ORAL DEVICE FOR OBSTRUCTIVE SLEEP APNEA

[chandrasky]

ORAL DEVICE FOR OBSTRUCTIVE SLEEP APNEA

After the sleep study, I was recommended "mandibular advancement device" for mild to moderate obstructive sleep apnea. I understand there are many types of this device. Which one do you recommend? Also, I understand there are side effects for some people like jaw pain, teeth dislocation, or teeth may begin to hit each other when eating. Did you have any of these complains?

Thank you for your help.

[chunkyfrog]

---And nobody mentioned CPAP?
(Which is the gold standard, incidentally)
It sounds like somebody needs to make a yacht payment.

[ChicagoGranny]

I understand there are many types of this device. Which one do you recommend?

Get a custom-fitted MAD from a dentist - probably $1200 - $2000 depending on where you are located. Some health insurance policies help.

The effectiveness of MADs for an individual is not predictable. You may spend the money and find out it's not effective for you. Or the side effects might be intolerable.

CPAP is the gold standard treatment. Especially so if you invest the time and effort to make sure your CPAP therapy is optimized.

[Janknitz]

As this is a CPAP forum, most people here are pro-CPAP. But SOME people can have success with a MAD.

My dentist, who makes such devices, said they might work for people with mild apnea. Even though he makes a tidy profit on them, he doesn't recommend them often. For someone with moderate or severe apnea, he believes they are not effective, and anyone trying to convince you otherwise just wants to sell you something for a tidy profit.

Is your apnea mild? Then it might be worth trying if you really don't want to go to CPAP.

Keep in mind that it changes the position of your jaw. You will need exercises to remove the device every morning when you wake to reset your normal position so as not have TMJ issues--make sure they show you what you will need to do.

Insurance may not cover this expensive device, and you should ask how the dentist will validate that the device is lowering your apneas enough.

[imrdyman]

First night i slept with one of these devices my jaw was already popping and clicking afterwards, so i just went with CPAP. They can work but just be careful with these things.

[Callen]

---And nobody mentioned CPAP?
(Which is the gold standard, incidentally)
It sounds like somebody needs to make a yacht payment.

That sleep medicine specialist needs to make a yacht payment, for sure! Wait, who makes Mandibular-Assist Devices?

"If you and your doctor decide that oral appliance therapy is the best treatment option for you, your doctor will write a prescription and refer you to a qualified dentist who can make a custom-fit oral appliance for you. The dentist will provide ongoing treatment to make sure your appliance remains comfortable and effective for you."

Oh, I guess someone doesn't need to make a yacht payment...

Doctors will often recommend MADs for patients with mild-moderate OSA even though PAP is the gold standard. Why do they make this recommendation? There is ample literature to suggest that patient compliance is markedly higher with MADs compared with PAP. Patients with mild-moderate sleep apnea are also less likely to notice an improvement with PAP, so they discontinue therapy as it's cumbersome.

"Volunteering" your opinion is not always altruistic, especially when your opinion is ill-informed. If you would like to provide adequate education to others, then let me know. I'll compile a cornucopia of literature for you to read.

[chunkyfrog]

Never heard of KICKBACKS?
Not at all surprised . . .

[Callen]

I understand there are many types of this device. Which one do you recommend?

Get a custom-fitted MAD from a dentist - probably $1200 - $2000 depending on where you are located. Some health insurance policies help.

The effectiveness of MADs for an individual is not predictable. You may spend the money and find out it's not effective for you. Or the side effects might be intolerable.

CPAP is the gold standard treatment. Especially so if you invest the time and effort to make sure your CPAP therapy is optimized.

I agree with ChicagoGranny. These devices have a greater likelihood of being efficacious for patients with Retrognathia (the lower jaw is set further back than the upper jaw.)

These devices require more effort than you'd think. You'll need to do mouth exercises every morning (or wear a different mouthpiece that serves this purpose), make multiple adjustments at your dentist's office (to make sure it's not uncomfortable but also ensure there's enough anterior movement to open your airway), and you'll, likely, have some discomfort when first starting.

I'm not suggesting you should or shouldn't use MAD, because PAP also comes with its pros and cons. I encourage you to read more about them and get a better idea if you feel it's something you'd be interested in.

[Callen]

Never heard of KICKBACKS?
Not at all surprised . . .

I apologize for assuming you'd be aware of legal statutes pertaining to "kickbacks". Nothing we can't fix with a little education!

"The Stark physician self-referral statute states that a “physician may not make a referral to [an] entity for the furnishing of designated health services,” reimbursable by Medicare, Medicare Advantage, Medicaid, or Medicaid Managed Care (collectively referred to as “Medicare/Medicaid”), if the “physician (or an immediate family member of such physician) has a financial relationship with [such] entity,” unless a Stark exception is met.[2] To understand the scope of Stark’s prohibition against self-referrals, it is necessary to understand the definitions of various terms. “Referral” means “the request by a physician for, or ordering of . . . any designated health service for which payment may be made under” Medicare.[3] This is a very broad definition; it is not limited to a physician’s referral to a specific supplier.[4] “Designated health services” (“DHS”) are categorized into 10 distinct types of services, including “durable medical equipment and supplies.”[5] The definition of DME includes CPAPs and supplies.[6] Stark is a strict liability statute. Unless an arrangement that implicates Stark meets a specific exception to the statute, then the arrangement violates Stark, even if the parties acted in good faith when they entered into the arrangement."

[chunkyfrog]

Legality is no impediment if the prize is great enough.
Only a fool ASSumes that others obey every law.

[Callen]

Never heard of KICKBACKS?
Not at all surprised . . .

Next, you're going to tell me that just because it's against the law doesn't mean it keeps providers from engaging in "kickbacks".

[Callen]

Legality is no impediment if the prize is great enough.
Only a fool ASSumes that others obey every law.

NO WAY I PREDICTED THAT!!!!!!!! LOOL

You're right! While we're at it, we should just do away with the entire judicial and legislative branches of government! After all, people commit crimes despite established laws!

[Pugsy]

Sigh....get back on topic folks and the topic wasn't the legal conspiracy crap I am hearing here.
Take this sort of discussion privately please.

[Callen]

Sigh....get back on topic folks and the topic wasn't the legal conspiracy crap I am hearing here.
Take this sort of discussion privately please.

Yes ma'am. I should've left it at Stark Laws and not engaged in tomfoolery.

[ozij]

As far is I'm concerned, the first reason not to use a MAD is that you can't track its effects on the quality of your breathing.