Mild OSA now...going to oral appliance need advice

I tried one of the $200 mail in molds and it definitely held the jaw forward and opened the airway in that area and seemed to orivide some comfort. Sometimes the jaw joints would get a little tender.

However, my obstructive apneas appear to be from the muscles in the throat below that area relaxing and collapsing, and the oral appliance couldn't help there. And then of course the central apneas started causing problems as I got older.

I'd like to get another $200 mandibular advancement device because I think it will help when and if I need to use a full face mask. It should help keep my jaw in place. So far I've been using nasal pillows and tape.

Good luck with the dentist's appliance. I almost got one of those, too.

I've used my Somnodent MAD device every night for over three years now, and its as good now as it was the day I got it. Fortunately, it came with directions of how to tighten it up so that my jaw stays forward without any discomfort. It took me about six weeks of experimentation to get it adjusted to the correct tightness. I went about 2 years with using it only. My sleep doc wanted to do a study to see if it was effective enough. So last spring I did a home test with his equipment and turned it in the next day. (I had to be there at 7:30 sharp to turn it in, otherwise they threatened to charge me a stiff fine). It turned out that he said it was "adequate". Well, I had been using my System One Bipap 750, on and off. When he told me that, I have been using it regularly now for several months, along with my MAD, and checking my AHI daily. It varies between 1 and 1.5.

So then, last fall I had a severe bicycle wreck which almost took me out of here. (I missed a concrete buffer by 1 ft, had a concussion with frontal lobe bleeding , unconscious for about an hour, and was in pretty bad shape for awhile in the ER. When I saw my sleep doc last time, he asked me a lot of questions about my accident, and seemed to be very concerned as to my brain function being normal. So much so that I asked him if I could get a new machine, since I am eligible. (My last one from Medicare was in 2008). So he said yes and wrote me the prescription for a new bipap. I will get it tomorrow. The reason I asked him for one is that the machine I have has been discontinued and who knows how long it will last, or if it malfunctions, it may not be fixable. Also, will Medicare still be available under the new administration? Things are uncertain for the next 4 years, in my opinion.

When I related all of this to the doc, he said it was a good idea, so I'm very happy how it worked out. I will probably go with the System One Dreamstation Bipap. But I also plan to keep using my MAD, simple because I'm used to it, and it is no problem to upkeep, or clean.

So that's my story in a nutshell.

Thank you for your constructive post that is on point regarding oral appliances.

So it sounds like you are doing OA and BiPap combination therapy??? But you used your Somnodent exclusively for the first two years? I confess I dont know much about the oral appliances yet, mainly I have learned about the Somnodent brand and another called a TAP. Ive learned there are a ton of cheaper "boil in a bit" type oral appliances FDA approved for not just snoring but also for mild OSA.

Im leary of the cheap boil and a bit type oral appliances. While they might be fine for their real intended use, snoring, for OSA I prefer a custom made device where Im being supervised by a professional.

Sorry to hear of your accident, sounds bad. Hope you are OK.

Does the Somnodent reduce your needed pressure for your Bipap? Thats the main point of combination therapy, is my understanding. Like if you need a pressure of 11 on CPAP or Bipap, if you use a Somnodent it can reduce your pressure needs to maybe 7 or 8 or something and reduce problematic side effects of higher pressures.

packitin wrote:I've used my Somnodent MAD device every night for over three years now, and its as good now as it was the day I got it. Fortunately, it came with directions of how to tighten it up so that my jaw stays forward without any discomfort. It took me about six weeks of experimentation to get it adjusted to the correct tightness. I went about 2 years with using it only. My sleep doc wanted to do a study to see if it was effective enough. So last spring I did a home test with his equipment and turned it in the next day. (I had to be there at 7:30 sharp to turn it in, otherwise they threatened to charge me a stiff fine). It turned out that he said it was "adequate". Well, I had been using my System One Bipap 750, on and off. When he told me that, I have been using it regularly now for several months, along with my MAD, and checking my AHI daily. It varies between 1 and 1.5.

So then, last fall I had a severe bicycle wreck which almost took me out of here. (I missed a concrete buffer by 1 ft, had a concussion with frontal lobe bleeding , unconscious for about an hour, and was in pretty bad shape for awhile in the ER. When I saw my sleep doc last time, he asked me a lot of questions about my accident, and seemed to be very concerned as to my brain function being normal. So much so that I asked him if I could get a new machine, since I am eligible. (My last one from Medicare was in 2008). So he said yes and wrote me the prescription for a new bipap. I will get it tomorrow. The reason I asked him for one is that the machine I have has been discontinued and who knows how long it will last, or if it malfunctions, it may not be fixable. Also, will Medicare still be available under the new administration? Things are uncertain for the next 4 years, in my opinion.

When I related all of this to the doc, he said it was a good idea, so I'm very happy how it worked out. I will probably go with the System One Dreamstation Bipap. But I also plan to keep using my MAD, simple because I'm used to it, and it is no problem to upkeep, or clean.

So that's my story in a nutshell.

Thank you.
I'm one of those who have never really adapted to cpap usage. I've struggled for 14 years since I was diagnosed. I'm still struggling. I do not know very much about all the "diagnostics" of usage and the different machines. All I care about is how I feel in the mornings and how much energy I have. Fortunately, I've been doing very good lately and I'm averaging about 20 days per month using both the MAD and my 750P bipap. Numbers: ipap 10.5, epap 8.5,BrFlex 2 Ramp time .15, Ramp start 7.5 Hum On, Auto On

At present, my AHI is 1.4 for the last 6 months. I arrived at those settings just by trial and error. I suppose I should have another all-night test done.
I'm getting the new machine this afternoon and I hope I can get some help here as far as adjusting the settings myself.

Okay, I just got my Dreamstation bipap auto a few hours ago, and looking forward to my first night tonight. So far, so good from what I was able to gather from the technician at American Homepatient, where I was given a 30 or 40 minute lecture on all the settings, features, etc.
I think I am going to be happy with it from what I've seen. Wish me luck. Any advice would be appreciated.

Good luck, sounds like youve had kind of a tough time there. I too, really only care about "how I feel" from this gear. I care about the numbers to a point but if I went purely by the machine numbers, I'd be feeling wonderful. Hint: Most of these modern CPAP/APAP/bipap machines are designed to give you a less than 4 AHI no matter how you use them or how they are set up. When I first started CPAP, it was not that way, on my original machines, Resmed S8 APAPs, if the pressure was not high enough or if I got a high enough leak rate, my AHI would reflect that the following morning. These companies made their machine algorhythms to "be under 4 AHI" no matter what, on purpose.

packitin wrote:Okay, I just got my Dreamstation bipap auto a few hours ago, and looking forward to my first night tonight. So far, so good from what I was able to gather from the technician at American Homepatient, where I was given a 30 or 40 minute lecture on all the settings, features, etc.
I think I am going to be happy with it from what I've seen. Wish me luck. Any advice would be appreciated.

MrGrumpy wrote:Well maybe I should just go shoot myself in the head then and give up? Geeeez come to a sleep apnea forum and ask about oral appliances and people come down on your like you are dog shit or something

You asked for advice, and people gave it to you from their own perspectives. For many of us, the oral appliances didn't work for one reason or another, and we are good at telling it like it is. So why are you complaining?

I haven't chimed in on this till now because I never tried an oral device of any kind, all I know about is CPAP use. Personally, though, if I were to try an oral device, I would start with the mail-in mold before going to the custom mold. If that approach doesn't appeal to you, then do whatever you want to do for relief now that you've had some replies, including one that seems to have made you happy.

MrGrumpy wrote: Hint: Most of these modern CPAP/APAP/bipap machines are designed to give you a less than 4 AHI no matter how you use them or how they are set up. When I first started CPAP, it was not that way, on my original machines, Resmed S8 APAPs, if the pressure was not high enough or if I got a high enough leak rate, my AHI would reflect that the following morning. These companies made their machine algorhythms to "be under 4 AHI" no matter what, on purpose.

Could you support this with some Data.. or links to some research that supports it.

grayghost4 wrote:

MrGrumpy wrote: Hint: Most of these modern CPAP/APAP/bipap machines are designed to give you a less than 4 AHI no matter how you use them or how they are set up. When I first started CPAP, it was not that way, on my original machines, Resmed S8 APAPs, if the pressure was not high enough or if I got a high enough leak rate, my AHI would reflect that the following morning. These companies made their machine algorhythms to "be under 4 AHI" no matter what, on purpose.

Could you support this with some Data.. or links to some research that supports it.

No he can't, he can't even make his treatment work, why he's giving advice to others is non-sence. Jim

Yeah I can give you some data. Firsthand personal experience with the older CPAP/APAP machines and the newer machines. When I first started with CPAP, I entered when the Resmed S8 series of machines was top of the line, along with equivalent Respironics CPAP/APAP machines. I found that the algorithm was "tighter," by that I mean if you gained weight or had a bad night of leaks, my AHI would oftentimes be above 4 or 5 AHI and I would not feel well that particular day.

When I switched to the Resmed S9 and the Respironics System One series of AutoPaps after using the Resmed S8 series exclusively, I quickly found out that these machines scored differently. I discovered these machines always scored me very very low no matter what. I went from four years of using Resmed S8 Autopaps with AHIs that ranged from the 2s to the periodic 4s and 5s and even a little higher once in a rare while.

I broached this with a sleep medicine specialist I was using in early 2011 and they explained to me that with the S9 series, Resmed had changed their algorithms and they were not as "aggressive" as the older machines. The major companies did that to accompany all the people entering the CPAP market back around the time the Resmed S9 and Respironics System One series machines came out, maybe around 2010/2011. I complained the S9s "did not feel the same as the S8s I was used to." I was told, well all you can do about that is to buy used S8s off the Internet til they run out or find a way to adapt to the S9.

I have no experience with the Resmed S10 series, except for a brief experience with a Resmed S10 autoVPAP (auto-bipap). And that was so brief I dont count it.

I dont care if you believe me or not. The algorithms these auto titrating devices use changed when they went from S8 to S9. Nowadays, even running my machines from the pathetic 4-20 method, which is the weakest way to run an autopap, my AHI is rarely above 3, usually in the 2s or under. If I switch back to an old S8 APAP and run it the same way, wow my AHI will be maybe 6 or 7. I dont have a technical answer as to why that is, I just know it is that way.

grayghost4 wrote:

MrGrumpy wrote: Hint: Most of these modern CPAP/APAP/bipap machines are designed to give you a less than 4 AHI no matter how you use them or how they are set up. When I first started CPAP, it was not that way, on my original machines, Resmed S8 APAPs, if the pressure was not high enough or if I got a high enough leak rate, my AHI would reflect that the following morning. These companies made their machine algorhythms to "be under 4 AHI" no matter what, on purpose.

Could you support this with some Data.. or links to some research that supports it.

MrGrumpy wrote:When I switched to the Resmed S9 and the Respironics System One series of AutoPaps after using the Resmed S8 series exclusively, I quickly found out that these machines scored differently. I discovered these machines always scored me very very low no matter what. I went from four years of using Resmed S8 Autopaps with AHIs that ranged from the 2s to the periodic 4s and 5s and even a little higher once in a rare while.

I dont care if you believe me or not. The algorithms these auto titrating devices use changed when they went from S8 to S9. Nowadays, even running my machines from the pathetic 4-20 method, which is the weakest way to run an autopap, my AHI is rarely above 3, usually in the 2s or under. If I switch back to an old S8 APAP and run it the same way, wow my AHI will be maybe 6 or 7. I dont have a technical answer as to why that is, I just know it is that way.

Did you change machine models after your surgery? Your theory doesn't pan out with a lot of others first hand experience. I have seen a lot of AHI' s higher than 4 on newer machines.
While getting a good night's sleep and how we feel the next day is important, and why most pursue this treatment. CPAP, or any other obstructive relieving treatment, only treats that. How you feel in the morning can be effected by many other components even with low AHI's.

grayghost4 wrote:

MrGrumpy wrote: Hint: Most of these modern CPAP/APAP/bipap machines are designed to give you a less than 4 AHI no matter how you use them or how they are set up. When I first started CPAP, it was not that way, on my original machines, Resmed S8 APAPs, if the pressure was not high enough or if I got a high enough leak rate, my AHI would reflect that the following morning. These companies made their machine algorhythms to "be under 4 AHI" no matter what, on purpose.

Could you support this with some Data.. or links to some research that supports it.

[/quote]

No change in machines after the surgery. Why does my story not pan out? You remove a large part of the blockage in my airway (tonsils) and I could thereafter not tolerate the same pressure as before the tonsillectomy. Whats does not pan out on that?

Ive found this forum to be a poor place to get advice beyond real basic stuff.

OkyDoky wrote:

MrGrumpy wrote:When I switched to the Resmed S9 and the Respironics System One series of AutoPaps after using the Resmed S8 series exclusively, I quickly found out that these machines scored differently. I discovered these machines always scored me very very low no matter what. I went from four years of using Resmed S8 Autopaps with AHIs that ranged from the 2s to the periodic 4s and 5s and even a little higher once in a rare while.

I dont care if you believe me or not. The algorithms these auto titrating devices use changed when they went from S8 to S9. Nowadays, even running my machines from the pathetic 4-20 method, which is the weakest way to run an autopap, my AHI is rarely above 3, usually in the 2s or under. If I switch back to an old S8 APAP and run it the same way, wow my AHI will be maybe 6 or 7. I dont have a technical answer as to why that is, I just know it is that way.

Did you change machine models after your surgery? Your theory doesn't pan out with a lot of others first hand experience. I have seen a lot of AHI' s higher than 4 on newer machines.
While getting a good night's sleep and how we feel the next day is important, and why most pursue this treatment. CPAP, or any other obstructive relieving treatment, only treats that. How you feel in the morning can be effected by many other components even with low AHI's.

grayghost4 wrote:

MrGrumpy wrote: Hint: Most of these modern CPAP/APAP/bipap machines are designed to give you a less than 4 AHI no matter how you use them or how they are set up. When I first started CPAP, it was not that way, on my original machines, Resmed S8 APAPs, if the pressure was not high enough or if I got a high enough leak rate, my AHI would reflect that the following morning. These companies made their machine algorhythms to "be under 4 AHI" no matter what, on purpose.

Could you support this with some Data.. or links to some research that supports it.

[/quote]

Ive found this forum to be a poor place to get advice beyond real basic stuff.


then why are you asking for help here ????

I check in once in a while to supervise you people to make sure you are not giving people whacked CPAP advice. Im good at telling people what to do.

grayghost4 wrote:Ive found this forum to be a poor place to get advice beyond real basic stuff.


then why are you asking for help here ????

MrGrumpy wrote: ↑

Sun Jan 15, 2017 5:28 pm

I check in once in a while to supervise you people to make sure you are not giving people whacked CPAP advice. Im good at telling people what to do.

grayghost4 wrote:Ive found this forum to be a poor place to get advice beyond real basic stuff.


then why are you asking for help here ????

How did the oral appliance work out MrGrumpy?