my oral appliance experience

I know that oral appliances are not always effective, and some people have great trouble adjusting to them. But I'd like to share a firsthand experience:

Because of an occasional desire to travel, for several days, in areas without electricity (backpacking and canoeing, for example), I started to look into the use of an oral appliance. The only recommendation from my dentist was "don't get one off TV or the internet". My somnodoc had referred me to an ENT surgeon, and he in turn referred me to an oral surgeon.

The oral surgeon told me that it would take several weeks to adjust, and that it may not provide as effective therapy as the APAP I was using (AutoSet II, FFM, with good results). He also warned me that those with severe OSA (like me) will not always find them effective. Since I had no better options, I figured I might as well try it and I went ahead with the fitting. He procured a PM Positioner for me.

I was worried about the first several nights with it, so I waited until a weekend for my first trial. I was worrying needlessly, I think. I felt okay the next morning, and felt no funny issues. I did find that my "bite" was maladjusted after waking up, and the oral surgeon had provided a small rubber piece that one clamps onto for a few minutes to help ease the readjustment period (for me, that was about 20 minutes, more or less, and I found that I was usually good to go after a morning shower and dressing, etc).

I worried about being able to "mouth breathe" when I had it in, but that hasn't been an issue either. I was surprised by one thing: this PM Positioner (and presumably, other devices like it) really clamps onto your teeth. There seems to be little worry that it will slip out in the middle of the night. Before the appliance is inserted, you heat it for a couple of minutes in hot tap water, and then you insert the device, clamping down on it. As it cools, it kind of wraps onto your teeth. Very solid fit.

Problems: only two, really. The first night, I woke up in the middle of the night, and had about a 5-second panic attack thinking I couldn't get it out of my mouth fast enough. So I concentrated on breathing deeply and relaxing my jaw. The feeling passed very quickly. I'm a trombone player, by avocation, so I'm well-acquainted with relaxing my jaw, tongue and mandible. That has been a handy skill to have.

The second issue was that on some nights, my lips became very dry. If they're dry when you try and remove the device, you risk cracking your lips, which is what happened to me. That's painful! But Chapstick cleared it up. I'll do the same throughout winter.

After a couple of weeks, I returned to the oral surgeon for the first adjustment (moves the mandible forward by 0.5mm). He then gave me instructions on how and when to make future adjustments. With each tiny adjustment, I felt little different and had no issues. By about the third week, I had a dream again. I took that to mean I was finally getting enough O2 to get to REM, which allowed me to dream. Another couple weeks, when I was to "full adjustment" then I returned to the oral surgeon. He's having me go back to the somnodoc for an overnight oximeter test. I asked if a sleep study would be preferable, and he said yes, and he also mentioned that some somnodocs are prescribing "home sleep studies" if insurance companies will cover it.

No lingering issues -- I would characterize my sleep as "hard and deep" lately. So hard that a couple of times, while sleeping with my face buried into a pillow, I wake up with a little TMJ pain. No debilitating pain, just an ache. The first time, that last a couple of days. Tylenol helped. The second time was yesterday, and today I feel fine (no Tylenol).

I finally had a followup with the somnodoc this week, and I'm on his list to have an overnight study with a "Watch-Pat" next month. I'm planning on continuing to use the oral appliance at least until then.

As far as camping goes, I used my APAP machine for a week in July (with a Black and Decker rechargeable battery) and that was fine. I then did weekend camping trips in September and October with the oral appliance and that was fine. It's mildly annoying to have to heat water (to the right temp, but not too hot!) right before going to sleep, but it's better than humping a rechargeable battery around.

I'll know more after the Watch-Pat test, but so far so good. Ideally, I'd like to alternate time on the oral appliance with time on the APAP machine.

By the way, the PM Positioner isn't cheap (the charge to the insurance company is not all that far from a *PAP: about $1600 in my case). I paid 10% out of pocket.

Thanks for reading -- I hope this helps someone with the same set of issues -- I would also say this has been a very easy transition for me. I feel I am lucky in that regard. I don't know that every has it this easy adjusting to an oral appliance.

Guy

Thanks for the feedback on your experience. I've been strongly considering going this route. My apnea is mild/moderate but my CPAP experience has been all over the place. I've been thinking that this might be a better option...

>>Ideally, I'd like to alternate time on the oral appliance with time on the APAP machine.<<
Since you had adjustments, etc., with your initial experience, won't you have a problem switching back and forth between APAP and device?

OldLincoln -- that is exactly the risk. I'll try it a day or two at first, and then work up to maybe a week at a time. The worst case scenario would be to ratchet back the appliance to it's initial setting and then work forwards (about six weeks of time). The only difficulty with that is that the "markings" are not marked. I'd have to be very careful to get it right. I might talk to the oral surgeon if that is the case.

One followup:
All along, the oral surgeon was very conservative. He did say that CPAP is "the gold standard" and that many people, especially people with severe OSA like me, don't always find relief. Weekly adjustments were slowly building. When I mentioned my idea about only using the oral appliance when I was away from electricity, he basically said "that may not work."

I haven't talked to him about alternating yet.

But in every other respect, I've had a good experience despite the tempered expectations. I do think positively about mostly everything, but I'm not really a Pollyanna.

mdintx -- I hope it goes well for you (and I would suggest there is no harm in talking to an oral surgeon about this).

I was doing fine with the aPAP -- the only real issues I had were with aerophagia. I wasn't feeling abdominal pain, but I was feeling back pain, and I have no clue it was due to aerophagia. But after expelling a bit of gas upon getting up in the morning, the back pain would be gone in 15 to 20 minutes.

My somnodoc had me try Prilosec OTC for the aerophagia, but after a couple of 14-day courses, I didn't see any difference. I got more relief from taking 8-hr Tylenol. The back pain wasn't as severe then.

But I do love the aPAP. I love the feel of cool air in my face when I sleep. I've always felt better sleeping in a room of cool air. The aPAP was made for me!

Guy

Thanks for sharing your experience, GuyK. You may want to purchase an oximeter to use at home so that you can monitor that the dental device is truly effective in preventing apneas, especially since you have a severe case.

For around $130 you can get a recording oximeter that comes with software. You wouldn't want your oxygen levels dropping too much at night, as that will continue to damage your body, and monitoring with the oximeter would be some added insurance that your treatment with the dental device is effective.

~ DreamOn

GuyK wrote: .... Ideally, I'd like to alternate time on the oral appliance with time on the APAP machine. ....

Many thanks for sharing. I spent almost ten very successful years with an oral appliance. Eventually, dental issues led to the introduction of using CPAP once a week, and then more often, to provide a "rest" from the appliance. This sort of "alternating" was highly profitable. Neither modality was "better" than the other (with periodic PSG confirmation), but I experienced a different "feeling" after using each. Some people have reported using both an appliance and CPAP simultaneously each night; I was never able to make that work.

Today is my first "anniversary" of having to give up the appliance and go to nightly CPAP exclusively. I do miss the convenience of just "putting in my teeth" each night. Best of luck. Velbor

Thanks, Velbor, DreamOn and the rest --

I'd forgotten to mention that at my first appointment with the oral surgeon he mentioned that some people used both the oral appliance and a CPAP at the same time. I thought that a little odd, but when I got the device and realized that adjustment takes several weeks (slowly advancing one's mandible forward), I suddenly realized that if one is not getting sufficient O2 with just the oral appliance at first, then it might makes sense to use both together. At least until one reaches a point where the oral appliance works by itself.

So, given that new "worry" I was prepared to attempt to use both together. But my first night went fine, and I felt okay the next day. So I went with just the oral appliance. Then I had the sensation, in the third week or so, of dreaming again, so I figured I'm fine.

As I mentioned, lately I've had the sensation of deep, hard sleep, with dreaming too. I'm looking forward to the Watch-Pat test (an oximeter, plus other monitoring) but based on that I was going to decide whether or not I get my own oximeter.

Thanks again -- Guy