Trying Dental Appliance?

[davecpap]

CPAP stats (past 141 days since I started):

Average Daily Use 7:33 hours
Median Daily Use 7:44 hours
Apnea Index 0.1
Hypopnea Index 3.5
AHI 3.6

I'd mentioned to sleep doctor maybe 1.5 months ago that I was still tired most days, and he said some people with mild sleep apnea just don't tolerate CPAP even if they're compliant and the AHI is <5. I thought if I could get my AHI less than 5 and wear it 7.5 hours a night that was the definition of tolerate?

So he suggested dental appliance... and after weeks of insurance paperwork, I got one last week. However, I'm kind of worried about using it Mainly because, how do I know its working? It doesn't have a data card that I can plug into my PC and see what my AHI is I do have a recordable pulse oximeter, which the dentist said he uses as a tool to see if the appliance is working by looking for oxygen desaturations. My sleep doctor also wants me to have another sleep study with the dental appliance on.

The dentist who made the dental appliance (who specializes in sleep apnea appliances, only thing he does) basically said my wife would be the best diagnostic tool, to see if I begin snoring again. He also had me breathe into this device that measures how well I can inhale/exhale, and with the MAD in place it seems I can suck in/push out a lot more air than I normally do. Again, I don't know what this tells me about how I am while asleep.

I thought about setting my CPAP machine at 4cm, wearing a full face mask with the dental appliance on and see if my CPAP machine records any apneas/hypopneas - or if it has to increase the pressure to prevent any events. Does anyone know if this method has any diagnostic value, or stick with the pulse ox?

[Julie]

You know you're doing better when you feel better, never mind the numbers (though snoring is obviously a tip-off things aren't great ).

[Sillyme]

I've thought of trying a non-prescription MAD along with CPAP myself. Please let us know what you learn. I know my APAP pressure goes down when I sleep on my side and I assume it is because my jaw doesn't fall back. It might be a good trade-off for a lower pressure.

[davecpap]

I'm also interested in the MAD because the dentist told me I'm clenching at night. It started after CPAP treatment, I think I'm subconsciously trying too hard to keep my mouth closed to keep air from escaping and began clenching. The sleep apnea dental appliance is like two birds with one stone, treating the clenching and sleep apnea (hopefully).

[jazzer4]

I've not gotten a TAP for the same reason, you can't really "see" how good your doing.
If you don't mind, would you share how much the MAD cost?
It is made in just one visit?

I'm a bit worried it my hurt my jaw or bit.
Am anxious to hear how it is working for you.
Details please.

[davecpap]

I've not gotten a TAP for the same reason, you can't really "see" how good your doing.
If you don't mind, would you share how much the MAD cost?
It is made in just one visit?

First visit was a consultation.. They had me breathe into a couple devices with/without my pulling my jaw forward to measure how moving my jaw forward increased the amount of airflow. I guess this is some indication as to the impact of moving the jaw forward. Also attached some stuff to my face and had me open/close my mouth a number of times to measure something with my Temporomandibular joint. Put a small video camera in my mouth to take pictures of my airway.

Second visit they took a panoramic xray of my head like the dentist would, some other x-ray, and took impressions of my teeth. I had to bite down into a tray of this fast setting goop... it set really fast, like 20 seconds - came off easily. They sent the xrays and the impressions of my teeth off to some lab to make the device, said it would take 2 weeks.

Third visit... I picked up the device they made some minute changes to it based on how the device fit. Gave me instructions on its use. I have a followup visit scheduled in a couple weeks. The device only moves my jaw forward every so slightly, its not noticeable to me except in pictures they took before/after the device was in place. It looks identical to this device, there are different size straps to adjust how far your jaw is moved:

http://www.myersontooth.com/sleepbetter/

Total cost was $1900... I did a pre-determination with my insurance (Blue Cross PPO) and they actually said they'd pay 100% just like the CPAP machine. I did NOT expect that - I assumed most insurance wouldn't pay. Unfortunately, I had to pay the doctor up front and the doctor's office would reimburse me when they get paid by Blue Cross. I made sure to get in writing from Blue Cross the pre-determination decision, it showed that they'd pay for a few visits and the device.

[jazzer4]

Dave is it comfortable?
One thing I was wondering, if insurance pays for it than I guess they won't pay anymore for C-Pap supplies.

Wow, it cost more than a C-pap machine.
My dentist is charging $1200 but he has only made 5 so I'm afraid to have him do one for me.
I also asked him if he knew how any of the 5 were doing. He said no, he didn't know.

I would feel better using someone that has made hundreds of these things.

Do you need to go back to him to get adjustments.

[davecpap]

Dave is it comfortable?

*I* find it comfortable, how is that I feel like I can move around in my sleep more, and sleep on my stomach.

I would feel better using someone that has made hundreds of these things.

Thats why I took the time to find someone who specializes in sleep dentistry. I went to the American Academy of Dental Sleep Medicine (AADSM) website to find a few providers in my area, settled on a guy focuses on sleep apnea appliances. Much like how I found a pulmonologist who deals primarily in sleep apnea.

Do you need to go back to him to get adjustments.

Not sure yet. I do know that the $1900 fee includes several followup appointments for adjustments, just not sure yet if I'll need them yet.

[tiredintenn]

I tried the dental device. It didn't work for me. Not sure why but I was just as tired. It is expensive and is usually not covered by insurance (at least it wasn't for me). I am now going to try CPAP.

[davecpap]

Well, I tried the dental appliance - the Sleep dentist thinks I'm giving up, which is correct. I like that it keep me from damaging my teeth (I grind them at night sometimes), but its not doing much in terms of waking up rested. I guess I forgot how miserable I feel without adequate treatment for my sleep apnea - it was awful after a couple nights with the appliance. I know it would get better as they gradually increase the amount my jaw is pulled forward, but I'm not keen on going through that when CPAP is working OK for me now. I currently have the longest band installed which does the least amount of good, over the course of a couple visits they move the lower jaw forward a couple millimeters at a time until you are rested.

As for the insurance, I thought I had everything in order talking to pre-determination/pre-certification departments, getting referrals, etc.. but they managed to screw me over anyways. I got a pre-certification reference number authorizing the appliance and 3 visits. However, the pre-certification was only good for 12 days! They (Blue Cross/Blue Shield) just said I was good for 3 visits, not that they was a time limit associated - and a ridiculously small one at that. Needless to say it takes a couple weeks to make the first appointment, 2 weeks to make the appliance, etc... everything fell out of that 12 day range except for the initial consult - the cheapest visit of them all. They want me to 'appeal' to get the appliance and other visits paid for!

I tried so hard to make sure I jumped through all the right hoops before I tried this It'd be one thing if the appliance worked for me, but this is ridiculous.

[Sillyme]

I tried so hard to make sure I jumped through all the right hoops before I tried this It'd be one thing if the appliance worked for me, but this is ridiculous.

My sympathies. Thanks for the feedback.

[crispin2006]

Have mercy with a stranger: What means MAD.
(I remember, when I was young, there was a magazine called MAD (Alfred E Neumann ?).)
I looked at several abreviation - sites, but can't find out.

[PST]

Have mercy with a stranger: What means MAD.
(I remember, when I was young, there was a magazine called MAD (Alfred E Neumann ?).)
I looked at several abreviation - sites, but can't find out.

Mandibular Advancement Device.

[davecpap]

So the dentist called with an idea I might try. He suggested getting a full face mask AND wearing the dental appliance temporarily. The idea is that I can use the CPAP to treat the sleep apnea while they gradually move the MAD into its final position. Once my jaw is gradually introduced to the MAD, I can remove the full face mask when the MAD is in its final position. I like this idea because I won't be miserable while they're adjusting the MAD.

I might give this another shot!

[RDawkinsPhDMPH]

I agree with your doctor, only another sleep study will show if it works. We have tested people that it worked great for and people that it didn't help.

I disagree that how you feel or an oximeter are adequate. Sleep apnea, per se, is damaging even if it doesn't make you feel bad or result in desaturations. A good multichannel home test would, however, be a good idea.