Oral Appliances: Let's Correct This Understanding

[BioPAP man]

I'm still confused. No matter how much data one views, or how many sites are inspected, there is no definite consensus that oral devices give the same quality of life that cpap does.

Also, go to as many medical facilities and/or universites that teach medicine, there are very few that describe or encourage anyone to pursue the oral devices. So far, I haven't found a dentist here, (120 thousand) who knows anything about the devices. I called the leading university in our state, and the lady could only recommend a local dentist, not associated with the university, who could talk to me. That same university has a sleep center site, but all I could see there was information about UPPP.

you can easily find a sleep dentist in your area by going on the homepage of American Academy of Dental Sleep Medicine and using the "Find a doctor" link. hope this helps.

[jnk]

... an easy test can be conducted to see if an oral appliance would be benificial. First try to replicate snoring sound with the throat only. Second, start advancing the mandable forward while generating the natural snoring sound. if you are a candidate for a MAD, then at a certain protrusion the snoring will become quiet and perhaps eventually go away all togather. One also can perform variations of vertical titration in combination vith protrusion to predetermine optimal results. I use this technique all the time, and had it proven clinically. try it.

Personally, I'm not so sure that our being able to simulate snoring while awake, then alter it with jaw postion, has much, if anything, to do with what our throats do in various sleep stages and sleep positions overnight, as far as obstruction.

Just my opinion, that. I haven't proven it clinically, whatever that means in this instance.

[carbonman]

Carbie,Do you ever wear a heart-rate monitor watch while biking?
Regards,

I gave up the HRM years ago.

...free at last, free at last......

When I start coughing up pieces of lung,
I know I'm at max. heart rate.
My body has fixed ways to tell me when to back off.

It's all good.

[-SWS]

... an easy test can be conducted to see if an oral appliance would be benificial. First try to replicate snoring sound with the throat only. Second, start advancing the mandable forward while generating the natural snoring sound. if you are a candidate for a MAD, then at a certain protrusion the snoring will become quiet and perhaps eventually go away all togather. One also can perform variations of vertical titration in combination vith protrusion to predetermine optimal results. I use this technique all the time, and had it proven clinically. try it.

Personally, I'm not so sure that our being able to simulate snoring while awake, then alter it with jaw postion, has much, if anything, to do with what our throats do in various sleep stages and sleep positions overnight, as far as obstruction.

Just my opinion, that. I haven't proven it clinically, whatever that means in this instance.

Well, upper airway crowding attributable to a receding mandible is well documented as being problematic for some of us. And this test can at least give a feel for changes in upper airway resistance with the mandible in the forward position versus ordinary position.

It's probably worth noting that anyone can unnaturally force snore. And that's different than simulating snore by merely relaxing the upper airway muscles. Forcing snore isn't going to give anyone a clue about upper airway resistance relative to a receding mandible. But simulating snore with nothing more than relaxation while breathing was very telling in my case---regarding differences in upper airway resistance attributable to mandible position. Using this test I can easily yield a heavy, occlusive snore by relaxing my muscles while breathing with my mandible in the ordinary position. When I moved my mandible forward, relaxation alone produced a much lighter, much less-occlusive snore.

I think that says something about me and upper airway resistance: my upper airway resistance is significantly affected by mandible position. But forgetting all about snore for a minute: I can breathe with significantly less resistance/effort with my mandible pulled forward that way compared to normal. While those test results don't tell me that a dental device is guaranteed to help, I think they hint that I'd probably be a fair-to-good candidate for a trial with MAD.

Conversely, if I didn't notice any improvement in upper airway resistance with my mandible experimentally thrust forward, then I don't see the point in giving a dental device further consideration. So perhaps this screening test is better suited for ruling out likelihood of success with a MAD than ruling in likelihood of success.

In general screening methods don't always yield highly accurate results. If they did, those methods would probably be considered definitive diagnostic procedures instead. But that's not to say less-precise screening methods cannot be useful IMHO. They provide guidance or direction, and sometimes they nicely rule out certain possibilities from further consideration.

[jnk]

. . . if I didn't notice any improvement in upper airway resistance with my mandible experimentally thrust forward, then I don't see the point in giving a dental device further consideration. . .

I wonder if there is anyone on the planet who wouldn't notice some difference in his airway with his mandible thrust forward? I can't imagine it making anything worse. So wouldn't it generally make things at least a little better?

[jdm2857]

Advancing my mandible makes no perceptible difference in my breathing effort.

And as far as I know, I'm still on the planet.

[-SWS]

. . . if I didn't notice any improvement in upper airway resistance with my mandible experimentally thrust forward, then I don't see the point in giving a dental device further consideration. . .

I wonder if there is anyone on the planet who wouldn't notice some difference in his airway with his mandible thrust forward? I can't imagine it making anything worse. So wouldn't it generally make things at least a little better?

Oh, fine, Mr. Ornery... just lump the entire species into one indistinguishable set of results. j/k

But Rooster claimed that he experienced MORE snore with his mandible advanced---not less. Maybe he was joking. Not that Rooster has ever kidded the entire forum before.

I will say I'm a bit surprised at what a noticeable difference moving my mandible forward makes regarding the "heaviness" or "sag" of that simulated snore. I had tried that kind of experiment in the past---but only to roughly gauge breathing effort or "smooth" flow resistance. But adding the snore simulation by totally relaxing the muscles kind of drives the point home for me: positioning the mandible forward really makes a noticeable difference in my case (again thanks, BioPAP man). While I don't think I can do without CPAP, I'm amenable to the idea of decreasing upper airway resistance---and conceivably decreasing arousal-prone effort or excessive Work of Breathing (WOB) during sleep.

So how about your dental appliance, Jeff? Does it seem to indirectly help with your quality of sleep by promoting easier breathing? Does it seem to impact your own pressure requirement as far as you can tell from nightly data?

Advancing my mandible makes no perceptible difference in my breathing effort.

And as far as I know, I'm still on the planet.

Thanks for that data point. I think my next SDB experiment may very well be a trip down to one of our area dentists certified in treating sleep apnea. Alternately, I might even consider trying an OTC dental device.

[jdm2857]

My only dental appliance is an Oral-B electric toothbrush.

[BioPAP man]

... Before obtaining a MAD an easy test can be conducted to see if an oral appliance would be benificial. First try to replicate snoring sound with the throat only. Second, start advancing the mandable forward while generating the natural snoring sound. if you are a candidate for a MAD, then at a certain protrusion the snoring will become quiet and perhaps eventually go away all togather. One also can perform variations of vertical titration in combination vith protrusion to predetermine optimal results. I use this technique all the time, and had it proven clinically. try it.

Oh crap. My "simulated throat snoring" is actually louder with my mandible positioned forward. There goes my hope of getting an oral appliance for short naps.

Sir, I recomend to try titrating vertical clearance in conjunction with protrusion, this might help. There are patients that may benifit more from vertical clearance then by forward translation of the mandable. Pherongometry test has shown that this is the case with one patient that I made an appliance for two years ago.

[jnk]

Mr. Ornery

I may change my forum name to that!

So how about your dental appliance, Jeff? Does it seem to indirectly help with your quality of sleep by promoting easier breathing? Does it seem to impact your own pressure requirement as far as you can tell from nightly data?

I mostly use my appliance to keep my jaw from dropping, to prevent mouth leak while using nasal pillows. But my conclusion is that anything that keeps my tongue farther from the back of my throat must be a good thing, and I assume it would be a good thing for most everyone whose tongue plays any role whatsoever in their SDB. That is why my personal position on the matter is so odd:

I believe that the prices should come down so that every OSA and UARS sufferer can have one. I think it should become standard practice for every patient diagnosed with OSA or UARS to get an MAD after the diagnostic PSG and before titration so that titration can occur with the MAD in place. That way, if the MAD is efficacious in solving the problem, lab results will prove it so. And if PAP is still needed, it can be titrated. If prices were reasonable (and they should become so from the volume if every patient got one), that might work--at least on the planet I live in inside my head.

I am under the impression that everything changes in REM, as far as how the throat behaves. So unless a person is tested in supine REM for the efficacy of the oral device in a particular case, I tend to file everything else under "guesswork." So I say titrate every patient with one to see. The problem with that now is that they are so dang expensive. If every sleep center made a deal with a dentist or two for large-volume referrals, maybe that could change.

Anyway, to be clear, my "anyone on the planet" comment was meant to be more of an argument FOR oral appliances, not against, even though I think that in most cases they should be used in conjunction with PAP, not as an alternative to it.

Mr. Ornery

[-SWS]

Anyway, to be clear, my "anyone on the planet" comment was meant to be more of an argument FOR oral appliances, not against, even though I think that in most cases they should be used in conjunction with PAP, not as an alternative to it.

Thanks for sharing those views... I recall, from some of your earliest posts here, that you had been using both CPAP and a dental device.

My only dental appliance is an Oral-B electric toothbrush.

Sir, let's not overlook the ordinary box of toothpicks sitting in the cupboard. Some people forget what a darn handy dental device those can be.






note to self: buy another box of toothpicks...

[roster]

........ But my conclusion is that anything that keeps my tongue farther from the back of my throat must be a good thing, ...............

Dang. -SWS beat me to that one. Nice setup Jeff. These creative forum members could run a very long thread on that one statement.

................. If prices were reasonable (and they should become so from the volume if every patient got one), .....

It won't happen because we regulate the crap out of everything restricting the supply side of the equation.

We are infernal sheep to put up with this government.

[jnk]

Please stay on topic, Rooster. You don't want to make the original poster of this thread mad.

[roster]

Please stay on topic, Rooster. You don't want to make the original poster of this thread mad.

He's an idiot. Let the moron get mad for all I care.

[jdm2857]

He's an idiot. Let the moron get mad for all I care.

You're not a chicken hawk, are you?