Oral appliance user -- should i go to cpap??

DHosehead wrote:I found all an oral appliance did was mess up my bite PERMANENTLY while not fully fixing the problem. And 1/2 a problem is still a problem. CPAP solved my problem.

When I started on an oral appliance, I thought the only option was it or surgery. I wish I had visited a sleep doctor sooner, had a sleep study and been put on CPAP at least a few months sooner. It would have helped me avoid all the mess oral appliances did to my mouth. I tried, PureSleep, The Ultimate Stop Snoring Solution, a couple other cheaper versions that are basically the same as the others. And even made my own by fusing together single sports mouth pieces and using dual mouth pieces too. It's all the same, just pushing the lower jaw forward. And none of it fixes the problem fully. It's like a band-aid for a cut that needs stitches. CPAP was a winner from me after night 2 of the sleep study when they let me try it for the first time.

I'd recommend people avoid the oral appliances. See a sleep doctor first. If they find you should have CPAP, get it.

I have read in this forum and many other places on the internet that the failure rate for CPAP is over 50% and that this does not even count the people who won't try because they think they could not wear a mask.

DHosehead wrote:I found all an oral appliance did was mess up my bite PERMANENTLY while not fully fixing the problem. And 1/2 a problem is still a problem. CPAP solved my problem.

When I started on an oral appliance, I thought the only option was it or surgery. I wish I had visited a sleep doctor sooner, had a sleep study and been put on CPAP at least a few months sooner. It would have helped me avoid all the mess oral appliances did to my mouth. I tried, PureSleep, The Ultimate Stop Snoring Solution, a couple other cheaper versions that are basically the same as the others. And even made my own by fusing together single sports mouth pieces and using dual mouth pieces too. It's all the same, just pushing the lower jaw forward. And none of it fixes the problem fully. It's like a band-aid for a cut that needs stitches. CPAP was a winner from me after night 2 of the sleep study when they let me try it for the first time.

I'd recommend people avoid the oral appliances. See a sleep doctor first. If they find you should have CPAP, get it.

DHosehead: I tried, PureSleep, The Ultimate Stop Snoring Solution, a couple other cheaper versions that are basically the same as the others. And even made my own by fusing together single sports mouth pieces and using dual mouth pieces too.

You tried the cheap, junk devices. You don't know what the outcome would have been if you had been fitted with an FDA-approved appliance for treating sleep apnea by a qualified dentist.

All of the cheap devices you mentioned are fit-at-home by patient. No wonder you screwed up your bite.

Christine L wrote: . . . I have read in this forum and many other places on the internet that the failure rate for CPAP is over 50% and that this does not even count the people who won't try because they think they could not wear a mask.

My understanding is that the often-cited "50% failure rate" for CPAP is based on very old figures from back when the machines and masks left much to be desired.

Furthermore, according to what I've read, the failure rate for oral appliances may actually be much higher than the failure rate for PAP therapy, especially right around the two-year mark and beyond:

"Adherence rates [for oral appliance use] tended to decrease with duration of use, with 1 study reporting 60% adherence at 1 year and 48% at 2 years. . . . The reasons for discontinuing appliance use included side effects, complications, and lack of efficacy. . . . A central issue is the need to establish a uniform definition of treatment success that includes both objective criteria (AHI and oxygenation) along with symptoms (snoring and sleepiness). A second issue is that the patient characteristics associated with treatment success need to be fully determined." -- SLEEP, Vol. 29, No. 2, 2006, "Oral Appliances for Snoring and Obstructive Sleep Apnea: A Review," Kathleen A. Ferguson, MD; Rosalind Cartwright, PhD; Robert Rogers, DMD; Wolfgang Schmidt-Nowara, MD. http://www.aasmnet.org/resources/practi ... nceosa.pdf

Of course, that all may have something to do with who funds the study. On both "sides."

Christine L wrote: I have read in this forum and many other places on the internet that the failure rate for CPAP is over 50% and that this does not even count the people who won't try because they think they could not wear a mask.

Not only is that rate old, but it is referring the compliance rate, not the actual success rate of the therapy. This includes all the people who got inaccurate titration and little followup, bricks that didn't show that their therapy was not correct, DMEs who didn't bother to help with multiple masks and followup, etc. Those people were doomed to fail because they had no assistance adjusting to their new treatment.

For people getting correct therapy and useful assistance in adjusting to their treatment, the success rate is over 80%.

For people getting correct therapy and useful assistance in adjusting to their treatment, the success rate is over 80%.

Well in that case, with oral appliances, for people getting correct therapy and useful assistance in adjusting to their treatment, the success rate is 100%.

1. Unlike CPAP, oral appliances, on average, are said to help 50% of patients reduce AHI by 50% WHEN ACTUALLY USED.
2. Unlike CPAP, oral appliances have no mechanism for reporting efficacy of treatment all night every night over the years.
3. Unlike CPAP, oral appliances can't be rented while proving treatment success for a particular patient, meaning it has to be paid for in full whether the darn things works at all for the patient or not!
4. Unlike CPAP adherence figures, which are based on electronic tracking of patient usage, adherence figures for oral appliances are based solely on reports from the patients, a notoriously easy way to inflate adherence figures for any treatment.

jnk wrote:1. Unlike CPAP, oral appliances, on average, are said to help 50% of patients reduce AHI by 50% WHEN ACTUALLY USED.
2. Unlike CPAP, oral appliances have no mechanism for reporting efficacy of treatment all night every night over the years.
3. Unlike CPAP, oral appliances can't be rented while proving treatment success for a particular patient, meaning it has to be paid for in full whether the darn things works at all for the patient or not!
4. Unlike CPAP adherence figures, which are based on electronic tracking of patient usage, adherence figures for oral appliances are based solely on reports from the patients, a notoriously easy way to inflate adherence figures for any treatment.

Hi Jnk,

Good point about the oral appliance efficiency being based on reports from patients.

By the way, alot of studies that end up in the news and look seemingly so scientific turn out to be relying on self reports. Can't think of any examples right now but that is why I thought of when you made the point about dental appliances.

Still, this is a good discussion to have since believe it or not, there are folks who do try very hard to make cpap work to no avail. So they definitely need alternative options.

Christine L wrote: I have read in this forum and many other places on the internet that the failure rate for CPAP is over 50% and that this does not even count the people who won't try because they think they could not wear a mask.

As was mentioned, that is the rate of people who continue using CPAP therapy, not a measure of effectiveness for people who use as directed.

DeadlySleep wrote: You tried the cheap, junk devices. You don't know what the outcome would have been if you had been fitted with an FDA-approved appliance for treating sleep apnea by a qualified dentist.

All of the cheap devices you mentioned are fit-at-home by patient. No wonder you screwed up your bite.

I could have went to the dentist and got an oral device made, but I have severe sleep apnea. So it would not have fully halted the problem, CPAP does. And even with custom made devices, they are still shifting the lower jaw and holding it out of its normal resting position overnight. In time, this is going to have an impact. With all of them in the morning, there is going to be some jaw discomfort and brief moment where the lower jaw sticks out even after its removed. Over time, that won't make for a good outcome.

By the way, the Puresleep device is FDA Cleared and was designed by a dentist . The Ultimate Stop Snoring Solution was also designed by a dentist. Who didn't go the FDA route, given the high additional costs involved in that process. That would be passed on to the consumer.

Christine L wrote:

For people getting correct therapy and useful assistance in adjusting to their treatment, the success rate is over 80%.

Well in that case, with oral appliances, for people getting correct therapy and useful assistance in adjusting to their treatment, the success rate is 100%.

For many of us, an oral appliance is not the correct therapy. But for everyone using an oral appliance, CPAP would help more of them than any oral appliance ever will.

No one will get the best answer of what is best for them by asking on a web forum. Because this is a question that a doctor should be answering for them.

Just something for reference's sake, but as I've mentioned, a doctor is the best means to get the answer of what would be best for you.

"A randomized crossover study of an oral appliance vs nasal-continuous positive airway pressure in the treatment of mild-moderate obstructive sleep apnea."
http://www.ncbi.nlm.nih.gov/pubmed/8625679

If your sleep apnea is severe, I'm doubting an oral device is the answer. Mild or moderate sleep apnea, maybe. And the oral devices are way easier to use.

Just the same, I'd recommend seeing a doctor. Not simply a dentist (aka dental doctor, DDS), but a doctor (MD) who specializes in sleep disorders. It's not about your teeth, it's about getting a good night's sleep .

Christine L wrote:

For people getting correct therapy and useful assistance in adjusting to their treatment, the success rate is over 80%.

Well in that case, with oral appliances, for people getting correct therapy and useful assistance in adjusting to their treatment, the success rate is 100%.

I as referring to the people continuing to use it. Since most people do NOT get correct therapy on the first try.

Perhaps we need to discuss this in a different way. With cpap, the pressure can be adjusted so that the most people can get their ahi below 5. In other words, almost everybody can get correct therapy from cpap/apap/bipap.

How about dental devices? Can most people get ahi below 5 with an dental device? Nope. Not successful. Dental devices get a false success rate because they consider success to be a 50% reduction of apneas, even if that leaves the person still with severe sleep apnea. Ann there is no way to confirm success without a sleep study. I can check my cpap data any day I want.

Do you have something against cpap treatment? You seem to be pretty negative in most of your posts. Any chance this is a second account for you? I have wondered that for awhile now.

Hello to all, It's been a while since I've checked in. I really figured my post had gotten lost by now, but I see it's still being kicked around. Some of you are for the OA and others think it a complete waste of time.

I'd have to say ......I'm sitting squarely on the fence myself.

Having now worn this device "silent nite sl" for 3.5 months, don't think I've missed a night, I've wondered if this is it, all I can expect??? I did visit my sleep Dr. last week, didn't find out much, but was sent home with a pulse oxymeter .

Still waiting to hear from the Dr. but did find out from the office my oxygen levels did drop to 82-83% .. That pretty well tells me it's not working. I will probably go to the next shorter band, that being the last one will have it advanced as far as it will go. Not expecting that to do much and rather think when I do hear from Dr. he will be leaning more to cpap..

After reading many post here and on apnea talk I know much more about this complex thing called SLEEP than I ever did before. THANKS to all for responses- suggestions Steve

DHosehead wrote:

By the way, the Puresleep device is FDA Cleared

You are confused. It was not approved by the FDA for the treatment of sleep apnea. Maybe it was cleared by the FDA for treatment of snoring?

DHosehead wrote:

I could have went to the dentist and got an oral device made, but I have severe sleep apnea. So it would not have fully halted the problem,

You are relying on the popular myth that MADs will not treat any severe cases. It is a myth.

Most literature states that oral appliance treatment of OSA should be reserved for mild to moderate cases.1-3 Our findings4,5 are that it is not the severity of OSA that predicts the success of oral appliance treatment, but the site of closure (velopharynx—high, oropharynx—mid, and hypopharynx—low).
................. Oral appliances need not be reserved for mild to moderate OSA cases.

http://www.sleepreviewmag.com/issues/ar ... -10_11.asp

Mandible advancing oral appliance seems not to be effective in reducing the AHI value in mild cases. However, it seems to be especially effective in reducing the apnea/hypopnea index in moderate and even certain severe OSA patients.
http://iadr.confex.com/iadr/papf09/webp ... 26401.html

"It's not the severity, it's the anatomy."

DeadlySleep wrote:

Mandible advancing oral appliance seems not to be effective in reducing the AHI value in mild cases. However, it seems to be especially effective in reducing the apnea/hypopnea index in moderate and even certain severe OSA patients.
http://iadr.confex.com/iadr/papf09/webp ... 26401.html

Can you post that link again? It didn't work. I'm surprised they found that it's not effective in mild cases.

Ive been wearing a SnoreRX OTC anti-snore oral device for three hours a day now. And notice no changes to my bite, yet. If that happens, I will be seriously pissed. That being said, I have found the thing is very uncomfortable to wear, makes me salivate like a rabied dog and when I take it out my gums and cheeks hurt. I notice some mild "pull" feeling on my upper teeth. Maybe I will end up looking like Bucky Larsen, from that porn star movie a few years back.

Then again, hopefully I wont end up looking like that.

These dental sleep medicine people gotta make their money, somehow.

Eric

Can you post that link again? It didn't work

I have edited the link.