Dental Care Sleep Apnea Solution

During my tenure as the directory of the Sleep Lab at Walter Reed Army Medical Center, I was involved with the sleep research program. In this program they were running a study on the efficacy of oral appliances on OSA. We tested every oral appliances on the market in 2005, the only one that proved a somewhat positive outcome was the TAP (Thornton Adjustable Positioner). With that device we were able to bring 48% of patinets with Mild-Moderate OSA to an AHI of 5 or less. The TAP device has changed since those tests, and they have added new devices that you can use in conjunction with CPAP I believe. Oral Appliances DO work, however you will need a follow up study to confirm it and most insurance companies won't cover the cost of the oral appliance.

packitin,
Right now Medicare will not pay for an oral appliance if your physician says it is used to treat OSA. There are ways to get Medicare to pay for it, but that involves the physician stretching the truth, so I won't get into that area.

However Medicare is exploring the posibility of paying for oral appliances for sleep apnea down the road, here is a link to the proposed LCD.

https://www.noridianmedicare.com/dme/co ... _apnea.htm

This DRAFT has not been reviewed or updated since Sept, 2008 though so I'm not sure where it stands in the process.

A review of some of the various appliances:

http://216.21.56.228/Resources/Practice ... nceOSA.pdf

echo, with severe apnea you were not a candidate for a dental device.

Wow! Great info in this thread, folks! Lets remember that sleep medicine is in its infancy. CPAP has only been around about 30 years. We are only going to see improvements and changes and alternatives if folks like us are willing to be guinea pigs. I tried the TAP and it was just too much for my tiny mouth, but maybe it will work for the next person. Too bad I can't donate it--it is made specifically for me and is sitting in a drawer.

There has got to be other alternatives to cpap that will work. Some day in the future after much experimentation and refinement, I'm sure the researchers will find what they are.

packitin wrote:Yes, I will keep you informed. I never had any faith in dental devices either, until the consultation session with this young, enthusiasitc, and energetic dentist, who is obviously on top of the latest treatments for OSA. This will be a customized device for my particular jaw structure. The adjustment and alignment will be ongoing, not just an installation and out the door you go. The goal is to "train" my brain, through this device, to keep my jaw forward so that my lower teeth will be meet my uppers. This will be a gradual process. My brain has to "relearn" how to hold the jaw forward. That's what this is supposed to do. I also have a small neck size - up until I was about 40 yrs. old, my neck size was 14.5. I'm also hoping my tongue will not collapse backward so easily. I'm praying this will work. Apap has not done the job I hoped it would. (past year: AHI 3.7; leaks 2.2; usage 4:40 hrs per ngt) My goal is to use both Apap and the mouth piece.

BEEN THERE DONE THAT!

Of course the young dentist is enthusiastic! He a) isn't using the device for his own OSA b) he's likely making an obscene (IMO) profit with the device c) he has no experience other than likely just theory.

My customized Klearway device was made and had the same goals as yours might. I had x-rays taken, jaw measurements done, the whole shebang. I went back for many many checkups & alterations over a 2 year period. I did not just go for one fitting and then out the door. This was all done through a university sleep center / orthodontist who "specializes" with OSA. However, even amongst the other sleep specialists at the University, I found out in the long run that their experience is that VERY few people gain much help from such devices and that the devices do not have much respect compared to PAP therapy.

As mentioned in another post, if perhaps a device such as the TAP in 2005, ONLY provided an AHI goal of 5 and was deemed a success, then I'd suggest that the TAP is next to useless, as an AHI of 5 +/- will still keep many people very very tired, it certainly does me.

I'd also suggest that FIRST, before you go for a fitting, work with your APAP Pressure and Range AND your SLEEPING POSITION, and LEARN TO SLEEP IN A SIDE POSITION or force yourself to. I'd suggest that perhaps your lack of success with APAP could be the wrong pressure and range and especially from being in a supine sleeping position, which is not good for OSA, no matter what device you are using. Fix your sleeping position FIRST, because if you don't, then you will likely fail miserably with the dental device and APAP in a supine position. Realize too, that the head AND body need to be in a side position, and that they will change position independently during the night. Both must be in a side position, but especially the head / neck.

I'd argue that your tongue is NOT the problem as much as just loose tissue in the neck to which the dental device does nothing to help open. Only air pressure from CPAP / APAP will do that and a side sleeping position. The tongue is a red herring compared to the neck / throat, IMO. My tongue has next to no impact compared to the throat sagging and the jaw opening to close the airway as well.

Personally, I think that you are being conned, and like most victims of con jobs, they actually want to be conned. I know I was and did, as I desperately wanted to feel normal and at that time I would almost try anything.

Forget the dental device for now. Video record your sleep to find out HOW you actually sleep and what is ACTUALLY going on. Otherwise you and your enthusiastic Dentist are only guessing. The device is no skin off his nose as YOU are the one dealing with OSA and he has your money. Next work on your sleeping position. I'll bet that will give you better results than the dental device and improve your APAP therapy, assuming that your APAP is set correctly enough, (which you may not know until you SEE your sleep videos AND compare the software results).

A supine sleep position is IMO, THE main thing to solve along with enough CPAP OR APAP pressure in a narrow range. Few people know what position that they sleep in all night long (many think that they know), which you won't truly know without several nights of video evidence.

I do use my device WITH APAP but only to keep my jaw closed and so instead of mouth taping, as my jaw must stay closed or it closes my airway when it drops open. However, a much less expensive device with no need for jaw advancement would do the same thing. This and my sleeping position were all convfirmed ONLY through video evidence becasue after 2 wasted years with the dental device, I was still as tired as ever. The video evidence had me fix my sleeping position and get me to go back to APAP.

Finally, I don't think that you may realize how severe the results of jaw advancement may be in side effects. Be careful of what you wish for as the results are not all good. it's also EASY for the dentist to say this or that. It's theory but on YOUR teeth and jaw. Get him to wear one along with you and then see how things go.

socknitster wrote:Wow! Great info in this thread, folks! Lets remember that sleep medicine is in its infancy. CPAP has only been around about 30 years. We are only going to see improvements and changes and alternatives if folks like us are willing to be guinea pigs. I tried the TAP and it was just too much for my tiny mouth, but maybe it will work for the next person. Too bad I can't donate it--it is made specifically for me and is sitting in a drawer.

There has got to be other alternatives to cpap that will work. Some day in the future after much experimentation and refinement, I'm sure the researchers will find what they are.

I tell this to people who ask if sleep apnea is nothing more than a money thing and why ALL of a sudden its a big deal. I tell them its very new as far as medical. We have only been doing all night sleep studies since the 1960's and CPAP just came out in the mid 1980's! im sure when they first came out with EKG and was able to see the heart people probably said same thing.

montana user wrote:. . . people who ask if sleep apnea is nothing more than a money thing and why ALL of a sudden its a big deal.

Making it "a money thing" was done on purpose. It was the only way for the early researchers in the know to get doctors and manufacturers interested in treating OSA. So, in that context, making it "a money thing" was a brilliant move. How else would you get doctors to pursue the subspecialty and get equipment people to know they would have a market?

And in the context of reaching the many thousands of sufferers, it ain't a big enough deal yet. There is a long way to go. Meantime, we should all be thankful that there was enough money in it for doctors to become sleep doctors and for equipment manufacturers to make such a variety of good machines available.