epiglottis was closing off. The ent said the appliance should have worked on me if it hadn't been for the epiglottis being involved. I heard the success rate was about 80%. It took me about a week to feel comfortable in it also. You feel alittle clostrafobic in it at first. I too have a heart condition ,but they thought it was a good chance for me. Good luck.

[lebowski8]

Personally, I didn't like the dental device I used (pureSleep)-- I got it for use during the period between my initial OSA consultation with the sleep neurologist in Feb. 09 --- i wasn't able to get the CPAP until April 09.
It was recommended with reservations by my neurologist ("you can try it, but I'm doubtful"). My dentist personally fit the dental device, which is unusual, since this in particular is an OTC device. But my dentist is my dad and he was curious.
I was able to use the dental appliance for 5 hours per night at most. 50% of nights I removed it in my sleep at some point. My wife reported a reduction in snoring noise level -- but not in frequency (just as often, not as loud). Nor did she see a reduction in apneas (but, you know, she's not a qualified observer). She also said it made my breath smell like a corpse, due to my mouth being partially open all night. I soaked pillows in buckets of drool.
I found the device irritating to my tongue and it caused a little pain in my front teeth. More disturbing was the displaced bite, which would usually last until past lunch time. I couldn't bite into my food right. My compliance with the dental device was about 75%

Cpap -- my compliance is 100%, I have experienced no pain and only occasional small discomforts. I greatly, greatly prefer the CPAP.

[roster]

Personally, I didn't like the dental device I used (pureSleep)-- .......

Ski,

You bought a product that is marketed to help snorers only. There is no claim, rightly so, that it will help even a mild case of sleep apnea.

That is why some of us members have a strong bias against the PureSleep company. (Besides we suspect them of spamming this site with phony testimonials. They seem to have given up on that lately.) We know they are making sales to people who have sleep apnea and snore. In the worse cases, the product might treat the snoring, leaving the consumer unaware that he has not taken care of the sleep apnea while his body and mind still accumulate damage.

When we talk about oral appliances here, we usually are talking about ones approved by the FDA for treating sleep apnea. These are always fitted by a dentist.

Some good appliances are Thornton Adjustable Positioner (TAP), SomnoMed MAS, and Herbst Telescopic Appliance. These products are approved to treat snoring and mild to moderate apnea. However, they will not work in every case! If you google the appliance names you can find more information including photographs.

Sorry your PureSleep did not work for you but glad your investment was small and you did not get fooled that it would treat sleep apnea.

Regards,