Considering a dental device for apnea. Appreciate feedback.

[Jak3099]

Hi all,

I tried sleeping without CPAP for a week to see how I responded. I used an iPhone app to record my snoring and record any factors that may affect my sleep. This is what I noticed:

without CPAP (just saline spray)
- I snore for about 1 hour each night
- I don't think I wake up as much at night, but I do have sore throat and sometimes headaches in the morning, and am tired
- I have vivid dreams (so I assume I'm reaching REM sleep). Interestingly, these dreams are about stuff stressing me out these days.

with CPAP
- Little to no detectable snoring
- I sometimes sweat and my bladder gets full
- I toss and turn and wake up from feeling the hose touch my face and/or the mask exhaust (I'm using a hose holder, but that doesn't really help)
- No dreams

To summarize: without CPAP, I don't wake up as much, but have apnea. With CPAP, the apnea clears up, but I wake up too much.

The last time I saw the sleep specialist, he basically said my AHIs are fine, and just gave me some Nuvigil pills to try out. I haven't taken any, because I think they're just a way to mask symptoms without getting to the root of the issue.

I'm considering a dental device because I think it will help me stay asleep (no mask/tubes touching me) while still keeping my airway clear. Does anyone have any experience/advice regarding dental devices? I'm going to ask my doctor for a referral.

I would love to wake up refreshed for once, so I'm kind of at my wit's end. I appreciate any feedback!

[49er]

HI Jak3099,

Go to http://www.apneasupport.org/sleep-apnea ... n-f20.html and look for posts by SleepDent who is very knowledgeable.

Also, you might want to review this study on the success rates at various AHIs to see what your chances would be in getting your AHI to 5 or below. You'll notice that the TAP is alot more successful than fixed appliance which seems to be SleepDent's experience.

https://advancedbrainmonitoring.app.box ... 7pjn8s11y4

Hope this helps.

49er

Hi all,

I tried sleeping without CPAP for a week to see how I responded. I used an iPhone app to record my snoring and record any factors that may affect my sleep. This is what I noticed:

without CPAP (just saline spray)
- I snore for about 1 hour each night
- I don't think I wake up as much at night, but I do have sore throat and sometimes headaches in the morning, and am tired
- I have vivid dreams (so I assume I'm reaching REM sleep). Interestingly, these dreams are about stuff stressing me out these days.

with CPAP
- Little to no detectable snoring
- I sometimes sweat and my bladder gets full
- I toss and turn and wake up from feeling the hose touch my face and/or the mask exhaust (I'm using a hose holder, but that doesn't really help)
- No dreams

To summarize: without CPAP, I don't wake up as much, but have apnea. With CPAP, the apnea clears up, but I wake up too much.

The last time I saw the sleep specialist, he basically said my AHIs are fine, and just gave me some Nuvigil pills to try out. I haven't taken any, because I think they're just a way to mask symptoms without getting to the root of the issue.

I'm considering a dental device because I think it will help me stay asleep (no mask/tubes touching me) while still keeping my airway clear. Does anyone have any experience/advice regarding dental devices? I'm going to ask my doctor for a referral.

I would love to wake up refreshed for once, so I'm kind of at my wit's end. I appreciate any feedback!

[Julie]

Your sore throat could be a tipoff about possible mouth breathing when asleep (and raising your pressure only will make it worse if you do it). You might want to consider trying a FF mask like the Quattro FX, Hybrid, etc. to see if they help when you do use Cpap. Sweating and a full bladder (as well as vivid dreams) are definite signs of untreated OSA, so something isn't working the way it should.

[hobbs]

The dental device was a waste of $$ for me.

[Jak3099]

Thanks for the responses everyone. I tried a full face mask about a year ago, and I was miserable. I woke up even more with that mask then with my nasal pillows. The sleep doctor advised me to lower my pressure to 4 cmH2O to help eliminate air swallowing. The AHIs have been below 1-2, but then I have the sweating problem.

Hobbs: Did you use a fixed appliance or TAP? I have heard mixed reactions to commercially available dental devices. I was aiming for a TAP that would be custom made by a dentist. Hopefully my insurance will cover it.

[sleeplessinaz]

Hello there. Sadly there is no quick fix for sleep apnea. If there was, we would all have one! I have a custom made mouth guard by a dentist. I also have TMJ. Now it helped the TMJ tremendously and stops me from clenching at night. I use it WITH CPAP - not instead of. You can try a mouth guard but you will still your CPAP machine and mask.

Hope this helps,
Carrie

[Julie]

Hi- 4 is the default low setting of most machines and NO one can really breathe at that setting! I can't understand your MD, or rather I suppose I can if he/she is like too many others and relatively ignorant about how to actually USE Cpap. Lowering the bottom end like that (what were your 90 and 95% levels?) won't help but setting it just one number (if that) below your most consistent numbers, and putting the high end setting say 4-5 (or more) about those levels should.

[hobbs]

Hobbs: Did you use a fixed appliance or TAP? I have heard mixed reactions to commercially available dental devices. I was aiming for a TAP that would be custom made by a dentist. Hopefully my insurance will cover it.

Made by a dentist. Stopped the snoring, but I still was extremely tired and in a fog most of the time.

[johnthomasmacdonald]

I have one that cost me about a $1000 and was custom made for me by my dentist - i forget the make ( began with a K ). It's not particularly uncomfortable but a sleep test showed that it had no effect on my apnea, however i've found that without it my machine can't fully control my apnea only getting it down to around 5-10 while with the dental implant,my ahi rarely goes over 0.2

[zoocrewphoto]

Thanks for the responses everyone. I tried a full face mask about a year ago, and I was miserable. I woke up even more with that mask then with my nasal pillows. The sleep doctor advised me to lower my pressure to 4 cmH2O to help eliminate air swallowing. The AHIs have been below 1-2, but then I have the sweating problem.

Hobbs: Did you use a fixed appliance or TAP? I have heard mixed reactions to commercially available dental devices. I was aiming for a TAP that would be custom made by a dentist. Hopefully my insurance will cover it.

Have you tried a hybrid mask? Those are more comfortable for a lot of people, yet still cover the mouth if you have mouth breathing issues.

I also wonder why your doctor is advising you to go to the lowest possible setting (which is very uncomfortable for most people). Does your doctor feel that a pressure of 4 will still treat your sleep apnea? For most people, it won't. And if it isn't being treated, you will still have problems. Your information line states that your pressure is 6-16. Did you change it to 4-16 or what? Can you post some data showing a typical night?

It also sounds like the cpap machine is helping you, but that you are having some trouble adjusting to it. That is normal. Odds are, people here have dealt with the same issues, so the more details you can give, the more we can help you.

[teachcsg]

I don't know too many people that use a dental device since we mainly see cpap users but I do recall a dentist that did an inservice for us at our workplace regarding dental devices. He stated that the devices work best for people with mild to moderate sleep apnea (mild OSA - AHI 5-15 and moderate OSA - AHI 15-30).
He mentioned that not all dental devices or dentist are created equal. He said that many dentist will take a "weekend" course on dental devices and don't really know what they are doing. Unfortunately the patients have bad results and dental devices get a bad rap. So if I could offer some advice it would be to look for a dentist in your city that specializes in dental devices for sleep apnea (i.e thats what his main focus is) and make an appt with him.
I do recall this particular dentist said they would do a sleep study with the dental device (after pt was fitted) to ensure it was working. All this to say they knew what they were doing.
So look for a good dentist that specializes in these devices to increase the chances of your success.

[chunkyfrog]

I would also look very hard for a dentist that will at least use a form of home sleep test
to determine the efficacy of all devices for every patient.

[kteague]

Since it seems it's largely the new physical sensations keeping you from sleeping well on the CPAP, keep in mind the dental device will be another set of new sensations. No matter what route you choose, you're going to need to allow time for your brain to accept those sensations as your new normal. Just because they keep you awake in week one is not an indication those same sensations will still bother you months later. As far as waking up wth a full bladder, if your treatment is not therapeutic, you could still be having events that trigger the need to urinate. Or there could be other causes. but a week is not long enough to see a trend unless almost every night that week on CPAP you had to urinate and almost never did off CPAP. Even then, a journal of other factors would be helpful in ruling out other influences, as in what you drank and when, what meds were taken late in the day, etc. Before therapeutic treatment my legs stayed swollen but when I started sleeping deeper (even for shorter periods) my legs would flush out overnight causing a potty trip or two. For me it was a sign of things finally working.

Nothing wrong with investigating other options, I just think it's premature to feel you've failed at CPAP or that CPAP has failed you. I was a late bloomer on CPAP. Even quit for a short time after a few months. Getting my treatment dialed in was my first need, then it was addressing other sleep disruptors (I had several), then it was in giving it time. I have to chuckle now thinking how things that used to make me crazy I barely notice any longer. Good luck in adjusting to whatever therapy will truly effectively treat your sleep apnea.

[Jak3099]

I truly appreciate all the feedback

I was diagnosed with OSA in 2011, and have been off and on of CPAP up until this past June, when I committed to sticking to a good therapy.

This time around, my sleep study showed I had mild OSA (AHI of 12) with the O2 reaching only 92% at it's worst. The report said I responded well at 5 cm H2O. I have been using nasal pillows since June with high compliance (except the week I took off to do my "experiment").

I realized I pretty much blindly accepted the sleep doctor's suggestion to set the pressure to 4. Last night I set it to 5.2, and it was better. I think I'm going to titrate on my own to see what works, using a sleep journal to help, as well as Sleepyhead reports. I definitely woke up a couple of times last night to adjust the hose on the hanger: it was too short and was pulling my nose up like the phantom of opera.

I'm sure self-titration isn't recommended, but I don't really trust that doctor anymore. I believe there was a sticky thread on self-titration, but has anyone had success with it? Thanks!

[chunkyfrog]

I retitrated myself on my autoset, starting with a range of 8-18 (my original lab pressure was 14)
After observing my 95% pressures, my AHI, and centrals, I gradually adjusted my range to 9-13.
My pressures are usually in the low 11's.