If you become "CPAP intolerant"

Kent Smith · Post by **Kent Smith** » Wed Mar 29, 2006 6:57 pm

For those of you who do not know, the American Academy of Sleep Medicine came out with new guidelines in February, stating that the CPAP was the gold standard for severe apnea, but that for anything less severe, a dental appliance is an acceptable form of treatment.

We started a new group called the Dental Organization for Sleep Apnea recently, and our mission is to alert the public that their dentist is someone they can turn to with certain sleep disorders, specifically mild to moderate sleep apnea.

I am glad to make myself available to answer any questions you might have relating to appliances for the CPAP-intolerant. I know the statistics for non-compliance, and they are not pretty. MDs are not known for their excellent follow up with non-compliant CPAP wearers.

Sleepless on LI · Post by **Sleepless on LI** » Thu Mar 30, 2006 8:20 am

Could you provide any links to this study that we could read? Thanks.

Barb (Seattle) · Post by **Barb (Seattle)** » Thu Mar 30, 2006 9:50 am

Tried one fitted by an orthodontist, of course my apnea is severe, so this didn't really work. I never got used to the drooling....

Kent Smith · Post by **Kent Smith** » Thu Mar 30, 2006 10:02 am

Glad to, Lori. http://www.aasmnet.org/PDF/PracParam_Or ... ance05.pdf

Sleepless on LI · Post by **Sleepless on LI** » Thu Mar 30, 2006 11:36 am

Kent Smith wrote:Glad to, Lori. http://www.aasmnet.org/PDF/PracParam_Or ... ance05.pdf

Thanks, Kent. Reading now.

Bella · Post by **Bella** » Thu Mar 30, 2006 11:46 am

And the title of the study supports what I suspected. When you refer to "sleep apnea" in your post you are referring only to obstructive sleep apnea. While I realize that the majority of those with sleep apnea have OSA, there are those of us who do have central sleep apnea. Perhaps you could clarify that in your post. (Not trying to be rude.)

PS - Barb, I drool enough with my regular appliance (TMJ). It's not a pretty sight.

Kent Smith · Post by **Kent Smith** » Thu Mar 30, 2006 12:49 pm

Thanks, Bella. I almost always type OSA or obstructive sleep apnea, but must have done that in haste. Thanks for the clarification. I definitely know the difference.

Bella · Post by **Bella** » Thu Mar 30, 2006 1:49 pm

Thanks Kent! I hope that it didn't come across as short. My apologies if I did. I'm new to sleep apnea, but in these short 5 months I've gotten frustrated (rarely here) about the assumption that apnea is only OSA.

PS - Ok, I just re-read my first post. I did sound rude. Again my apologies.

Edited for PS.

Swordz · Post by **Swordz** » Thu Mar 30, 2006 8:44 pm

What the study and organization stated is common knowledge to those that truly study OSA and the various treatments. Course, its good to have backup for those naysayers.

OSA treatment is dependent on the patient, the obstruction(s), and the type of apnea. One treatment doesn't fit all, but this is a common mistake that some doctors do. My original sleep doc (pulmologist) didn't even notify me of my alternatives; CPAP was it. Again, one solution isn't the best answer in all situations.

Patients should take the time and effort to fully understand the condition and all possible treatments: Pillar, MMA, GA, Hyoid Advancement, dental device (TAP, etc), CPAP/APAP/BIPAP, on and on.

Kent Smith · Post by **Kent Smith** » Fri Mar 31, 2006 12:19 am

Good points, Swordz. There are more than 90 dental appliances alone on the market (not all FDA approved), and as I counsel dentists frequently, if they are prescribing the same one to all of their patients, they are doing them a disservice.

On a new patient today, we went over various dental appliances, various CPAPs, behavior modification (he didn't like the alcohol talk), bite reconstruction to increase his vertical dimension, medications, pillar implants, UPPP, GA, and even a breathe-right strip. Sounds like your pulmonologist either needs some education or needs to check his kickback incentives at the examination door.

leaveye · Post by **leaveye** » Fri Mar 31, 2006 2:43 am

Speaking of Kickbacks... This all sounds pretty lucrative for the dentists and DOSA.

If I may ask, Mr. Smith: What are you credentials and affiliations? What does your organization stand to gain by dentists buying memberships in your organization? Who funded the research? What are your personal incentives? Is the DOSA a non-profit organization?

I find it hard to believe that you would be more motivated by the goodness of your heart, than by the platinum corporate sponsors who all seem to have a hand in the manufacture of dental appliances.

It may very well be that the products you are peddling have the potential to help a great many people, but that doesn't excuse the fact that the purpose of this forum is not to provide free advertising, but rather to provide support for and by CPAP users.

Guest · Post by **Guest** » Fri Mar 31, 2006 3:38 am

It is interesting that a relatively simple dental device -- completely mechanical -- can cost three times the price of an APAP embodying the latest electro-mechanical/computerized technology.

wading thru the muck! · Post by **wading thru the muck!** » Fri Mar 31, 2006 6:23 am

Guest wrote:It is interesting that a relatively simple dental device -- completely mechanical -- can cost three times the price of an APAP embodying the latest electro-mechanical/computerized technology.

Guest,

That's because an APAP doesn't drive a Benz and have off every Tues and Thurs. LOL!

Kent Smith · Post by **Kent Smith** » Fri Mar 31, 2006 10:02 am

OK, I knew someone would ask these questions, so I really don't mind answering anything you guys want to ask. That's why I made the offer to begin with, and in fact, I appreciate the dialogue. It's all about learning.

DOSA was actually founded by Dr. Bruce Baird, who asked me to be the co-director with him. He has spent much more than you can imagine to this point (75,000 DVDS to mail out to dental offices is an example), and is at this time in the process of converting this to a non-profit organization. If there is no revenue to offset his expenses, it would be no organization at all.

I am a member of the Academy of Dental Sleep Medicine and the American Academy of Craniofacial Pain, but to be honest, no credentials or affiliations are even necessary to screen dental patients for snoring/OSA and to make sure they get the correct treatment. I've been placing dental appliances for snoring for about 10 years, and have probably learned more from this practical experience than through "education".

DOSA has not engaged in any research, so I am not sure what you are asking in that area. If you clarify, I would be glad to expand.

When you stated that the purpose of this forum is to provide support for CPAP users, thst was my purpose for the original post. Unfortunately, the reported compliance % for CPAP users is abysmal, and from what we have learned over the years, follow up from the MDs who prescribe them is even worse. As you all know, OSA is not something to be treated lightly, and if someone stops using their CPAP completely, they should look for alternatives.

I agree that these devices are expensive, but to be honest, the lab fees are so high for the good ones, that this is basically a non-profit item in my office. I really do have a heart for my patients with non-treated OSA, and at this point in my practice, am not looking to make a fast buck off of them. In fact, I'm not sure where you got "can cost three times the price of an APAP", but if an APAP is $300, I need to think long and hard about this.

Guest · Post by **Guest** » Fri Mar 31, 2006 10:58 am

Anyone interested in a dental appliance may want to click on this link containing several links compiled by rested gal. Look under the section: Pillar Procedure and TAP Dental Device:

LINKS to surgery, turbinates, Pillar, TAP experiences

If you become "CPAP intolerant"

If you become "CPAP intolerant"

Re: If you become "CPAP intolerant"

Just took a quick look...