Why did you choose cpap over the OA?

RogerSC wrote:I noticed that you mention the mask and head straps as being an issue. There are many different models of masks, and they have different ways of staying on. There's even a new one that is held on orally, anchored to your teeth (like an OA), and has no straps (ideally). .

This may be PERFECT! I sleep with my mouth firmly (my mollars are clenched, but I don't grind) so this could be exactly what I need.

Now, I'm new to this. Does this change the machine the tech wants me to use? Do I just inform the DME that I want to switch masks? What if this one doesn't work? Do I buy a replacement or do they 'exchange' masks/ tap pap?

All masks work will all machines, so no problem there. How you get new masks will depend on your DME and insurance. MOst DMEs will allow you to exchange masks within 30 days, but some don't. Some insurance companies will let you get an additional mask without having to exchange your old mask. I was able to get a new mask a month after my first mask and keep both. I did have to pay my 15% of both masks, but that wasn't a big deal to me. I just got a replacement mask less than 2 months ago, and I just ordered a new mask that I want to try. I asked them how soon I would be allowed to get another mask with my insurance, and I was told I could get one now.

Without cpap I sleep 12 hours with no rest, I function at the speed of an amoeba, it takes me 1-2 hours to fully "wake up", my attention span is negative , my grumpiness gets exponentially larger than the distance from here to the sun, life loses taste; so yeah evn though my weak esophageal sphincter limits my treatment due to acid reflux, I figure I dont want those desaturations killing my silly neurons right and left like flies, so yep :
I choose Cpap over being a retarted amoeba any old day ( no offense to retarted amoebas who are proud and representing),
Dreamrobot

docjl wrote:

I

Then why discuss MAD (mandibular advancement devices) with a dentist?
]http://www.umm.edu/patiented/articles/w ... 0065_9.htm[/url] University of MD and it states on the page that side sleepers aren't very successful with it and that it may cause some sleep apnea gets worse. Is that true? I hadn't heard that before!

I think you may have gotten that backwards..... back sleeping causes more apneas in most people, so we are encouraged to sleep on our side. I can successfully sleep on my side wearing any kind of mask, from full face to nasal pillows with an ahi from 0.0 to 0.4.... my ahi WAS 27 before using my machine. The reason I chose cpap over dental device was that .... you don't know how you are doing with a dental device, but with cpap you can visually see how you are doing via your data each and every day.
My sister uses a dental device and has no clue whether it is working or not other than how she feels, I on the other hand use my trusty cpap machine and can see and feel how I am progressing.

docjl wrote:

RogerSC wrote:I noticed that you mention the mask and head straps as being an issue. There are many different models of masks, and they have different ways of staying on. There's even a new one that is held on orally, anchored to your teeth (like an OA), and has no straps (ideally). .

This may be PERFECT! I sleep with my mouth firmly (my mollars are clenched, but I don't grind) so this could be exactly what I need.

Now, I'm new to this. Does this change the machine the tech wants me to use? Do I just inform the DME that I want to switch masks? What if this one doesn't work? Do I buy a replacement or do they 'exchange' masks/ tap pap?

Be careful sleeping with your teeth together (especially clenched), I was doing this recently related to cpap, and developed a very sensitive area in my molars on one side. Have been working on this one, and over a period of time have reversed this by consciously not having my teeth together (except when I chew *smile*). This may not happen to you, and it was the first time for me, too, but very uncomfortable to be so sensitive to cold. Just a head's up if you experience this.

I think you may have gotten that backwards..... back sleeping causes more apneas in most people, so we are encouraged to sleep on our side. I can successfully sleep on my side wearing any kind of mask, from full face to nasal pillows with an ahi from 0.0 to 0.4.... my ahi WAS 27 before using my machine. The reason I chose cpap over dental device was that .... you don't know how you are doing with a dental device, but with cpap you can visually see how you are doing via your data each and every day.
My sister uses a dental device and has no clue whether it is working or not other than how she feels, I on the other hand use my trusty cpap machine and can see and feel how I am progressing.

I thought that, too, but this is what it reads: (copy/pasted from the website- I put it in italics. my comments are in blue.)
Benefits of Dental Devices. Dental devices seem to offer the following benefits:

Significant reduction in apneas for those with mild-to-moderate apnea, particularly if patients sleep either on their backs or stomachs. They do not work as well if patients lie on their side. The devices may also improve airflow for some patients with severe apnea.
Improvement in sleep in many patients.
Improvement and reduction in the frequency of snoring and loudness of snoring in most (but not all) patients.


Higher compliance rates than with CPAP.
Dental devices have shown better long-term control of sleep apnea when compared to uvulopalatopharyngoplasty (UPPP), the standard surgical treatment. There are also few complications with a dental device.

Disadvantages of Dental Devices. Dental devices are not as effective as CPAP therapy. The cost of these devices tends to be high. Side effects associated with dental devices include:

Nighttime pain, dry lips, tooth discomfort, and excessive salivation. In general, these side effects are mild, although over the long term they cause nearly half of patients to stop using dental devices. Devices made of softer materials may produce fewer side effects.
Permanent changes in the position of the teeth or jaw have occurred in some cases of long-term use. Patients should have regular visits with a health professional to check the devices and make adjustments.
In a small percentage of patients, the treatment may worsen apnea.


Source: Obstructive sleep apnea - Dental Devices http://www.umm.edu/patiented/articles/w ... z2TmpHYjjY
University of Maryland Medical Center Follow us: @UMMC on Twitter | MedCenter on Facebook

Perhaps there is an error on their page?

I suspect it is a way to fool customers. They are saying that their device gets the best results when used under the worst situation. Remember, the define success as a 50% reduction. If the can get you to increase the number of potential apneas, then it sounds better if the number is reduced.

Without treatment, sleep apneas is usually worst while sleeping on the back. Why would the encourage somebody to sleep in the worst position? So that they can make it look like it is making a big difference. But chances are, you will still be having too many events.

My dentist was quite frank with me. He said he could fit me for an oral appliance, but it was going to cost a lot of money (not covered by insurance) and he didn't think it would be effective for me because my apnea is severe. I very much appreciated his honesty.

Prior to being diagnosed with OSA, I was put on CPAP as an empiric trial to determine if it would benefit my EDS. I wound up diagnosed with OSA, and kept using CPAP. The reason I didn't head for a MAD shortly thereafter was because I was/am nervous that it will affect my bite (both functionally and aesthetically). The reason I'm going to be getting a MAD is because I have intractable aerophagia with CPAP, at pressures considerably lower than what I am prescribed, and having tried EVERYTHING, it is not improving. So my choices are to continue with PAP and continue to suffer with EDS and poor quality of life, or try a MAD and hope it will address my EDS. (Or in the worst of both worlds scenario, do the two together. Oh. My. God.)

While I'm no expert on MADs, based on the little bit that I know, I would take the MAD success statistics you read on this site with less than a grain of salt (no offense, Friends! ). First of all, I think that the actual success rate is much higher than what most people believe. Also, I don't think having "severe" OSA is necessarily a deal breaker. If I were someone who could use CPAP and I desaturated horribly, perhaps I would not think about MAD, or at least I would make very sure it's addressing those unhealthy desaturations. However, as someone with decent oxygen saturations even without CPAP (92-93%), but horrible EDS, I don't give a rat's tushy what my AHI is or isn't on MAD, as long as I feel better. I think that the AHI<5 is a false idol that we've been worshiping too long, particularly for those who don't desaturate significantly.

That's my two cents, for what it's worth!

My sleep apnea journey began with a oral appliance and finished with CPAP, so I can give you my perspective

When I was initially diagnosed with sleep apnea, my sleep doctor mentioned both solutions, OA & CPAP and gave me the choice of which to pursue.

Initially I went with the OA solution. For me the OA just seemed like a better solution; passive, no hoses, no mask, no high tech box to blow air up my nose, more "portable", etc

I used the OA for about 4 months and then abandoned it. Here are the problems that I had:

1) the OA DID NOT resolve my sleep apnea. Actually the OA made it much worse. My AHI with untreated apnea was 7. With the OA it jumped to 23. I could not believe it when I saw these results. Both sleep studies were completed in the same medical sleep lab.

2) slow, steady permanent advancement of the lower jaw. I had a normal overbite before using the OA. When waking up in the morning, the lower teeth actually jut out past the upper teeth. The OA that I selected came with a "morning repositioner". I had to insert the repositioner and do jaw clenching exercises for 10-15 minutes in the morning immediately after removing the OA. Unfortunately in my case, the lower jaw just continued advancing. It got to the point where my lower teeth were just about lined up with my upper teeth. Use of the repositioner also took time in the morning since you can't just "wake up and go"

3) when I woke up in the morning my entire jaw had a "dull ache" for about an hour. This was concerning since I was worried about long-term shifting of my teeth and/or jaw

The OA's work by mechanically jacking the lower jaw forward and it takes a lot of force to move the lower jaw forward. It's not surprising that it's difficult to get the jaw to go back into it's normal position after being jacked forward for 8 hours.

Since this bad experience with the OA I've changed to regular CPAP and my apnea is now under control. I've adapted to using a nasal mask and now regularly have AHI's in the 2-3 range. Even if the OA had been able to improve my AHI, I strongly prefer CPAP, even with all the inconveniences of the mask, hose, etc.

I wish I had never gone down the OA road. It was just a complete waste of time and money. Also the long term effects of using the OA device made me very nervous, I'm glad I stopped using it before causing serious damage to my teeth and jaw. Maybe the results are different for others, but the OA was a complete disaster for me.

Significant reduction in apneas for those with mild-to-moderate apnea, particularly if patients sleep either on their backs or stomachs. They do not work as well if patients lie on their side.

I read that as: "If you use our product, it works almost as well as when some patients switch from back-sleeping to side-sleeping!"

I have nothing against OAs. Got one myself to tide me over until I got my machine. For those who can't use the gold-standard treatment for whatever reason, OAs can be just the ticket to getting some improvement in their condition. All I ask is that people give the gold-standard treatment the full shot before moving on to less-effective approaches.

I take issue with the word "significant" in the copy, though. "Significant" is a word and concept that is often misused. It usually means "mathematically significant" or "statistically significant" to the writer but generally reads as "medically significant" or "leading to meaningful ultimate outcomes" to the audience, including the newspaper people who try to report on the product. That verbal slight of hand is designed to mislead unless aimed at other researchers. And it works. Whenever I see that trick in print in an ad for the public, it makes me lose all respect for the product and the company, myself. And when I see a newspaperman fall for the trick, or misunderstand the use of the word as used in research documents, I tend to lose respect for him and his paper. The question is, " 'Significant' in what sense and when being compared to what?"

Gearhead, which OA did you use?

docjl wrote:

...Significant reduction in apneas for those with mild-to-moderate apnea, particularly if patients sleep either on their backs or stomachs. They do not work as well if patients lie on their side. The devices may also improve airflow for some patients with severe apnea...
Source: Obstructive sleep apnea - Dental Devices http://www.umm.edu/patiented/articles/w ... z2TmpHYjjY
University of Maryland Medical Center Follow us: @UMMC on Twitter | MedCenter on Facebook[/i]

Perhaps there is an error on their page?

Seems from what they are saying that the device is more effective addressing a front-to-back collapse only rather than when a side-to-side collapse of tissues is added to the mix. Am I reading it wrong?

I suspect the OA may not even be mentioned to a patient unless there are reasons
the person may not be able (or willing) to use CPAP. It may work, albeit not as well as CPAP;
but better than nothing. --and, sadly, if the patient refuses to even try cpap,
at least somebody gets to make a living.

SleepingUgly wrote:The reason I'm going to be getting a MAD is because I have intractable aerophagia with CPAP, at pressures considerably lower than what I am prescribed, and having tried EVERYTHING, it is not improving. So my choices are to continue with PAP and continue to suffer with EDS and poor quality of life, or try a MAD and hope it will address my EDS. (Or in the worst of both worlds scenario, do the two together. Oh. My. God.)

To be sure, have your aerophagia symptoms been been confirmed as NIV/CPAP induced, in this manner?"

In the case of aerophagia during NIV, it is normally diagnosed by experienced medical specialists who check on patients intermittently during NIV use. The diagnosis is based on the sound heard by listening through a stethoscope placed outside the abdominal cavity.

http://en.wikipedia.org/wiki/Aerophagia

Respectfully, Nate