Is Oral Dental Appliance Worth Considering?

[edm_msu]

I just started about 6 weeks ago with an auto CPAP and it is working pretty well. I'd rather not use a CPAP for the rest of my life, but will if I need to. My overall AHI is 22.3, supine (back) AHI is 69.9, and side AHI is 8.4. If I slept on my side (not back) is an Oral Dental Appliance worth considering? Do techniques such as a tennis ball attached to my back or using a special pillow work well to prevent back sleeping? Are there other good techniques?

Do oral appliances usually significantly reduce or prevent snoring? If not, then I'll have to stay with CPAP to keep my wife happy. She really likes the CPAP.

The dental appliance costs $1,500. Would Blue Cross pay for this, even though they are already paying for the CPAP? My deductable is already met for this year. Would they pay for the appliance next year when they are done paying for the CPAP? Blue Cross usually follows Medicare guidelines.

Thanks,
Ed M.

[nanwilson]

I just started about 6 weeks ago with an auto CPAP and it is working pretty well. I'd rather not use a CPAP for the rest of my life, but will if I need to. My overall AHI is 22.3, supine (back) AHI is 69.9, and side AHI is 8.4. If I slept on my side (not back) is an Oral Dental Appliance worth considering? Do techniques such as a tennis ball attached to my back or using a special pillow work well to prevent back sleeping? Are there other good techniques?

Do oral appliances usually significantly reduce or prevent snoring? If not, then I'll have to stay with CPAP to keep my wife happy. She really likes the CPAP.

The dental appliance costs $1,500. Would Blue Cross pay for this, even though they are already paying for the CPAP? My deductable is already met for this year. Would they pay for the appliance next year when they are done paying for the CPAP? Blue Cross usually follows Medicare guidelines.

Thanks
Ed M.

Yes tennis balls or a small backpack work, give one of them a try. You could also try a small pillow stuffed against your back. Do some reading here on dental appliance and you will get lots of info, just type into the search field above. We are not insurance companies, you will need to call your insurance to find out if they will pay for a dental appliance. If you used a dental appliance how would you know if its working, they don't carry software.
Good luck and welcome to the land of hoseheads.

[locust78]

It seems like some people do really well with dental appliances, some don't. The closest I came is picking up a mid-range Somnoguard. It's a two-piece boil and bite appliance that advances my lower jaw. I thought that it would be a good alternative to CPAP, especially for travel. It did work for me, but there was some discomfort with my teeth and jaw. (Perhaps because I only used it sporadically.) Also, it was kind of bulky and I had a hard time maintaining a good seal, and ended up doing more mouth-breathing than I wanted to. Now I just pack up my CPAP equipment & take it with me, while the appliance sits in a drawer. In all fairness, I did get one of the lower end appliances. I have to imagine that the more you pay, the better product you'll get.

[need2snooze]

I think it's "Buyer Beware" when it comes to dental appliances, as there is no "money back guarantee" that they will work. At least there wasn't for me. For the same reasons you have, I decided to purchase a dental device from my dentist, who convinced me that most of his CPAP patients loved their dental appliances and said that a lot of his patients didn't need their machines anymore. I plunked down $500 for a Silent Night dental appliance. FYI - those come with adjustable sizers that the dentist uses to fit to your mouth. After the first size didn't make any difference with my sleep apnea (much to my dentist's surprise, I was still heavily snoring and felt crummy the next day), he adjusted my appliance to the maximum size. I'm a small size gal with a small size mouth. Getting the appliance into my small size mouth was no easy feat, but the next morning I had to physically coax my lower jaw back into place. Seriously, it was about 15 minutes before everything was back into alignment. I tried using this for a few nights and then gave up. I would much rather travel with an extra piece of luggage than fight with a dental appliance, no matter how convenient it is. Unlike a CPAP machine, I can't sell my used dental appliance. The experience made me appreciate my CPAP machine more. At the very least, ask your dentist plenty of questions re: his experience with sleep apnea and the appliance he is selling. I tend to view this as an easy money making venture for dentists, but possibly, there are some dentists out there that do know what they are doing.

[kong]

Do techniques such as a tennis ball attached to my back or using a special pillow work well to prevent back sleeping? Are there other good techniques?

Look at your sleep study. It should tell you whether your AHI is lower when you sleep on your side. If it is lower, then using a special pillow or tennis ball may work to lower your AHI.

The dental appliance costs $1,500. Would Blue Cross pay for this, even though they are already paying for the CPAP? . . . Would they pay for the appliance next year when they are done paying for the CPAP?

I belong to Anthem Blue Cross of California. They purchased a CPAP machine for me this year. I called yesterday to see if they would also cover a dental appliance. The representative told me that it would be covered. However, insurance policies vary greatly. Call the phone number on the back of your card and ask.

[akcpapguy]

If you are truely serious about trading in your CPAP for an Oral Appliance to treat your OSA this is the product you want.

http://amisleep.com/tap-3-elite/


1. Find a Dentist in your area who works with this specific Oral Appliance. A Dentist who does this will take the molds for the appliance and then xray your jaw at different adjustment intervals to get an acceptable titration range.

2. Find a Sleep Lab that has done Oral Appliance titrations and have another sleep study with the Oral Appliance instead of the CPAP. The Sleep Lab should be able to provide you and your Physician/Dentist a detailed report of your AHI at each setting they used on the Oral Appliance during the study.

Anything lesss than this and you are just guessing about the effectivness of the Oral Appliance in treating your OSA.

[edm_msu]

Thanks for your input everybody. It was helpful. akcpapguy, I'll research that appliance. This is a field where everybody claims their device is the best so it is a difficult choice. Very little unbiased testing in the field. How to decide????? I do like the way it can be adjusted. Have you used this? How comfortable is it? Cost? Insurance paid? If it is as good as advertised, it's really good.
Ed M.

[edm_msu]

From internet research, this is good. There are dentists in my area and it is probably covered by insurance. I'd have to go to yet another medical professional. This might require another titration study that is billed at around $3,000, more than the TAP appliance itself.

Does anyone know anything about the TAP oral appliance?
Thanks.

[akcpapguy]

Yes the TAP IS that good if you have mild/moderate OSA AND your anatomy can tolerate the needed adjustments. When I managed the Walter Reed sleep lab we used the TAP exclusively. Every service member that wanted to try the TAP went through the procedure outlined in my previous post. During my time there we did between 6-8 TAP titrations a week and I don't ever recall a physical failure of the device. I can't speak to the cost of them because they are free for the service members, but i have heard various reports from people on here that they are in the $2,000-$3,000 range. Regardless of the Oral Appliance you decide to get it is vital that you get a followup titration study using the Oral Appliance.

[edm_msu]

akcpapguy,

Yes the TAP IS that good if you have mild/moderate OSA

My overall AHI is 22.3, supine (back) AHI is 69.9, and side AHI is 8.4. If I slept on my side (not back), approximately what will the AHI be with TAP?

AND your anatomy can tolerate the needed adjustments.

Could you elaborate on that?
Thanks,
Ed M.

[akcpapguy]

I wouldn't even begin to speculate what your AHI would be with the TAP. We always aimed for an AHI of 5 or less when we titrated a TAP. Judging from your numbers while side sleeping I would say that you could easily achieve that while sleeping on your side.

The TAP (along with many of the other successful Oral Appliances) treat OSA by advancing the lower jaw forward thus moving the attachment point of the tongue forward and hopefully far enough so that when it relaxes it does not displace far enough back to cause an obstruction in the airway. Some people do not have enough movement in their lower jaw achieve this effect and therefore are not good candidates for an Oral Appliance. This is why it's soo important to find a Dentist that will do the things i outlined in my first post.

I will say again (because I thing it's the most important element), you NEED to have another titration study using the TAP (or whatever Oral Appliance you choose) or else you are just throwing your money down the drain.

[Aladra]

I've been using a SomnoMed oral appliance for about 2 yrs...I have mild/mod OSA.

My ins at the time was Blue Cross, and it was covered fully ($1500 device). You wear it for a while, and do some adjustments (at home, as recommended by the appliance doc) (you do these slow just to avoid any jaw pain or discomfort) . Then, after you've done the adjustments over a couple weeks, you'd want to have a f/u sleep study to test the appliance. My f/u sleep study showed no events. I just had another f/u sleep study this month bc of daytime sleepiness, and it showed minimal hypopnea and just 1 apnea event.

I really like the appliance - I've never had CPAP, but I really was glad to have this other option bc I couldn't imagine how I was going to sleep w/ a mask on my face as I have very bad insomnia. The appliance is small and comfortable - I've never had any jaw soreness from it (apparently, some people do at first). Also, the appliance keeps me from grinding my teeth, which is a bonus.

It does make my mouth feel dry and yucky in the morning...but I can work around that.

[edm_msu]

Aladra,
That is great it's working for you.
Would you mind providing your AHI numbers before you started using the oral appliance? Specifically, overall, side, and supine (back) AHI numbers? Do you need to sleep on your side when using this?
Thanks,
Ed M.

[Aladra]

I had to dig out my 1st sleep study, which means I had to find it . I don't have to sleep on my side w/ this appliance, I can sleep naturally. I don't think my apnea is too severe, but I think these are the numbers you're asking about...

Total - 7.4 (I think this number is the total..? not sure); Supine - 22.9; non-supine - 1.8

My first sleep study showed 44 apnea/hypopnea events; my f/u studies showed about 1 each time.

Hope this helps. The other nice thing about these appliances is if you travel, it's very easy to bring along (vs CPAP).

[rickymarkokc]

I have a class II jaw recession. My dentist is a friend of mine. He told me today that it costs them $400 to have the Tap III device made and that they charge $800 for the entire process. I think i'm going to do it. We feel this is a logical step before even considering MMA surgery (that the oral surgeon is strongly recommending).

Cost isn't the only consideration, but if your dentist is wanting to charge several thousand for this device I would look around. Granted, I'm in oklahoma and some things are just cheaper here.

I'm looking forward to treating the anatomical problem at hand (jaw recession), and not just the symptoms (cpap).