I'm a dentist treating myself! CPAP Results... Advice please?

[nee]

Hey all!

I'll give a history of my case. If you'd like to jump to my CPAP results, they're at the end of this post. My first night with the CPAP was last night.

-5'11" male, 29 years old, 175 lbs, exercises frequently, no significant medical/surgical history. No medications. History of anxiety (starting 5 years ago, peaked 2 years ago, and has been better since), heartburn, difficulty concentrating, fatigue, unrefreshed sleep.

-I've been told I moan in my sleep since 2007 (nocturnal groaning), that I hold my breath in my sleep since 2013, but never thought seriously of it.

-2017: I self-referred to an ENT for a sleep study due to increasingly feeling like shit during the day and not sleeping well. My girlfriend at the time was concerned because I was "choking in my sleep." I went home with one of those wrist contraptions, slept with it for a few nights, and upon viewing my results the ENT flatly said I don't have sleep apnea. I took his word for it.

-05/2019: Took a dental course last year on recognizing oral signs of sleep apnea, referring patients for treatment, and treating with oral appliances. During this course I recognized many of the signs and symptoms in myself. The course instructor recommended me to visit an airway focused dentist in Southern California.

-06/2019: Was evaluated by the dentist, went home with a high resolution pulse oximeter, and slept with it for four nights. Here is a result of one of the nights:

6.19.19 HRPO.jpg (488.83 KiB) Viewed 4944 times

Impressions from his evaluation: "Sleep fragmentation secondary to craniofacial risk factors and associated soft tissue compensations. Possible UARS."

-07/2019: Started treatment with the myTAP sleep appliance which brings my lower jaw forward. Couldn't really tolerate it. After a couple of weeks I re-did the high resolution pulse oximeter while wearing the appliance and it showed some improvement in my respiratory disturbance index.

-09/2019: Had a lab fabricate me a Prosomnus MicrO2 sleep appliance. Much more comfortable than the myTAP. Current girlfriend says I moan/hold my breath less.

-12/2019: Evaluated by an oral surgeon for eventual MMA surgery to open up my airway. I'm pretty severely retrognathic, and don't want to be in a sleep appliance forever. Already reviewed the risks and benefits and this is the eventual course of treatment I'll be taking.

-01/2020: Made an appointment with a sleep specialist for 01/28/2020, for documentation/health insurance purposes (coverage for MMA surgery).

-Currently: Not too happy with the oral appliance. I feel like it's not doing enough for me and it's gotten to the point where I don't want to wait for the sleep specialist's appointment, sleep study, prescription, etc etc...

SO... Went ahead and purchased a secondhand AirSense 10 AutoSet CPAP, an AirFit P10 nasal mask, and tried it last night.

Here are my results!

CPAP 1.8.2020.jpg (630.4 KiB) Viewed 4872 times

I remember waking up a few times during the night but didn't have difficulty falling asleep. The nasal mask was comfortable. A few of the times I woke up, the mask was completely off and I had to put it back on it. The minimum of 10 cmH2O didn't feel bothersome as I went to sleep.

If anything else is needed or anyone has any questions/remarks, I welcome them

Curious as to thoughts about how to proceed with these results.

Thank you!

[nee]

Also, forgot to mention that last night I wore my sleep appliance that brings my jaw forward, as well as taped my mouth shut. So these results reflect that.

[palerider]

Your results are good for a first night, I'd like to see the obstructive apnea index a little lower, but,sleep with things as they are for a few more nights.

Keep an eye on it, and see what tonight looks like.

Please review the I stuctions in the "read this before posting" thread at the top of the first page for now to format the screenshot so it will have better info.

[chunkyfrog]

I celebrate the fact that dentists are becoming more aware of sleep apnea.
Before cpap, it was not uncommon for me to sleep during dental procedures
--including a ROOT CANAL.
If my then-dentist had known, my cpap treatment would have started years earlier.
It is good that this improved education may be saving the dentists themselves.

[nee]

I celebrate the fact that dentists are becoming more aware of sleep apnea.
Before cpap, it was not uncommon for me to sleep during dental procedures--including a ROOT CANAL.
If my then-dentist had known, my cpap treatment would have started years earlier.
It is good that this improved education may be saving the dentists themselves.

I screen every one of my patients for their Mallampati score, tonsil size, scalloping on the tongue, tongue tie, grinding/clenching during sleep, history of acid reflux, history of snoring, craniofacial structure, etc. and strongly encourage them to get sleep studies done. I have had many that had all the signs and symptoms but their physicians refused sleep testing because they didn't fit the obese/large neck stereotype. Or who were told "oh you only have mild sleep apnea, don't worry about it." Insane. I was one of those patients, and so I try to advocate for mine as much as possible.

By the way, sleeping during a root canal is taken as a compliment. It means we have you nice and numb and comfortable

Palerider - just updated my results from last night in my original post. Hopefully it's more clear now.

[turbo]

Hey there SoCal buddy. looks like you posted the same pic again

[nee]

Hey there SoCal buddy. looks like you posted the same pic again

Hey buddy!

Yes, I updated it in my original post as well for clarity

Edit: Just removed it from my other post so there's not too many images in this thread.

[Stephaniedp3]

I celebrate the fact that dentists are becoming more aware of sleep apnea.
Before cpap, it was not uncommon for me to sleep during dental procedures--including a ROOT CANAL.
If my then-dentist had known, my cpap treatment would have started years earlier.
It is good that this improved education may be saving the dentists themselves.

I screen every one of my patients for their Mallampati score, tonsil size, scalloping on the tongue, tongue tie, grinding/clenching during sleep, history of acid reflux, history of snoring, craniofacial structure, etc. and strongly encourage them to get sleep studies done. I have had many that had all the signs and symptoms but their physicians refused sleep testing because they didn't fit the obese/large neck stereotype. Or who were told "oh you only have mild sleep apnea, don't worry about it." Insane. I was one of those patients, and so I try to advocate for mine as much as possible.

By the way, sleeping during a root canal is taken as a compliment. It means we have you nice and numb and comfortable

Palerider - just updated my results from last night in my original post. Hopefully it's more clear now.

I had to look up scalloping on tongue and I have that. Is that related to sleep apnea?

[nee]

I had to look up scalloping on tongue and I have that. Is that related to sleep apnea?

There is a correlation (no causation as far as I know, but I could be wrong) between clenching the jaw and breathing problems during sleep. It is thought that perhaps clenching is our bodies effort to open the airway for more oxygen. That clenching leaves marks on the sides of the tongue. It also leads to mandibular tori and buccal exostoses (check for those!)

Or, bruxism could be just a normal part of getting into/leaving certain sleep cycles. Or it could be just due to stress. It's probably impossible to know for sure.

In any case, I just did a check-up on a patient with scalloping, a really large tongue, and ground down teeth. Asked her if she snores and she said "ohhh yeah." Off to her primary care physician she goes for a sleep evaluation! Never hurts to rule out sleep apnea.

[Miss Emerita]

Your results are good for a first night, I'd like to see the hypopnea index a little lower, but,sleep with things as they are for a few more nights.

PR, I didn't see any hypopneas on the chart. Also, I'm curious whether you would interpret the signs of clustering as suggesting a soft cervical collar could be useful.

[palerider]

Palerider - just updated my results from last night in my original post. Hopefully it's more clear now.

Yup, thanks.

[palerider]

Your results are good for a first night, I'd like to see the hypopnea index a little lower, but,sleep with things as they are for a few more nights.

PR, I didn't see any hypopneas on the chart. Also, I'm curious whether you would interpret the signs of clustering as suggesting a soft cervical collar could be useful.

Oops, read the wrong line. OAI, post corrected.

I have no idea whether a cervical collar would help at all. If I *don't* tuck my chin, then I get much more mouth leakage, so for me, a cervical collar, as well as being uncomfortable, would also be a real mouth dryer/cheek blower-upper.

[nee]

Here are last night's results:

1.09.2020 CPAP.jpg (694.6 KiB) Viewed 4734 times

Interesting that there are seemingly more leaks compared to the first night. I don't recall waking up with the nasal mask off as I did the first night, and thought that overall I tolerated the nasal mask much better.

Thoughts?

[slowriter]

Per Miss Emerita's suggestion, I would give a soft cervical collar a try and see if that helps with those clustered OAs.

[prodigyplace]

Since the OP is a Dentist and works in the mouth, I found this article interesting and perhaps relevant.

https://www.dailymail.co.uk/health/arti ... gests.html