One person’s journey - cpap FAIL (so far) [long post]

[HoseCrusher]

... more air results in more evaporation...

I don't know. Hey, I am "outside the box" here. The "normal" stuff looked like it had already been covered, so I looked beyond that.

[SleepingUgly]

... more air results in more evaporation...

I don't know. Hey, I am "outside the box" here. The "normal" stuff looked like it had already been covered, so I looked beyond that.

Fair enough.

[SRSDDS]

_____

Stephen,

I have been told that I snore at times. I don’t have much more detail than that.

RE: dental appliances...I don’t want to risk jaw problems. I haven’t seen impressive statics on effectiveness—do you maybe have some I haven’t seen? I don’t see much transparency in clarifying who they tend to help and who they don’t--Aren’t they more suitable for people where the tongue rather than the throat is causing the blockage? Finally, I think they would be uncomfortable. I hated braces. I can’t stand a tiny speck of food between my teeth.

The aches and soreness are anywhere from hips/lower back to head/neck/shoulders. I suspect 4 things: residual effects from soft tissue injury after being rear-ended in my car some years ago, getting older and forgetting to stretch, not enough walking, and poor (skeletal/musculature) alignment. I try not to neglect those last 3.

TMD = Temporomandibular disorders. I don’t believe I have this, and I don’t want to develop it. My dentist said I probably used to grind my teeth, but I don’t think I do anymore. No pain there, but if I eat too much hard, crunchy food at once, they develop a clicking sound and feel of bones not lining up right. Very infrequent.
_____

Jade,
--If someone says you snore at times----you snore
--If you would like to see studies on dental appliances for sleep apnea, google will very likely give you 300K+ hits. OSA is a very hot topic in dentistry right now. As far as how they all work, it is controlled mandibular advancement, and has nothing to do with tongue control. Also, being a removeable device, you will be much less annoyed by it than by fixed braces. A properly adjusted device will not be uncomfortable.
--If you have upper back, head and neck, and shoulder muscular discomfort, the overwhelming liklihood is that that you clench and possibly grind your teeth. Temporal muscles, neck muscles, shoulder muscles, believe it or not, are dental closing muscles. Pathological oral hyperfunction will cause these muscles to become spasmed and painful.
--the sound of "clicking sound and feel of bones not lining up right" is not bones. It is spasmed muscles. The pathologic muscle pull is causing things to feel like they don't line up. If you were having bony contact to make clicking noises, you would be an invalid. It's not pretty and requires surgery to correct if it can ever be corrected.
--Please, go to a dentist who deals with OSA. You sound like you have almost all of the symptoms of TMD and probably a mild case of apnea, all of which can very easily corrected with a dental appliance that you will find to be surprisingly comfortable.

Stephen

[gasp]

. . . There is evidence that dental devices are effective, certain for some people. Some argue that for severe OSA, such as yours, dental devices should not be the first line of treatment, but others say they can be effective even in severe OSA. I guess no one would argue that they are more effective than what you're considering using (i.e., nothing).

As to a dental device, I had one and previous posts can be found on the forum detailing my experience with it. Of course everyone is different, but my biggest takeaways from using the Advanced Mandibular Device are:

- it did cause a bite change and more teeth and jaw mobility than I believe would be good over the hopeful many years I have left to use an apnea device.
- my salivating reduced from initial use but never did subside and waking to a wet pillow was annoying to say the least.
- last but not least the sleep study I had with the device showed it did not significantly reduce events.

[jnk]

. . . TMD and probably a mild case of apnea . . . very easily corrected with a dental appliance. . . .

Personally, I'm not sure I'd sign off on "very easily" with that combination ( http://www.ncbi.nlm.nih.gov/pubmed/20967571 ), but I agree that dental appliance may very well be worth a shot. It can be an expensive crapshoot (50% helped, 50% reduction, not cheap, yada yada), but when it pays off, it do pay off BIG TIME for some. It might help to get the right dentist experienced with that specific combination of problems, though.

[SRSDDS]

. . . TMD and probably a mild case of apnea . . . very easily corrected with a dental appliance. . . .

It might help to get the right dentist experienced with that specific combination of problems, though.

http://www.aadsm.org/ American Association of Dental Sleep Medicine
This site may help you find the right dentist.
With the symptoms and descriptions given by OP, it's pretty obvious she snores, has TMD, and fairly mild OSA. This is where oral appliances can be of most help. Will a dental device work for severe OSA or CSA? A lot less likely. But her constellation of symptoms is really not unlike that of so many patients who I have seen and simply treated with an NTI appliance (not a sleep apnea or anti snoring appliance) very successfully.
Don't get me wrong. Oral appliance therapy is not for everyone. To wit, I use an APAP

Stephen

[rested gal]

Stephen, I think I should have had you on my list of "good'uns" a long time ago. Sorry for the oversight.

You're most definitely there now.

viewtopic.php?p=442957#p442957

[SleepingUgly]

With the symptoms and descriptions given by OP, it's pretty obvious she snores, has TMD, and fairly mild OSA.

With an AHI of 60 or 70-something, as she said, I would argue that this is not fairly mild OSA (although that point may have limited relevance here, depending on who you ask).

But her constellation of symptoms is really not unlike that of so many patients who I have seen and simply treated with an NTI appliance (not a sleep apnea or anti snoring appliance) very successfully.

What is an NTI? I'm confused... are you saying the NTI successfully treats sleep apnea even though it's not a sleep apnea appliance? Or are you talking about it treating her TMD?

What do you think of the notion that certain nightguards for bruxism make SDB worse because the bruxism is a compensatory mechanism for a collapsing airway, and certain splints inhibit that? How do I know if mine does or not? I've been wearing the same upper teeth guard for 16 years due to bruxism found on a sleep study (and every dentist who looks at my teeth concludes that I brux--or did brux--based on the wear of my teeth).

[rested gal]

With the symptoms and descriptions given by OP, it's pretty obvious she snores, has TMD, and fairly mild OSA.

With an AHI of 60 or 70-something, as she said, I would argue that this is not fairly mild OSA (although that point may have limited relevance here, depending on who you ask).

My first sleep study (over 2 years ago) showed hypopneas only, but with an AHI of 60 or 70-something. Minimal oxygen desats.

----

Based on discussion with my dr and my own research, my OSA is more of a UARS-kind.

The figure she gave as the "AHI" may have actually been an "RDI" figure (just my guess) -- Respiratory Disturbance Index -- which would count arousals from any respiratory event (like flow limitations that don't qualify as an apnea or hypopnea.) Especially since she says subsequent discussion with her doctor points toward UARS (Upper Airway Resistance Syndrome.)

But even if it really was an AHI of 60 or 70 something, and the events were "hypopneas only" (no apneas) ... then regardless of what label (mild, moderate, severe) is used for those numbers, I think there'd be a good chance of a dental device opening the airway just the little bit more to keep hypopneas from happening. Worth trying, imho.

[SleepingUgly]

Yeah, one doc's hypopnea is another doc's RERA is another doc's Nothing.

Unless I missed something, she hasn't had a real titration, which might just be the piece she's missing. If she's eliminated hypopneas (and one can do that just by switching to an S9, IMO!), but isn't looking at FL, she may just have titrated her hypopneas into RERAs, and wouldn't expect to feel rested. In her position, I'd go for a titration before I went after a MAD, as she appears to have adapted well to CPAP and the only missing piece may be a titration (which may even find other issues, such as PLMS, etc.).

[jnk]

Stephen . . . my list of "good'uns" . . . most definitely there now. . . .

Well-deserved!

I've been impressed by the posts, myself.

. . . not fairly mild . . .

Aside from the number of events and number of arousals, I guess the severity of a person's events may be refered to as "mild" in one sense if the events are barely hypopneas and are not causing sustained desaturations, even if AHI is the measurement most often tossed around.

The association of teeth grinding and jaw pain and breathing changes can cause interactions in which it can be unclear which is "causing" which. Taking any one of them out of the mix may improve someone's sleep and could even lessen the other two problems. Maybe. So I hear.

For me, when it comes to oral appliance discussions, though, there isn't yet enough information on them to have meaningful discourse on what usually happens across any certain population presenting a certain way. At this point, it is mostly about individual response to treatment. The variety in individual anatomy, in individual nervous-system response, and in the devices themselves makes it all mostly unpredictable. You don't know until you know.

[SRSDDS]

With the symptoms and descriptions given by OP, it's pretty obvious she snores, has TMD, and fairly mild OSA.

With an AHI of 60 or 70-something, as she said, I would argue that this is not fairly mild OSA (although that point may have limited relevance here, depending on who you ask).

But her constellation of symptoms is really not unlike that of so many patients who I have seen and simply treated with an NTI appliance (not a sleep apnea or anti snoring appliance) very successfully.

What is an NTI? I'm confused... are you saying the NTI successfully treats sleep apnea even though it's not a sleep apnea appliance? Or are you talking about it treating her TMD?

What do you think of the notion that certain nightguards for bruxism make SDB worse because the bruxism is a compensatory mechanism for a collapsing airway, and certain splints inhibit that? How do I know if mine does or not? I've been wearing the same upper teeth guard for 16 years due to bruxism found on a sleep study (and every dentist who looks at my teeth concludes that I brux--or did brux--based on the wear of my teeth).

NTI=Nociceptive Trigeminal Inhibition. I would recommend this based on the fact that I believe, based on the OP's symptoms, that trigeminal excitement, ie clenching and bruxism, is the basis of her problem. She has primarily hypopneas, making me believe that she mixed up AHI and RDI. Trigeminal arousal can significantly increase RDI and reduce quality of sleep. My guess would be that if the trigeminal arousal eliminated, then the AHI/RDI would drastically decrease and OP would have a greater sense of well being.
The NTI is significantly different from your common horseshoe night guard. It prevents posterior tooth contact and transfers all contact to the anterior teeth, which are physiologically protected from the pressure of clenching. Also, it raises the vertical dimension and very often will make a slightly advanced mandibular position the most comfortable position, thereby offering some opening of the airway. It is not a primary device for OSA, but again I do not think OSA is the OP's problem.
By the way, if you are wearing a horseshoe night guard, you are still not inhibiting trigeminal arousal. You are just clenching at an increased vertical dimension which somewhat lessens the stress on the closing muscles but does not eliminate it.

Stephen

[SleepingUgly]

NTI=Nociceptive Trigeminal Inhibition. I would recommend this based on the fact that I believe, based on the OP's symptoms, that trigeminal excitement, ie clenching and bruxism, is the basis of her problem. She has primarily hypopneas, making me believe that she mixed up AHI and RDI. Trigeminal arousal can significantly increase RDI and reduce quality of sleep. My guess would be that if the trigeminal arousal eliminated, then the AHI/RDI would drastically decrease and OP would have a greater sense of well being.
The NTI is significantly different from your common horseshoe night guard. It prevents posterior tooth contact and transfers all contact to the anterior teeth, which are physiologically protected from the pressure of clenching. Also, it raises the vertical dimension and very often will make a slightly advanced mandibular position the most comfortable position, thereby offering some opening of the airway. It is not a primary device for OSA, but again I do not think OSA is the OP's problem.
By the way, if you are wearing a horseshoe night guard, you are still not inhibiting trigeminal arousal. You are just clenching at an increased vertical dimension which somewhat lessens the stress on the closing muscles but does not eliminate it.

Wow! I don't want to hijack the thread, but can I anyway?? If not I'll be happy to copy Stephen's last post to another thread all of my own. But it seems the OP and I have some similarities, so maybe this can help us both.

I had an RDI of 15 based on a REM RDI of 58 and NREM RDI of 4 (and continuous FLs in NREM). All were hypopneas, associated with arousals, not desaturations. My oxygen saturation didn't go below 92%. I was diagnosed with OSA, but I don't mind if you call it UARS (just don't send me back to the Idiopathic Hypersomnia category!). I obviously did/do(?) brux, but except very rarely, I don't feel pain from it. I don't do it during the day. I AM using a horseshoe shaped, rigid plastic, upper teeth nightguard.

Questions:

What is a trigeminal arousal and how do I know if I'm having them?

Does an NTI cause bite changes? What are the risks with using an NTI? Can one close their mouth with it and use CPAP?

Is there any evidence to support that the NTI can improve SDB?

Can my horseshoe shaped mouthguard be making my SDB worse by preventing a compensatory mechanism for the collapsing airway (do you believe that theory?)?

Thanks!!

[jnk]

http://journalgateway.com/index.php/ijp ... 011.4/html

I would pay good money to read -SWS's take on the above.

[SleepingUgly]

http://journalgateway.com/index.php/ijp ... 011.4/html

I would pay good money to read -SWS's take on the above.

On the link you posted here or on the contents of this thread?