My Solution for Apnea Related to Tongue Position

Disclaimer: I am not a Doctor. As such, the information I’m providing is based solely on my own lengthy (~ 8 yrs) experience with apnea and efforts to eliminate it. I hope my solution will help others with apnea resulting from Tongue blocking the airway. My apnea was considered “severe” at the sleep lab with 40 breathing stoppages per hour.

Based on my personal experience, and contrary to the conventional wisdom my sleep doctor, CPAP/APAP is not the best solution for apnea resulting from tongue blocking airway. For me the pressure needed to get air to flow around the tongue could be very high (depending on variables out of my control) which would lead to other troubles like mask leaks, awakenings, and other problems that have negative consequences on treatment. I have tried full faced masks, nasal only masks, CPAP, APAP, different pressures and rarely got decent sleep. I also took steps to eliminate sleeping in my back (supine position). While this helped, I still had many awakenings and fragmented sleep.

My solution: SUAD mandible (lower jaw) advancement device including 2 modifications to make it 100% effective for me. One modification was to create a 5mm air space between the top and bottom teeth. The space facilitates air to flow into mouth in case I want to mouth breath. (I also needed this space when I experimented with combining SUAD with CPAP full faced mask). The second modification was to add multiple rubber bands for holding the top and bottom part of the device tightly together and prevent my mouth from opening during sleep. If my mouth opens at all during sleep, my breathing stops because my tongue will fall back into the airway.

Below is picture of my SUAD device with modifications:




Results: For the past couple weeks I have used only the SUAD device – No CPAP. I use an oximeter to check my O2 levels each night and consistently achieve 94 – 97% O2 levels. I continue to wear a fanny pack high on my back to prevent sleeping on my back (supine). I don’t wake up nearly as frequently I did with CPAP. I average 1 awakening per night with SUAD compared with 4-5 per night using CPAP. I am feeling like a normal person again. Finally!!

Conclusion: My experience has convinced me that many suffering with apnea due to tongue position can get better results by using a mechanical method to move the tongue out of the airway rather than using a somewhat uncontrolled swirling of pressurized air. I will continue to monitor my sleep with the oximeter and will report back if something changes in my results.

I had about a week of minor jaw soreness getting used to the SUAD device. Should there be any signs that my teeth or jaw is negatively affected by using the device I would then consider a surgical process called genioglossus advancement - moving the tongue forward with a type of strong line that loops around base muscle of the tongue and is pulled forward and tied to screw in lower jaw. Again, a more controlled, mechanical solution for moving the tongue forward to clear the airway.

I'm glad to read that this is working for you! That was an option presented to me as well, but I chose to use CPAP instead. I'm happy with my own decision.

I hope that you will continue to sleep with the oximeter throughout your life, to make sure that your sleep apnea hasn't advanced to the point that the mandibular device is no longer fully effective. Please let us know how it goes for you longer term. Sleep well!

Happy with your success. In designing the device, did you consult with doctors and dentists? How do you know that your apnea is due to tongue position and how to differentiate this with other causes of apneas? Is there a list of items that differentiate this type of apneas vs others?

Who manufactured the device for you?

I doubt that your experience is typical as you previously had uvula surgery.

The mandibular dental appliances do work on some mild sleep apnea cases and are recommended for some patients. However, CPAP is the GOLD standard for sleep apnea treatment.

Unless you have a financial interest in this device (SPAM), you should not be recommending an unproven non-medical device to people that need a medical device to provide life long and very important medical therapy.

I'm all for whatever works for each individual. Have you tried using your cpap with the device, with the machine set a few digits lower than your titrated pressure? Seems that would document the success of the device for you. Well, ok... for others.

Thanks for posting this information Thomas. I have tried a mandibular splint and found it quite effective. I use mine for flights, overnight stays and naps but would love to be able to use it in place of the cpap full time. Just need to find a doctor/dentist who can confirm that something like yours is likely to work for me, and then have it engineered. Unfortunately my sleep lab people are tied up with a cpap supplier and don't consider other options.

Many people on this forum can't see past cpap and you may not get too many positive responses here, but I for one would like to hear more on how you managed to come by it, and how it performs in the future.
Regards
KenD
bris
oz

cpapernewbie wrote: In designing the device, did you consult with doctors and dentists? How do you know that your apnea is due to tongue position and how to differentiate this with other causes of apneas? Is there a list of items that differentiate this type of apneas vs others?

Who manufactured the device for you?

I was fitted by a dentist in Atlanta. If you PM me I will give you contact info, The device I have is manufactured by SUAD. Google SUAD you can get more information from the manufacturer. There are other types of devices on the market which might also be effective but I only have personal experience with SUAD.

Just some of the causes of apnea are:

1. Obesity - too much weight in neck. Suffocate under your own weight during deep sleep phase.
2. low pallet - flesh in airway
3. tonsils/uvula blocking
4. tongue blocking airway
5. Central apnea - brain not sending signal to breath
6. Possible combinations of above

I had a tonsillectomy 8 years ago so that eliminated #3 for me. My ENT said my pallet looked normal. I weigh 185 lbs and only have 1 chin so no weight problem. When I lay on my back and completely relax my throat area I can actually feel my throat get blocked. When my lower jaw drops open the problem is even more pronounced. Here is another test. While breathing air in through your nose squeeze your nose. When I did this before treatment my tongue moved back into my airway almost like a vacuum-suction effect. When I use the dental appliance this does not happen. Since I began sleeping good again my sinuses are clearer and I breath much better through my nose. I'm not sure why this is the case but my guess is I am now much more relaxed, lower blood pressure, and this has reduced swelling in my nasal passages.


My purpose for posting this information is that:

1. I had to make modifications to the device to make it 100% effective for me. In my experience this device did not work until I prevented my mouth from dropping open. Maybe this information will help others struggling with dental appliances and about to give them up as not effective. I got help from many on CPAPtalk so maybe I can help others that have a similar cause of apnea.

2. YES --- CPAP is the gold standard for many. A friend of mine fits the profile of #1 above. Never had a meal that he did not supersize. He immediately took to CPAP with no problems at all. Sleeps like a baby. My belief is this is the least complicated form of apnea --- just inflate the balloon. However, if your jaw is set back, tongue in-the-way, the situation can be more complicated. This is not the sweet spot for CPAP treatment IMHO. I should mention there are also very overweight people on CPAP that began with tongue related apnea but put on much weight because of exhaustion and a screwed up metabolism because of sleep deprivation. Then they have combined apnea 1 and 4 from list above.

For some weeks I used CPAP + Dental appliance. I was able to reduce my pressure from 12 to 9 which definitely made life with CPAP easier for me. But I still had awakenings and fragmented sleep with CPAP. Measuring my O2 levels, I see no difference with CPAP + dental appliance vs. dental appliance alone. I continue to monitor my O2 levels. Now that my memory is returning I trust I can remember where I put my CPAP machine should I have to go that route in the future.