Dental appliances versus CPAP

[klutzo]

Hi all,
I recently read an article that shocked me. It said that the preferred treatment for uncomplicated apnea is now the dental appliance, with CPAP only being used as a last resort if dental appliances don't work. It was a couple weeks ago, and I can't remember where I read it, but I wondered what you all think of that.

My CPAP machine is about to die. It is making noises when it starts up that are taking longer and longer to get calmed down, and sometimes I must give it a hard tap to make the noise stop. It is 7 years old. I also turn it off and on a lot more than most people, since I get up 6-7 times per night. If the above is true, I would like to try a dental appliance before paying out endless rent for another CPAP machine and dealing with the headgear hassles I have to deal with, like chin straps, which I despise. I am a bit leery of dental appliances, since I used to have TMJ and do not want to reactivate it. (I got rid of it about 10 yrs. ago with only two sessions of cranial-sacral therapy.... a miracle!).

Since a lot of what we read on the Internet is untrue, have any of you had experience with the most up to date dental appliances and how did you fare with them? How much did they cost? How were you able to tell if they controlled your apnea.....yet another night of torture at the sleep lab?

Any advice from the real experts.....you.....is greatly appreciated.

klutzo

[Pugsy]

How were you able to tell if they controlled your apnea.....yet another night of torture at the sleep lab?

Yep, that is the only way to know for sure.

How much did they cost?

Prices vary a lot...custom appliances can cost thousands of dollars. Minimal cost appliances will still cost as much as a cpap machine.

On one of the other apnea boards there is a dentist that talks about which one he has had the greatest success with. I don't remember which board...Some who knows should come along shortly that remembers and point you to more specific oral appliance discussions. We don't have a lot of current forum members here using appliance primary because this is a cpap forum. If they don't use a cpap machine they are unlikely to stick around here very long.

A lot how successful the oral appliance is comes from how severe the OSA is and what is the primary cause.

[49er]

Hi,

Go to http://www.apneasupport.org/ and look in the dental appliance forum for posts by Dr. Luisi. He likes the Tap3 appliance the best.

If you go this route, you might need a sleep medicine dentist who also specialized in TMJ issues.

Pugsy is right, the only way to know is to do a sleep test.

49er

Hi all,
I recently read an article that shocked me. It said that the preferred treatment for uncomplicated apnea is now the dental appliance, with CPAP only being used as a last resort if dental appliances don't work. It was a couple weeks ago, and I can't remember where I read it, but I wondered what you all think of that.

My CPAP machine is about to die. It is making noises when it starts up that are taking longer and longer to get calmed down, and sometimes I must give it a hard tap to make the noise stop. It is 7 years old. I also turn it off and on a lot more than most people, since I get up 6-7 times per night. If the above is true, I would like to try a dental appliance before paying out endless rent for another CPAP machine and dealing with the headgear hassles I have to deal with, like chin straps, which I despise. I am a bit leery of dental appliances, since I used to have TMJ and do not want to reactivate it. (I got rid of it about 10 yrs. ago with only two sessions of cranial-sacral therapy.... a miracle!).

Since a lot of what we read on the Internet is untrue, have any of you had experience with the most up to date dental appliances and how did you fare with them? How much did they cost? How were you able to tell if they controlled your apnea.....yet another night of torture at the sleep lab?

Any advice from the real experts.....you.....is greatly appreciated.

klutzo

[chunkyfrog]

Dental devices are of limited use to a few patients--the source of the article may be suspect.
It is not unusual for "articles" to actually be press releases put out by the companies promoting a particular device.
The rule that such press releases have to be identified as advertising is either circumvented or ignored.
It is also quite common for wishful thinking to be expressed as fact, thus somebody's nose is extending at a logarithmic rate.
It is good to note the source of any suspicious statement;
An established medical source will not wish to sully their reputation by being caught publishing lies.

[49er]

Dental devices are of limited use to a few patients--the source of the article may be suspect.
It is not unusual for "articles" to actually be press releases put out by the companies promoting a particular device.
The rule that such press releases have to be identified as advertising is either circumvented or ignored.
It is also quite common for wishful thinking to be expressed as fact, thus somebody's nose is extending at a logarithmic rate.
It is good to note the source of any suspicious statement;
An established medical source will not wish to sully their reputation by being caught publishing lies.

Hi Chunkyfrog,

I agree that companies can put out press releases that look like news. Drug companies do this all the time.

But I would greatly disagree that they are of limited use to a few patients. A relative's sleep medicine doctor whom I was unable to see for various reasons but who has a good reputation has said they are a viable alternative, particularly if you have minor or moderate apnea.

I suspect what may lessen the effectiveness is not using devices appropriate for a patient's situation as many sleep medicine dentists are more caught up in the hype vs. what really works. That is why you really have to do your homework if you're considering one.

But if you are cpap intolerant in spite of trying everything under the sun and yes those people do exist, including me so far, some treatment is better than nothing. And if you have a minor or moderate case, your chances are quite good of getting optimal treatment.

49er

[klutzo]

None of my replies to you are showing up! I am going to look like I am ignoring you. I have no idea why they are not posting. I hope you can see this one and know how much I appreciate your help.

klutzo

[Kenwood]

Since a lot of what we read on the Internet is untrue, have any of you had experience with the most up to date dental appliances and how did you fare with them? How much did they cost? How were you able to tell if they controlled your apnea.....yet another night of torture at the sleep lab?

I tried a dental mouthpiece for a while. It cost me about $350 (not covered under dental nor health insurance) - it really didn't work much. It was form fitted to my mouth using a goo for make a mold of my upper and lower teeth. About a week later you get your mouthpiece. It can be adjusted (by the dentist only) with spacers - which more your lower jaw. It was very uncomfortable, as it forces your lower jaw forward (you do get used to it tho). I stopped using it several months in as one morning I woke up with severe jaw pain and could not chew for a while. Then months latter I tried it again, but the fit bothered my teeth (didn't align perfectly with my teeth impressions anymore). Now that I'm on the PAP....its in the bathroom junk drawer.

[Pugsy]

But if you are cpap intolerant in spite of trying everything under the sun and yes those people do exist, including me so far, some treatment is better than nothing. And if you have a minor or moderate case, your chances are quite good of getting optimal treatment.

I totally agree with 49er here. Any therapy is better than no therapy. Be it short hours on the machine or whatever.
Is it ideal? Of course not but we don't always get ideal in life. That's just a cold hard fact of life that sucks.

If I thought that an oral appliance might do it for me....I would consider it if I could afford it. I hear the ad from the dentist in the big city near me all the time and I listen. Unfortunately my insurance wouldn't pay and my pockets aren't deep enough and more importantly I doubt it would help greatly in my own personal situation. My situation is more from purely floppy airway tissues down below the tongue and not oral structures that need to be moved to open up the airway at the mouth level and my O2 desats were massive...50% improvement wouldn't be all that much help to me but I would do it if that was all I could do. I am lucky...cpap and me get along just fine but if it didn't...yep I would beat feet to try something even if less than ideal.

My doctor and I think that a neck surgery I had years ago may have impacted the patency of my airway just below the tongue area.

[Docky999]

Sleep apnea is caused by 2 problems in the upper air way tract. 1 - The lower jaw dropping back (towards the spine) taking the tongue with it to obstruct the air way. 2 - The soft palate losing its normal muscle tone as we age.
1. The dental appliances help relieve the cause #1 at a cost. If the appliance is adjusted enough to open the air way enough, one will develop TMJ if one did not have it before, not to mention how much worse it will get if one already is suffering from TMJ.
2. Loss of soft palate tone is sometime helped by surgery, but most often nothing helps other than CPAP.
To my knowledge there is no way to tell which problem is causing sleep apnea. It is assumed that in most people, sleep apnea is caused by both problems. I have used different types of dental appliances before getting the CPAP machine. My conclusion - substantial improvement with CPAP and dental appliance provided marginal relief if any. ( developed TMJ as I tried to move the jaw to open the air way more)

[khauser]

If I thought that an oral appliance might do it for me....I would consider it if I could afford it.

In the YMMV category ... I don't think I would consider it. But bear in mind that I am VERY acclimated to CPAP therapy, to the point that I find it relaxing instead of bothersome...

I wouldn't consider a change unless it had the promise of additional improvements with little risk.

With ANY dental appliance I would be concerned about TMJ. Any includes, for instance, the Tap Pap mask I use, and I was careful with that to be sure it wouldn't be an issue. I have very mild TMJ, but my daughter has the opposite and can barely eat some times. I would NEVER want to get that bad (though I do admit it is keeping her nice and slim ... just doesn't seem the right way).

[Pugsy]

In the YMMV category ... I don't think I would consider it. But bear in mind that I am VERY acclimated to CPAP therapy

As am I...but sometimes there is that little part of me that says "what if"...so far it isn't very loud though and I know deep down it likely not offer as good of results...but sometimes I do feel the pull...

But then I sometimes feel the pull of the red Corvette (man I love the looks of the new ones) but I know I won't ever yield to the temptation. So the chances of me ever really doing something about an oral appliance...slim and none.

Though if I was having severe problems with cpap..you bet your sweet life I would try it. Some therapy is better than no therapy.
I would have looked under every rock possible with cpap first though.

[chunkyfrog]

I, too, am totally OK with apap; but am a bit concerned about a freshly diagnosed-and still-in-denial person
going straight to a device without giving PAP a fair chance.
It's good to present all sides to someone who may be easily led down what could be a very wrong path.

[klutzo]

Hello all,
I have tried repeatedly to post my thanks for all your opinions, and for some reason the only one that posted was the one that said I had been trying to post! It may be because the last time I posted on here I had a windows computer and now I have an iMac. That's the only thing I can think of. I sure hope this posts, because I am going to type a lot (again) and am getting tired of retyping, only to have it not post.

Thanks to Kevin for talking about the TMJ experience. I used to have severe TMJ and had to wear a hard night guard made by a dentist. Two sessions of cranial-sacral therapy cured it completely over ten years ago. I do NOT want to get it back again! I highly recommend CST to anyone with TMJ....I went in as a desperate skeptic and emerged with a miracle after years of suffering and grinding my teeth against that painful mouth guard all night.

As to the severity of my apnea: I do not have apnea, strictly speaking. I have hypopnea, and I have it 24 hours a day due to severe fibromyalgia, secondary to advanced Lyme Disease. Lyme Disease can also cause apnea, which can be cured rapidly by a combo of two antibiotics, both of which I am allergic to, so I am screwed. I also take enough depressant-type medicines at bedtime to kill most people, but I need them to lower a dangerous blood pressure rise when I lie down and to overcome another sleep disorder called alpha-delta sleep intrusion anomoly. I feel the meds could be the cause of the hypopnea also, or it could be caused by a combo of all of the preceding problems.

Before CPAP, my AHI was 29. With CPAP, it is 0.8. However, I've been using CPAP for 7 years and do not feel one bit better. I fall asleep faster, but no other symptoms have changed except that I fall asleep sitting up now, and I never used to. I had my card read recently because of that and I am still at 0.8. For some reason, even though it is in my Profile, it no longer shows my machine below.....it is a Respironics Remstar Pro M Series with heated humidifier.

I have no problem with CPAP, am totally compliant, and I love my Breeze, but it is getting harder and harder to find the Breeze headgear. My current DME has to special order them, and I've had to change DMEs twice to find one who would do that. My current 7 yr. old CPAP machine is making loud noise when it's turned on, like it's having to work hard to get going, so I think it's about to conk out, and I wanted to explore other options before renting a new one. Why? Thanks to what Lyme Disease has done to my immune system, I have severe Multiple Chemical Sensitivities and cannot tolerate silicone, not even after a year of letting it outgas. Because of that, I must use nasal pillows and only the Breeze, which is heavy, hard plastic. I am a mouth breather too, so I have to use a chin strap and I hate them. I have waist length naturally curly hair, which is very dry and a bitch to wash, and I am forced to wash it more than twice as often due to the sweating from the neoprene chin strap. Other types of chin straps have not worked. I don't want to cut my hair off because I am starting to go bald on top in front due to what the disease has done to my thyroid, and without the length it will look like I have no hair. My long hair is also the only thing I have left of what I used to look like before I got so sick, so psychologically, it helps to still have it. I am very ill and just untangling and washing my hair all the time is exhausting, so combining that with the Breeze maybe being taken off the market leaving me in deep doo doo, and a desire to travel a little while I still can and travel light, not lugging that machine and distilled water for the humidifier and Dawn to wash it with, etc., I wanted to look into dental appliances, if they really had improved as much as that article said.

I have an appt. with my sleep doctor on May 23rd and hopefully my machine will not die completely before then. Thanks to your posts, I will ask him about the Tap 3 dental applicance, but I will be very skeptical, and probably stick with my CPAP, at least as long as I can get the Breeze.

Thank you all so much for your inputs. You're the best!
Klutzo

[SleepingUgly]

I also take enough depressant-type medicines at bedtime to kill most people, but I need them to lower a dangerous blood pressure rise when I lie down and to overcome another sleep disorder called alpha-delta sleep intrusion anomoly. I feel the meds could be the cause of the hypopnea also, or it could be caused by a combo of all of the preceding problems.

Just curious, what kind of medication are you talking about here? I thought perhaps you were talking about narcotics, but I haven't heard of those used to treat alpha intrusions.

Anyway, to your question...

First of all (and no offense to all my good friends at cpaptalk), this is the wrong site to get information about dental devices. These good folks here are die hard CPAPers (the vast majority) and many (not necessarily those who have responded on this threat) regard any alternatives to CPAP as if it were a zombie coming to eat their brains out.

As previously posted, you can get more information at apneasupport.org in the section on dental devices.

Secondly, I don't think it's accurate to say that MADs (mandibular advancement devices) are not as effective as CPAP. The literature was pretty supportive of it being efficacious in mild to moderate cases, and I've read some research suggesting that it can be even in severe cases. Per Dr. Luisi (who Pugsby mentioned), the TAP is approved for severe apnea as well. There's a TAP3 and a TAP3 Elite. Also, I think I've read that it may have less to do with whether you're "mild", "moderate", or "severe" and perhaps the area of obstruction, but I'm not sure about that (it's been awhile since I read it).

That said...

Before CPAP, my AHI was 29. With CPAP, it is 0.8. However, I've been using CPAP for 7 years and do not feel one bit better. I fall asleep faster, but no other symptoms have changed except that I fall asleep sitting up now, and I never used to.

...I don't think that sleepiness is solely attributable to OSA in all cases, and in some cases where it is, it just doesn't improve (research shows that, although don't ask me how they know it's due to the OSA). In someone who tolerates CPAP well, their data is good, and they really sleep well with CPAP, I'd wonder if their sleepiness is caused by the OSA (or again, maybe they are in that % of people with OSA whose EDS does not remit).

I don't want to cut my hair off because I am starting to go bald on top in front due to what the disease has done to my thyroid,

Speaking of thyroid, could that be the cause of your sleepiness?

BTW, not that you asked (and once someone chewed my head off here for offering unsolicited advice that at least was partly on topic, and this is so not, but...), Biotin Forte as well as Vitamin C are great for hair. I found out the latter by sheer accident and now I'm staying on!

[SleepingUgly]

My situation is more from purely floppy airway tissues down below the tongue and not oral structures that need to be moved to open up the airway at the mouth level

Pugsy, I'm curious how you know this. Despite reading many articles that suggested that "sites of obstruction" need to be identified to more appropriate choose a surgery for a particular patient, I haven't seen any evidence whatsoever that even the best of the best can identify where the site of obstruction is.