Silent Nite titration; home study?

I have mild to moderate OSA; and have a sibling who has had very good results (confirmed by sleep study) with Silent Nite OA. I've been fitted for a SN appliance, but my insurance won't pay for it or for a study with it.

Haven't been able to find much info about titration...it came with two sizes of hinges, apparently determining how far lower jaw gets moved forward. Looking for more titration info, and wondering if there's any home/self test I can do to figure out how well it's working and which titration is best. Suggestions appreciated.

(I know that CPAP is more effective than oral appliances, and that an overnight study at a sleep clinic would be ideal)

Two big problems with oral appliances are (1) the lack of a good way to know who will respond and (2) a lack of a way to titrate. Even defining what "success" means over time is difficult, in that realm.

To many dentists, titration simply means being able to find the best location for the jaw--far enough forward to improve sleep-breathing but not so far as to cause discomfort or jaw-muscle difficulties over time. This can be more of an art than a science. I believe that some manufacturers suggest the dentist hit the exact middle mark between all-the-way-forward position of the jaw and where the jaw naturally rests, as a starting point. Others have more complicated formulas for finding the sweet spot. A lot of it depends on individual anatomy and what a user is willing to tolerate and how the jaw muscles deal with it over time.

I won't give you a hard time about choosing oral appliance, other than saying that between the two approaches, I personally found CPAP to actually be easier, more comfortable, and less trouble than oral appliance. That is beyond the separate fact that for my moderate-to-severe diagnosis and anatomy, CPAP was really my only viable choice.

I used the oral appliance to tide me over between diagnosis and getting my machine. I used my oral appliance in conjunction with CPAP after that, to help me keep my mouth shut with nasal pillows. Now I just use CPAP, or actually APAP, to be more precise. But I have no trouble with people with mild sleep-breathing issues who respond to OA with no sleepiness. My only concern is that the AHI could sneak up over 15 or so over time and start doing silent damage, with no way of knowing.

Thanks for the reply; I agree that CPAP is clearly the superior treatment. Unfortunately, I've been trying for years to use it (trying different models, types of masks, etc), and am unable to keep it on all night.

I have read several studies that show that OAs--though not as effective as CPAP--can be effective.

Have you tried posting your data here using SleepyHead software? Often CPAP only works well when it is dialed in by a patient. There are plenty of tricks and adjustments for making it work.

No pressure. (Pun intended.) And I trust your judgment. But docs aren't very good at making CPAP work. Fellow patients, on the other hand, like some of the experienced ones in this forum, have worked wonders in making CPAP downright enjoyable for some of us, to the point where we have fallen in love with the machine and the therapy.

Just an offer. I don't think I would have made a success of my therapy, myself, without the help of the good folks here.

That said, I wish you all the best with OA. When it works, it really works, in that it can lower AHI by 50% for about 50% of the people who use it. At least for a while.

But if you are still sleepy using the OA, keep us in mind, for reasons of safety. Looking back, I can't believe how dangerous it was that I was driving as sleepy as I was. I just didn't know how sleepy I was because I had never experienced being fully awake until using PAP successfully for a while.

I still have bad nights when I take my mask off without meaning to. But after getting my comfort features dialed in, getting humidity right, and getting enough pressure from my super-comfy ResMed S9, it happens less and less.

"There are plenty of tricks and adjustments for making it work."

Yes, I've done lots of research here, and got good numbers from my CPAP. But for numerous reasons I can't keep it on all night. Not interested in discussing CPAP vs OA anymore, or how to make CPAP work; just looking for info about how to make the best of the OA. Thanks for your interest.

arthuref wrote: ↑

Mon Jul 02, 2018 3:09 pm

"There are plenty of tricks and adjustments for making it work."

Yes, I've done lots of research here, and got good numbers from my CPAP. But for numerous reasons I can't keep it on all night. Not interested in discussing CPAP vs OA anymore, or how to make CPAP work; just looking for info about how to make the best of the OA. Thanks for your interest.

Fair enough. I respect that.

I don't have anything to offer other than suggesting using a dentist listed by their sleep association. The experience of the dentist can make all the difference in the world for that approach, in my opinion. ( https://mms.aadsm.org/members/directory ... rg_id=ADSM )

I would also suggest combining the OA with all the other non-CPAP approaches, to the extent possible. Raising the head of the bed. Nothing but water within hours of bedtime. Finding a non-sleep-disturbing way of staying off my back, to the extent possible. And so on.

Hopefully someone else here will have better, more specific info for you that is directly related to your question.

May you be successful!

arthuref wrote: ↑

Mon Jul 02, 2018 3:09 pm

"There are plenty of tricks and adjustments for making it work."

Yes, I've done lots of research here, and got good numbers from my CPAP. But for numerous reasons I can't keep it on all night. Not interested in discussing CPAP vs OA anymore, or how to make CPAP work; just looking for info about how to make the best of the OA. Thanks for your interest.

This forum's main purpose is to discuss CPAP, hence the forum name.
Perhaps you could look for an OA forum for answers?

Here, a dentist recommends trying CPAP first. https://myapnea.org/blog/2018/01/oral-a ... erspective

A lot of research has tried to find out which patients respond best to oral appliances. Unfortunately, there is no answer yet. So, it is generally recommended that most people with obstructive sleep apnea try CPAP first. This is because CPAP is currently the most effect treatment for sleep apnea. However, oral appliances are the second most effective treatment and could be a good option for many patients who do not tolerate CPAP well.

This forum's main purpose is to discuss CPAP, hence the forum name.
Perhaps you could look for an OA forum for answers?

OK, will do.

arthuref wrote: ↑

Mon Jul 02, 2018 5:16 pm

This forum's main purpose is to discuss CPAP, hence the forum name.
Perhaps you could look for an OA forum for answers?

OK, will do.

Apneaboard.com has a wider remit than here.

palerider wrote: ↑

Mon Jul 02, 2018 8:08 pm

arthuref wrote: ↑

Mon Jul 02, 2018 5:16 pm

This forum's main purpose is to discuss CPAP, hence the forum name.
Perhaps you could look for an OA forum for answers?

OK, will do.

Apneaboard.com has a wider remit than here.

Will check it out, thanks.

Consider wearing an oximeter with an alarm that you can set to go off at certain percentages of saturated oxygen or pulse rate. The alarm will wake you and you will start breathing deeper immediately. While you might have fragmented sleep, you won't have the oxygen desaturations that are so dangerous. If the alarm keeps going off, it will let you know whether the oral appliance is enough to manage your sleep apnea.

Muse-Inc wrote: ↑

Tue Jul 03, 2018 1:20 am

Consider wearing an oximeter with an alarm that you can set to go off at certain percentages of saturated oxygen or pulse rate. The alarm will wake you and you will start breathing deeper immediately. While you might have fragmented sleep, you won't have the oxygen desaturations that are so dangerous. If the alarm keeps going off, it will let you know whether the oral appliance is enough to manage your sleep apnea.

This is the kind of information I'm looking for, thanks!

OSA is not primarily an O2 issue, especially for the mild to moderate. It is primarily a sleep issue. So, many people who NEVER significantly desaturate STILL have a very, very serious SDB problem. Keeping saturated does not prove success, or even prove benefit, to sleep in the treatment of a so-called mild-to-moderate OSA problem, as defined by AHI. Yes, a cheap pulse-ox can prove sleep breathing is especially bad. But it can't ever prove that sleep remains undisturbed by one's breathing. And sleep is the point.

In my opinion. And i'm full of 'em. Can't help it. Sorry.

Muse-Inc wrote: ↑

Tue Jul 03, 2018 1:20 am

Consider wearing an oximeter with an alarm that you can set to go off at certain percentages of saturated oxygen or pulse rate. The alarm will wake you and you will start breathing deeper immediately. While you might have fragmented sleep, you won't have the oxygen desaturations that are so dangerous.

I too have to say that I think this is a bad idea, as you say, leading to fragmented sleep, and increasing the chances of killing someone else on the freeway when you go to sleep while driving.