Oral Appliances: Let's Correct This Understanding

millich wrote:Rooster - I hope this was on-topic enough for your stringent standards!

Roosters stringent standards is an oxymoron.

carbonman wrote:

millich wrote:Rooster - I hope this was on-topic enough for your stringent standards!

Roosters stringent standards is an oxymoron.

I have stringent standards - for the bunch of you. For me, all standards are waived.

(I guess that qualifies me to run for political office. )

Rooster - love the cartoon!

-SWS wrote:

millich wrote: Note: If you go the route of a mandibular device, you REALLY should have a follow-up sleep study to determine it's effectiveness.

I would posit that these three practical indicators can suffice in lieu of that sleep study: 1) a marked improvement in perceived quality of sleep, 2) a marked improvement in daytime cognition, and 3) satisfactory SpO2 scores during a simple nocturnal oximetry test.

-SWS,

Now you've got me really curious! Mind if I ask for clarification in my normal, irritating way?

Would the use of those three practical indicators be sufficient for judging the efficacy of surgical procedures and PAP therapy too, or just oral devices?

I had always assumed that, in much the same way it was important for a patient to use home-machine data to confirm efficacy of xPAP treatment, a polysomnography should confirm efficacy of any other SDB treatment.

And couldn't attempts to judge for ourselves how "marked" an improvement is be subjective to the point of being self-misleading for many of us?

I am not disagreeing with you, just trying to wrap my damaged brain around those words.

Thanks,

jeff

rooster wrote:

........just keep in mind, I'm laugh'n at you ,
not with you......

...but always there for you.

I'm still confused. No matter how much data one views, or how many sites are inspected, there is no definite consensus that oral devices give the same quality of life that cpap does.

Also, go to as many medical facilities and/or universites that teach medicine, there are very few that describe or encourage anyone to pursue the oral devices. So far, I haven't found a dentist here, (120 thousand) who knows anything about the devices. I called the leading university in our state, and the lady could only recommend a local dentist, not associated with the university, who could talk to me. That same university has a sleep center site, but all I could see there was information about UPPP.

midnightdweary wrote:I'm still confused. No matter how much data one views, or how many sites are inspected, there is no definite consensus that oral devices give the same quality of life that cpap does.

Also, go to as many medical facilities and/or universites that teach medicine, there are very few that describe or encourage anyone to pursue the oral devices. So far, I haven't found a dentist here, (120 thousand) who knows anything about the devices. I called the leading university in our state, and the lady could only recommend a local dentist, not associated with the university, who could talk to me. That same university has a sleep center site, but all I could see there was information about UPPP.

you can easily find a sleep dentist in your area by going on the homepage of American Academy of Dental Sleep Medicine and using the "Find a doctor" link. hope this helps.

rooster wrote:For me, all standards are waived.

I admit it. I would vote Rooster one of the top guys on the forum I'd most like to have a beer with to talk to in person about religion, politics, morals, current events, memories of Snoredog, and the future of SDB diagnosis and treatment. But, for the record, I would NEVER let that stop me from giving him a hard time whenever possible.

jnk wrote:

-SWS wrote:

millich wrote: Note: If you go the route of a mandibular device, you REALLY should have a follow-up sleep study to determine it's effectiveness.

I would posit that these three practical indicators can suffice in lieu of that sleep study: 1) a marked improvement in perceived quality of sleep, 2) a marked improvement in daytime cognition, and 3) satisfactory SpO2 scores during a simple nocturnal oximetry test.

-SWS,

Now you've got me really curious! Mind if I ask for clarification in my normal, irritating way?

Would the use of those three practical indicators be sufficient for judging the efficacy of surgical procedures and PAP therapy too, or just oral devices?

I had always assumed that, in much the same way it was important for a patient to use home-machine data to confirm efficacy of xPAP treatment, a polysomnography should confirm efficacy of any other SDB treatment.

And couldn't attempts to judge for ourselves how "marked" an improvement is be subjective to the point of being self-misleading for many of us?

I am not disagreeing with you, just trying to wrap my damaged brain around those words.

Thanks,

jeff

Jeff, I'm referring to people who have already received a diagnostic PSG with obstructive SDB as their only sleep-related DX. Those would be patients who were symptomatic of SDB, received a highly common obstructive DX, but also went on to find CPAP treatment problematic in one way or another (a somewhat common experience).

As a side note, we don't normally send the asymptomatic general population through the expensive PSG process. Right? It makes little sense to tax personal and health-care related resources on the asymptomatic general population in that manner...

So if a formerly symptomatic SDB patient becomes entirely asymptomatic upon application of that MAD, then what exactly is the rationale for routinely requiring that additional expensive PSG? How/why would that rationale differ from how the medical establishment treats the asymptomatic general population? Unlike the asymptomatic general population, these patients would have the benefit of home-based oximetry and clinical questionnaires evaluated by their clinicians.

That's merely food for thought. Regarding the surgery scenario: I really hadn't given that case any thought. But hey, I'm just an SDB-low-though layperson! But I think there's some room here to question whether the expensive PSG process is sometimes applied unnecessarily.

-SWS wrote:I think there's some room here to question whether the expensive PSG process is sometimes applied unnecessarily.

That's for sure!

My sleep doc put on his titration summary that I should have a follow-up PSG a few months after being on PAP to verify efficacy, but he backed off on that recommendation when my PCP sent him a pdf of my ResScan data. (Seems to me it would be more cost-effective just to prescribe full-data machines to patients who need follow-up, but what do I know.)

Anyway, I believe I see what you mean now. That helps to temper my hard-line view on that.

Thanks again!

Well, my hunch is that more often than not the follow-up PSG is going to be necessary...

I say that because I don't think the majority of people trying MAD will become asymptomatic. If they need to use MAD and CPAP together, for instance, then a new CPAP pressure will likely need to be retitrated.

But I think the idea is to encourage practitioners the latitude to practice both the science and art of medicine. When a doctor relies too heavily on procedure, protocol, and rote, then the crucial art of medicine itself and even common sense can sometimes fall by the wayside. At least that's the impression I get reading some of the amazing anecdotes posted here and on other boards.

My gut tells me (and when something that big talks, I listen) that anyone diagnosed with something as insidious as OSA is gonna wanna be sure what he/she uses is as effective as possible.

How long, I wonder, till they make an oral device that tells me my AHI every morning?

carbonman wrote: .......
...but always there for you.

Carbie,

Do you ever wear a heart-rate monitor watch while biking?

Regards,

BioPAP man wrote:... Before obtaining a MAD an easy test can be conducted to see if an oral appliance would be benificial. First try to replicate snoring sound with the throat only. Second, start advancing the mandable forward while generating the natural snoring sound. if you are a candidate for a MAD, then at a certain protrusion the snoring will become quiet and perhaps eventually go away all togather. One also can perform variations of vertical titration in combination vith protrusion to predetermine optimal results. I use this technique all the time, and had it proven clinically. try it.

Oh crap. My "simulated throat snoring" is actually louder with my mandible positioned forward. There goes my hope of getting an oral appliance for short naps.

Ok, since nobody else has asked yet, how would one know if their obstructions are at the velopharynx, oropharynx, or hypopharynx level so as to predetermine probability of success with an oral appliance? And I wonder, since severity has long been the gauge, is there a location/severity correlation? Just wondering if we're still saying the same thing - or not?
Kathy