Are oral appliances worth the thousands of dollars?

I'm a long-time CPAP user (now on a Resmed S9). My wife has just had a sleep study with an AHI of around 6-8.

I took to the CPAP the way a fish takes to water. I think I've missed maybe 10 nights in the 20 or so years since I've been diagnosed. At least a couple of those were for nights like the night before a colonoscopy (no sleep for that night ). I also wear both a grind guard (upper) and a retainer (lower). Some years ago, I tried a dental-fit, approximately $500 oral appliance. I didn't work for me because my bite is too fragile. My teeth were to big for my mouth and I had some of them pulled and the rest moved around when I was a teenager. They don't do that anymore because the teeth don't stay there (hence the retainer).

Any way, back to my wife. She thinks she'll have issues with a CPAP mask, and her sleep doctor said she should consider an oral appliance. I think she was quoted something like $4500. This is for a custom-made from either imaging or impressions from her mouth system. Since I will never consider a modern one, she would like to know about other's experiences good or bad. Do they work for most people?

Thanks for your input.
JimDrowsy

If they did, would we all be here (some for actual decades)?

There are people for whom those 'work' for some time, but so many find issues with e.g. TMJ (jaw problems, dislocation, pain), and/or other things even in a short time, we thought that a Cpap forum was a better idea than one for that device.

JimDrowsy wrote: ↑

Mon Dec 21, 2020 1:50 pm

Any way, back to my wife. She thinks she'll have issues with a CPAP mask, and her sleep doctor said she should consider an oral appliance. I think she was quoted something like $4500. This is for a custom-made from either imaging or impressions from her mouth system. Since I will never consider a modern one, she would like to know about other's experiences good or bad. Do they work for most people?

there are dentist who come here now and then. perhaps one will speak up.

i don't know if it easy for you, but finding the right mask is prolly THE most problematic task when it comes to finding the one that works for one's face. many people here had to go through several before finding one that was "just right". me, i got lucky in that the 4th mask i tried was a fit.

now, it is known far and wide on this forum that i'm a cheap so 'n' so. but even with that, who wouldn't think $4500 is expensive? i can't imagine that she would spend near that much on cpap therapy!

btw, you didn't say her issues would be. can you(or your wife) clarify that?

at any rate, good luck getting someone to speak about an oral appliance on a forum called cpaptalk might be a bit of a stretch.

whatever the case, hope your wife finds therapy!

My wife swore up and down that she would never be able to sleep with that strange thing on her face. When she actually tried it, she had less trouble adapting to it than I did. My first night, I could only keep it on for about two hours. She slept for over eight hours with it and has used it for over three and a half years.

I am a retired dentist. I personally used an oral appliance for my "mild" sleep apnea for a few years. It was called a "dorsal fin." I am on CPAP now for moderate OSA. That should tell you the story!

I did not mind sleeping with the appliance and I was very compliant. It definitely messed up my bite. It took months for it to revert back to normal after discontinuing it. That is a huge reason I would NEVER go back to it even if someone could prove to me that it worked. I have dentist friends that treat OSA with appliances and they would kill me for saying this. Some of them are "hot shot" lecturers who are extremely intelligent and could probably give many reasons why the appliances are so good. Personally I have done it both ways and I believe CPAP is far superior - the gold standard! But what do I know?

You probably know a lot more about dentistry than me. About the only thing I know about dentistry is that it is expensive.

Okie bipap wrote: ↑

Mon Dec 21, 2020 3:08 pm

You probably know a lot more about dentistry than me. About the only thing I know about dentistry is that it is expensive.

LOL Okie, it depends. Preventive is much less expensive than major treatment for sure!!!

One thing I will add to this thread that my dental friends would NOT like to see.
Many dentists these days take a "weekend course" at a hotel to learn how to treat OSA because it's sold by some companies as a wonderful "profit center." Not all, but many of these dentists that do this have "slow" practices and they are searching for something to increase revenues. And they are told this is the answer. If anyone ever does decide to go the oral appliance route you better make darn sure your doc has been doing this for a long time and that he/she knows what he's doing. It would downright scare me to go to some of these docs that I have seen taking these courses. OK, I unloaded that... I feel much better now!

zonker wrote: ↑

Mon Dec 21, 2020 2:38 pm

btw, you didn't say her issues would be. can you(or your wife) clarify that?

at any rate, good luck getting someone to speak about an oral appliance on a forum called cpaptalk might be a bit of a stretch.

whatever the case, hope your wife finds therapy!

She tried my nasal pillows for a minute and felt like she couldn't breath. Pressure was @ 6. She has a ton of other sleep issues (circadian-rhythm issues, frequent wakes, trouble falling asleep again, etc. She is afraid that the mask would keep her awake.

I realize this isn't "oral appliance talk", but I figured it couldn't hurt to ask. Who knows, there might be a couple of failed hoseheads who went to appliances .

Jim

JimDrowsy wrote: ↑

Mon Dec 21, 2020 4:56 pm

Who knows, there might be a couple of failed hoseheads who went to appliances .

I figure if they did fail cpap and opted for the oral device they probably won't hang around here so you have a rather captive audience.

About nasal pillows at 6 cm and not being comfortable with them.
Couple of ideas I always suggest...try a larger size nasal pillow and make sure exhale relief is on and ramp is NOT on.
It's weird sounding I know but 7 inhale with exhale relief on (say at 3 cm for ResMed machine) so that exhale is at 4 cm....is a whole lot more comfortable than straight 6 cm. Big difference comfort wise. Plus sometimes just going up one size in nasal pillows allows more air movement and is more comfortable.

As far as using the oral device...no experience at all so I can't comment.

JimDrowsy wrote: ↑

Mon Dec 21, 2020 4:56 pm

zonker wrote: ↑

Mon Dec 21, 2020 2:38 pm

btw, you didn't say her issues would be. can you(or your wife) clarify that?

at any rate, good luck getting someone to speak about an oral appliance on a forum called cpaptalk might be a bit of a stretch.

whatever the case, hope your wife finds therapy!

She tried my nasal pillows for a minute and felt like she couldn't breath. Pressure was @ 6. She has a ton of other sleep issues (circadian-rhythm issues, frequent wakes, trouble falling asleep again, etc. She is afraid that the mask would keep her awake.

I realize this isn't "oral appliance talk", but I figured it couldn't hurt to ask. Who knows, there might be a couple of failed hoseheads who went to appliances .

Jim

understood. was thinking along the lines of pugsy's comment about pressures.

but then, "happy wife, happy life".

Even if the chance of TMJ was only one in ten, it wouldn't be worth the risk.
I had a cubicle mate who had it, and she was in CONSTANT pain.
When she was diagnosed with cancer, I think she just gave up and let it take her,
---just to end the pain.

x

I used one for several months. It worked well for my mainly positional apnea and I tolerated it well. But I noticed that the spaces between my molars were increasing which is apparently an issue with these. I went back to CPAP because of this. I still use the MAD when I travel. My health insurance covered most of the MAD but even if I had paid all of it out of pocket, the cost would have been 1/2 what you were quoted.

Are oral appliances worth the thousands of dollars?

If you have "thousands of dollars" laying around to use on something that probably won't work, then it may be worth it to you. If you're like most people that would have to borrow the money it wouldn't be worth it.