So confused. What to do?

[KathJL]

My issues: mild sleep apnea, jaw clenching.
Options: Mouth guard with cpap OR oral appliance.
My step-sister orthodontist told me about the patients she sees who need ortho after years of oral appliances have shifted their teeth.
My dentist is encouraging of the oral appliance because he's seen great success with them.
I don't know what to decide. Any comments would be much appreciated!!

[BlackSpinner]

A proper oral appliance keeps the teeth from shifting so go for cpap machine and an appliance.

Just an appliance only helps less then 50% of people.

[chunkyfrog]

Misalignment of teeth would be a good enough reason to chuck the appliance.
But of course, cpap works very well for me.
Some people have good luck with an appliance--it depends on what causes your apnea.
Second, or even third IMPARTIAL opinions are in order.
Do not trust the sole advice of the person who profits from your decision.

[jdm2857]

I'd be skeptical about the oral appliance.

If they had a track record of great success, there would be many fewer CPAPs sold.

[kteague]

As you make your decision you may want to factor in the possibility of using CPAP also helping your bruxism. If you choose to go on CPAP it may be prudent to do them sequentially just in case that applies to you. For that matter, if a dental device did resolve your OSA, I guess that could help your bruxism too if it is a disordered breathing response.

I can't speak to how oral devices might affect the teeth over time. Just an observation that your family member has nothing to gain or lose with their professional advice while your dentist has everything to gain. Just saying.

http://www.ncbi.nlm.nih.gov/pubmed/14592147

[KathyJL]

Thanks for your comments, everyone! I failed to mention that I've been on CPAP for 3.5 years already. My AHI is under control (ave. 2.9) with CPAP, but since I'm having these clenching problems (and really, problems resulting from the clenching), I was thinking of switching to an oral appliance.
It also crossed my mind that my step-sister has nothing to gain; she just told me of her experiences VS. my dentist who would make a bunch of money on the oral appliance.
I guess my thinking was that I sleep okay now. Just okay. I wake up 2-3 times per night (very brief awareness) because of something with my CPAP (tubing around my neck, nasal pillow shifting, rainout, etc). If I could get my sleep to the point of NOT waking up at all, then I would take the chance of an oral appliance, considering it would solve my clenching AND sleep apnea. However, I'm not really wanting to sacrifice my teeth for it. I've gone back and forth on this so much that it's driving me nuts.
Again, thanks for your comments, and any additional ones would be greatly appreciated!!

[avi123]

Oral appliance could solve your bruxism but may not solve your OSA problem. Only low levels of OSA could be solved by oral appliances. Most dentists are not knowledgeable of dealing with Oral Appliances for Sleep Apnea patients. You need to find those dentists who are. Those who could tell you are Sleep Doctors in your area. They are those who can tell you if an Oral Appliance could treat your OSA.

[herefishy]

Don't really know if it is helping, but when my dentist said he wanted to fit me with a $400 mouth piece for my clenching, I found a 2.95(including shipping) mouthpiece on e-bay that at least protects my teeth from being ground on. Would never try an oral appliance again after the mouthpiece that actually did work for my snoring gave me TMJ. Seeing the Dentist Thursday and maybe will find out then if my clenching approach is working.

[khauser]

(Sometimes I come off sounding like a salesman for Tap Pap ... I have no relationship whatsoever with them)
Have you considered the Tap Pap? It could help with Bruxism and is an otherwise great CPAP interface. I showed mine to my dentist and he thought very highly of it.

If someone had a custom-made appliance that eventually caused them to need orthodontia I would think the dentist and the company that made the appliance would both bear some responsibility towards the cost of that orthodontia. It certainly isn't SUPPOSED to cause that.

[KathyJL]

I actually did try the TAP-PAP. I had the best sleep ever (my stats remained the same, but I didn't wake up at night); however, every morning and pretty much until late afternoon, my bite was off. It felt weird. I also had daily bad headaches. I still have almost daily headaches, but they are not as severe. My only guess is that I was clenching more with the TAP-PAP, thus intensifying my headaches. I had to switch back to my Swift FX. I really, really wanted the TAP-PAP to work because I didn't wake up at night with it. I loved it...except for the bite misalignment & headaches
If anyone has any suggestions regarding clenching or the bite with TAP-PAP, I'm willing to try it!!
Thank you!!

[khauser]

Before Tap Pap there was another product with a boil and bite piece ... they suggested having a dentist create a combined mouthguard if the boil and bite was not working. I imagine you could do the same with Tap Pap ... ask the dentist to create a mouth guard that works for you and incorporates the Tap Pap. Just a thought.

[slepybear]

I tried a oral appliance for a couple of years. It did not correct my snoring or OSA. One of the effects was that my teeth needed to align every morning. It took about 15 minutes.
I got APAP last december. My dentist made a proper nightguard in february. So far both OSA and bruxism are under control. Teeth are all aligned in the morning.

[John from Brookston]

Not really on topic, since it doesn't involve PAP, but I just had an incisor replaced w/a implant/crown system. My dentist is trying to sell me on a mouth guard, and one of his, not the "boil and bite" type, to "protect" the prosthesis. I have absolutely NO history of bruxism/clenching, so why would I need something to prevent something that doesn't happen?
Told him about the Tap-PAP and he thought that sounded like a way to hit 2 birds with one brick. But the mouthpiece is boil and bite, and not professionally made, right?

[Sir NoddinOff]

I tried those dental solutions for years (and a bunch of other stuff). Sad to say, I mostly ended up with mediocre sleep, sore teeth, sore jaw muscles, headaches and not much success. But that's just me. Hey, give it a shot if you want... especially if you've got insurance to defray the bills and they can be hefty.

Anyway, come back and report to us if it does or doesn't work out... you are always welcome here. EDIT: teeth grinding is another issue and it might be worth while to explore solutions for that.

[KathyJL]

Yes, TAP PAP is boil & bite. I'm wondering if I can get a better fit if I reboil.
As for insurance coverage...they do cover quite a bit & my dentist is so convinced that it will work for me that I don't pay my part until we know its working (via sleep study). If it doesn't work, then it's just the cost of a night guard ($300).
I just don't know if I want to go through all that for possibly no results. Then again, maybe i'll sleep better & actually feel rested in the morning.