Dr suggested dental appliance with CPAP - what do you think?

[DougalMcDougal]

Hi all

I saw an ENT specialist today to identify any treatable anatomical cause for my severe obstructive sleep apnoa (untreated AHI = 42).

He did a nasal endoscopy and said surgery wouldn't help as there were no major anatomical issues but found that my airway opened moderately when i protruded my jaw forward so he told me that a dental appliance was an option and gave me the name of his favorite orthodontist to see if I wanted a dental appliance at night.

He said the appliance might reduce my AHI from 42 to around 25 but would not be a complete fix so I could just reserve its use for when i travel or use it together with CPAP to lower the CPAP pressure

My current APAP pressure is set at 8 to 12 giving me a consistent AHI of between 0.5 to 3.4. I have no difficulties or problems using the APAP

Is there any point in me wearing a dental appliance in this situation? I'm thinking probably not but I might get one just for the odd occasion when I sleep away from home

thanks for any advice

[acidragon]

Im personally new to this whole thing, but before I got my cpap while I was lying in bed I would try to relax and see how my body was having apneas and me moving my jaw forward and backwards would make a huge difference in how much effort it took to collapse. So I can see how it could help.

[BlackSpinner]

Price them before you decide.

You can also try a cheap boil & bite sports guard before forking over thousands for a maybe.

[Otter]

Is there any point in me wearing a dental appliance in this situation? I'm thinking probably not but I might get one just for the odd occasion when I sleep away from home

Aside from helping the orthodontist pay for his kids' college? Probably not. Considering that an AHI of 25 means that 25 times an hour you stopped breathing or had to struggle for breath, I don't think you'd sleep very well. But 25 is just a guesstimate, and given that your ENT did see your airway open up a little, there might be something there for you. Maybe you'll get lucky and your AHI with just the appliance will be around 5 instead of 25. If you have the time and can pay for it, there's no harm in trying.

Experimenting with a cheap plate before you shell out for a custom one seems like a good idea.

[Suddenly Worn Out]

That "doctor" is attempting to scam you. If you already tolerate APAP fine as you claim and your AHI is that low consistently, an oral appliance is nothing but an extra expense and extra PITA for you to deal with. And its money in your "doctor's" pocket.

Why do you need an OA in addition to APAP if you already are doing fine on APAP? I dont understand that. Oral appliances are for folks who are having problems tolerating CPAP/APAP or BIPAP.

You may want to find another sleep physician, in all honesty. Maybe even report this physician to your state medical board. I mean, that is inexcusable. Suggesting you do "combination therapy" when you are doing just fine with APAP alone.

Now if you were not tolerating APAP well, it would be a different story and your physician would be fine suggesting combination therapy. That would be a different story.

Eric

My current APAP pressure is set at 8 to 12 giving me a consistent AHI of between 0.5 to 3.4. I have no difficulties or problems using the APAP

Is there any point in me wearing a dental appliance in this situation?

[DougalMcDougal]

when you say try a cheap one first do you mean just a standard mouth guard available from a sport shop like a boxer would wear or can you be more specific?

I'm not sure how useful that would be because my subjective experience of sleep is the same when my AHI is 0 as it is when it is 42 so I wouldn't be able to tell unless I go off the reading on the ResMed S9 APAP machine
even if the cheap one worked or did not work that wouldn't necessarrily tell me much about how a customised dental appliance would work would it?

[Kitatonic]

The boil and plate guard will not move your jaw forward, it's designed for teeth grinders. Bruxism is very common among those of us with OSA, as the stress of nightly apneas cause the grinding, resulting in tooth chipping, worn- down teeth or jaw pain. If the dentist or you think you are grinding your teeth, then this would be a first option. I have worn a customized night guard years before the OSA dx with AHI of 50, so the guard only saved the teeth from chipping.

I think the ENT was referring to a customized appliance that protrudes the jaw forward. My husband found his appliance very uncomfortable, and even thinks the force on his lower teeth resulted in needing a root canal, he now only uses CPAP. Another sleep specialist thought the appliance that was made for him, was not entirely custom-fit, but that particular doctor prescribes the same type of appliance for everyone. So be aware of any doctor that only provides only one type of appliance.

[DougalMcDougal]

I'm fairly sure the ENT Dr was not scamming me because he gets nothing out of it if I go to a different person (i.e. the orthodontist) for the device and he did say that its up to me, just explaining the options.
I'm just toying with the idea of getting one so i can have an occasional break from the APAP or if I need to sleep away from home (probably 3 or 4 weeks per year) as it presumably would be better than nothing

That "doctor" is attempting to scam you. If you already tolerate APAP fine as you claim and your AHI is that low consistently, an oral appliance is nothing but an extra expense and extra PITA for you to deal with. And its money in your "doctor's" pocket.

My current APAP pressure is set at 8 to 12 giving me a consistent AHI of between 0.5 to 3.4. I have no difficulties or problems using the APAP

Is there any point in me wearing a dental appliance in this situation?

[DougalMcDougal]

the same ENT Dr saw a friend of mine 5 years ago and sent him for a similar oral appliance and he is very happy with it and not using CPAP
- he says he's feeling much better since using the appliance although I don't think he's ever had a formal sleep study

[Suddenly Worn Out]

No such thing as "taking a break" from CPAP therapy. This is like taking your blood pressure pill to manage your hypertension. You either take your pill every day or you dont. If you sleep away from home a couple weeks a year, buy a second APAP for travel. Ive got three APAPs. Ive traveled with mine many many times. I cant imagine traveling without my APAP. I wish I could get a different mask setup, but I always use my APAP.

Oral appliances do not have the effectiveness record that properly titrated CPAP or BIPAP have for OSA. Oral appliances plus CPAP therapy (combination therapy) is effective, but its not normally recommended unless there is some sort of problem tolerating high CPAP pressures.

I'd spend the money on a second APAP unit. You could buy one from the company that sponsors this forum.


Eric

I'm just toying with the idea of getting one so i can have an occasional break from the APAP or if I need to sleep away from home (probably 3 or 4 weeks per year) as it presumably would be better than nothing

My current APAP pressure is set at 8 to 12 giving me a consistent AHI of between 0.5 to 3.4. I have no difficulties or problems using the APAP

Is there any point in me wearing a dental appliance in this situation?

[/quote]

[49er]

when you say try a cheap one first do you mean just a standard mouth guard available from a sport shop like a boxer would wear or can you be more specific?

I'm not sure how useful that would be because my subjective experience of sleep is the same when my AHI is 0 as it is when it is 42 so I wouldn't be able to tell unless I go off the reading on the ResMed S9 APAP machine
even if the cheap one worked or did not work that wouldn't necessarrily tell me much about how a customised dental appliance would work would it?

Hi Dougal,

The purpose of trying a mouthguard first would be to get a sense of whether you would feel comfortable sleeping with something inside of your mouth the whole night. You're right, it wouldn't give any indication of how well a dental appliance would work.

Regarding which one to get, the sleep medicine dentist who posts on the other board, says the TAPIII appliance works best for severe apnea. He has never wavered on this.

49er

[DougalMcDougal]

when you say try a cheap one first do you mean just a standard mouth guard available from a sport shop like a boxer would wear or can you be more specific?

I'm not sure how useful that would be because my subjective experience of

Hi Dougal,

The purpose of trying a mouthguard first would be to get a sense of whether you would feel comfortable sleeping with something inside of your mouth the whole night.

49er

Great point - I think I'd probably hate sleeping with something in my mouth -

[The Choker]

He said the appliance might reduce my AHI from 42 to around 25 but would not be a complete fix so I could just reserve its use for when i travel

25 eh? Planning on some fantastic vacations and business trips?