A Sleep Apnea Treatment I Can Live With
This post is long and has absolutely nothing to do with PR or marketing. Regardless, it is something that is extremely important to me and millions of other people. If you or someone you know suffers from Obstructive Sleep Apnea, you might find it worthwhile.
Obstructive sleep apnea (OSA) is a very bad thing. In fact, it is lethal. Since being diagnosed with sleep apnea a few years ago, I’ve tried a couple of different treatments. I’m pleased to say I’ve finally found one that I can live with (literally). Unfortunately, this treatment isn’t one the medical community seems to have embraced. Nor is it something that is regularly recommended or even frequently discussed by the sleep medicine community. Frankly, I think this is criminal. For those who would prefer to get straight to the punch line, the treatment is an oral appliance that I got from the good folks at the Sleep Medicine Network in Portland, Oregon. The device has changed – and most likely extended – my life. Suffice it to say that the folks at SMN have quickly become my new BFFs.
Obstructive sleep apnea occurs when a person’s breathing is interrupted during sleep due to a blockage of the airway usually caused when the soft tissue in the back of the neck collapses as the muscles relax during sleep. People with sleep apnea actually stop breathing, often for a minute or longer and as many as hundreds of times during a single night. When the airway closes and breathing stops, the body eventually recognizes a significant decrease in blood oxygen and the sleeper awakens to begin breathing again. The arousal from sleep only lasts a few seconds and the person is never really conscious of being awake, but awake they are. This makes it very difficult for them to get REM sleep, which means what little sleep they actually do get isn’t terribly rejuvenating.
All of this is extremely hard on the body and the mind. The frequent drops in oxygen levels trigger the release of stress hormones. These hormones raise the heart rate and increase the risk of high blood pressure, heart attack, diabetes, stroke, irregular heartbeat and heart failure. In fact, the overwhelming majority of those who suffer from these conditions have OSA. Sleeplessness can also be a major cause of depression. People who have any of these conditions or are overweight or snore profusely are taking an unnecessary risk with their health if they don’t get checked for OSA.
There are a lot of reasons people with OSA are never treated. First, many people who suffer from OSA don’t even know it. They aren’t conscious of waking up over and over again all night; they only know they are always tired. The National Sleep Foundation estimates 25% of adults in the US suffer from OSA, yet 85-90% of them go undiagnosed. Second, it isn’t something primary care physicians routinely discuss with patients that aren’t reporting symptoms.
The Medical Community – How Do They Sleep at Night?
The most commonly prescribed solutions to OSA are surgery or the use of a CPAP machine. Surgery is extremely painful and often fails to solve the problem. This leaves the CPAP, which provides positive air pressure to prevent the soft tissue from collapsing as the go-to treatment used by the sleep medicine community.
My experience with the CPAP was extremely unpleasant. It sucks wearing a mask strapped to your head all night. And because I require a lot of air pressure to keep my airway open, the mask would leak and blow a high volume of air all over my face and eyes that would wake me up repeatedly throughout the night. The mask required daily cleaning. It gave me zits. It dried out my mouth. It was cumbersome to travel with. The rare nights when it wasn’t leaking, it filled my stomach and bowels with air. This is extremely uncomfortable, though I did take some juvenile pleasure in the fact that I was able to produce belches and flatulence with a volume, tone and resonance that one cannot achieve naturally (my wife was not amused). Most nights, I ended up taking it off after about 3 hours.
CPAP set on full blast really blows
My CPAP difficulties were far from uncommon. According to the Journal of the American Medical Association, 20% of people who try CPAP reject it outright and fewer than 50% stick with it for more than 4 years. Unfortunately, most sleep medicine clinics don’t have much incentive to recommend other alternatives. In fact, I actually asked my sleep medicine doctor about the oral appliance and he said that, best case scenario, it would only allow someone built like me to use a lower CPAP pressure.
In some cases this is true. In others it isn’t. With the benefit of hindsight, going to a lower pressure would have still made the device worthwhile. I ultimately discovered that much of the common wisdom regarding who will and who won’t be helped by the oral appliance is flat out wrong. The truth is, most sleep medicine professionals don’t have enough experience with the device to know what they are talking about. What makes me upset is the underlying reason that so few sleep medicine doctors don’t know much about the devices and aren’t really motivated to experiment with them – profit. The fact is that sleep medicine clinics make a tidy profit off of the ridiculously overpriced CPAP equipment.
While a patient can buy the same equipment online for a fraction of what it costs at a sleep clinic, most of the time insurance won’t cover it unless you buy it from the healthcare provider. Furthermore, you need to frequently replace CPAP parts, so there is a lot of recurring revenue. It would be nice if this sort of nonsense wasn’t so prevalent in healthcare, but it is.
Getting Oral and Loving it.
The first time I heard about the oral appliance was from a friend with mild sleep apnea. It allowed her to get rid of the CPAP entirely. Since I was under the impression that it wouldn’t allow me to do the same, it wasn’t something I decided to pursue. Fortunately, it turns out I also grind my teeth when I sleep, and my dentist insisted I begin wearing a mouth guard. I decided that if I was going to have to have to sleep with something in my mouth anyhow, it might as well be something that helps with OSA. That’s when I was referred to the Sleep Medicine Network.
The oral appliance works by moving and holding the lower jaw in a forward position, which opens the airway. There is a reason why the first step in rescue breathing/CPR is to perform a jaw thrust and this is it. If you look at the video below, you’ll see the guy’s jaw move back before he starts choking. Keeping the jaw forward makes intuitive sense and it works. You can even try it for yourself. Simply bring your lower jaw as far toward the back of your throat as you can and make a snoring sound. It is easy to do. Now jut your lower jaw out as far as you can – it is a lot harder to make the same noise. That’s all there is to it.
Only sexy to a perverse few
My thinking is that this device should be the FIRST – not the last – treatment someone tries for sleep apnea. It might just solve the problem outright. Even if it doesn’t, it makes the CPAP experience a lot more tolerable. It also gives you a much better option for traveling. And, let’s face it, few chicks dig the way a CPAP looks.
Where to Go for Treatment
Another important decision is where to get the oral appliance. Since the device itself involves the teeth and jaw, it falls under the domain of the dentist. However, since OSA is a very serious medical condition, sleep apnea treatment and management is something a medical professional should oversee. The key is to find a provider who offers both. Insurance companies look at it the same way. Devices are not covered unless medical supervision is part of the solution. It goes without saying that the do-it-yourself devices advertised on TV are completely unacceptable. I understand they also don’t work.
In summary, OSA, if left untreated WILL contribute to medical issues and an untimely death. Finding the right treatment is important and, for my money, there is nothing better than the oral appliance.
I suffer from apnea and tried different treatments with no luck. I will ask my doctor about the oral appliance, I hope it helps. Thanks
I have sleep apnea, too. I have learned to get used to the CPAP and figure out ways to make it work for me. What irritates me is that I saw a doctor, whose brother just happens to be a dentist. Without knowing anything about me or my particular health issues, he advised me that I would be better off with an oral device. So who’s trying to make money here? The doc trying to give me a dental referral brochure so his brother could benefit, that’s who.
Sounds like you need a different doctor. Dentists alone aren’t suitable to provide ongoing sleep apnea treatment. Treatment should be a collaboration between dentists and sleep health care professionals. Lots of people have found a way to make CPAP work. I like my oral appliance much more than my CPAP and could not imagine going back.
Dean, I’m happy that you’ve found a solution that works for you. I think the ability to get effective treatment from such a device depends on one’s anatomy. Also, it’s not clear that compliance is any greater than with CPAP, and it might be worse: http://www.sleepguide.com/forum/topics/oral-appliances-compliance/
It definitely doesn’t work for everyone. However, the anatomy argument is one I question. My initial sleep medicine guy told me that the oral appliance would absolutely NOT work based on my size/weight. He was dead wrong. I suspect the oral appliance stats about compliance are badly flawed due to the facts that:
1) The sleep medicine community so often goes straight to CPAP so a very small percentage of people actually try oral appliances
2) Many dentists who set patients up with the devices don’t really understand sleep apnea/sleep apnea treatment. They just set up a device and leave the patients to themselves.
3) The “boil and bite” appliances — which don’t work — are thrown into the mix.
The place that did my appliance is a genuine sleep medicine place that has dentists and sleep medicine professionals. They tell me that the oral appliance doesn’t solve the problem for everyone (but it does let virtually everyone at least switch to a lower pressure — wich can be a huge benefit in and of itself for those who have their CPAPs cranked all the way up.
I could not tolerate my CPAP (which was set to 20). It leaked, was uncomfortable, gave me zits, etc., etc., etc. The oral appliance is 100X more comfortable for me. YMMV.
This looks very interesting, I have to look into it. Thanks!
I have had the same experience as you, the first and only solution is often CPAP. Good to see you found some kind of solution. You probably know of the online sleep apnea forums etc but its worth listing a few for anyone that comes across this site (like me!)
http://www.apneasupport.org/index.php
How does this help your sleep apnea? I am interested in this as I know I grind my teeth at night. Since the CPAP machines force air down your nose or throat so I understand, (I don’t have one but DH does) how can this be as effective? Please let me know. Thank you so much
Elizabeth
I read your article over again, and tried moving my bottom jaw and snoring. It isn’t the exact snoring sound, but it is no problem for me to make a snoring sound, regardless of how my jaw is. Please let me know though, as I am supposed to wear a dental guard as I grind my teeth, and my DH told me I stopped breathing in my sleep a few years ago. My DH can’t tell if I do now, as he wears a CPAP every night. Since I have nasal polyps, I would have to get something for my mouth, and I am nervous about a CPAP for my mouth, as I can’t breath through my nose anyways. Thank you Elizabeth
Elizabeth,
It helps sleep apnea by opening your airway. It also serves as a dental guard (this is why I got mine in the first place). It might or might not completely solve your sleep apnea completely. Some need to use this in conjunction with a CPAP. In this case, it dramatically reduces the pressure you need to make your CPAP work, which is huge.
Dean,
Thank you for sharing your story. It gives me hope to know that an oral appliance can solve some people’s sleep apnea. I am in the process of getting an oral appliance made. I’m just waiting on my insurance to pay for it.
CPAP helped me for a little while, but I started getting really tired again so my doctor changed the pressure to a much higher setting & I’m having the same troubles you did with CPAP: too much air, its too loud, the mask leaks, etc.
I can’t wait to get the oral appliance & try it out.
Just wondering: Do you have any jaw pain in the morning after wearing the oral appliance? Also, did it take a while for you to get used to wearing it, or was it comfortable right away? Did you have to keep getting it adjusted? Any info is greatly appreciated.
Thanks,
Jason
Jason,
It depends on the device. Mine is adjustable. You turn a screw and it pushes your jaw out a little farther. The only time I had jaw pain was if I adjusted too far out too fast. Also, you have to make sure you can get your jaw back in its normal position during the day. Mine just goes back naturally, but some people need to do some simple exercises.
Good luck with your device!
I went from a SEVERE apnea index of 66/per hour to less than 3 obstructions per hour wearing my new oral appliance! I just did the sleep study last night and I am ecstatic and wanting to share this news with anyone who will listen! I am in a state of shock. Figured it was only going to lessen my apnea…but WOW…it totally eliminated it! I guess you just have to try it. Everyone is different….don’t be put off by the status quo literature.
Oh…and Jason….my Jaw doesn’t seem to be stiff at all. I was perfectly fine wearing by the second night! It has been a total of 2 weeks now and the only negative I find is I sometimes “drool” lol…. but I can live with that!
Right on! Great news, Diane.
Thanks Dean….and quoting YOUR spot-on wisdom regarding this subject:
***”My thinking is that this device should be the FIRST – not the last – treatment someone tries for sleep apnea. It might just solve the problem outright.”***
BTW…what was your Apnea Score prior to the appliance?
I forget exactly, but it was either in the high 30s or low 40s in terms of events per hour. With my device, it is down to seven. I now also have a modified mask that incorporates the mouth piece. I use it with an HPAP set to a very, very low pressure. That will get me down to 1 or 0 per hour. However, it is kind of a hassle to put on and I usually just go with the mouth piece.
Where did you get your appliance? Was it a sleep medicine place or a dentist?
LOL “both” I got my appliance from a dentist working with a sleep center here in Cleveland. I didn’t really fit the criteria for severe apnea.(?) My weight isn’t that bad…maybe 35-40 lbs extra. They said my palette is narrow and my tongue is large! But, hey, whatever the reason…the appliance did the trick! I hope your blog will reach a lot more people. Especially those non-compliant their w/cpaps.
Thank You so much for your efforts….keep it up!
Dean,
I can’t tell you how helpful this has been. I’ve had two sleep studies done and have been diagnosed with mild to moderate sleep apnea. I hated the cpap machines they used on me and I couldn’t understand why they had such a “bent” toward cpap machines and against oral appliances. I said to my husband that I bet they get a kickback of some sort.
Anyway, I have an appointment with a dentist who specializes in oral appliances for sleep apnea on the 12th of November. I am praying I am a good candidate for it and it helps me. Please pray for me too Dean and thanks so much for all the great information.
Jill
DEAN! I just got my written Doctor’s evaluation of my latest sleep study. (when I posted above, it was an “unofficial” guestimate of the technician)
THE REAL RESULTS ARE TOTAL ELIMINATION OF MY APNEA!
Previous: Sleep Study 11/16/08 = AHI 66.2/hr
Current: Sleep Study 10/22/09 = AHI 0.0/hr with ORAL APPLIANCE!!!
JILL…..you go girl…and good luck with it….hope you have fantastic results as well!
This is life altering…..I am already feeling so much more energized and my house is looking a lot Cleaner! LOL
Sleep Study Results, Impression (using Oral Appliance)
As compared to the baseline sleep study, there appears to be an excellent resolution of sleep apnea. Also, there appears to be a significant improvement in Snoring.
Recommendations: continuation of oral-airway dilator device for sleep apnea, advised to follow-up with her dentist to ensure that orthodontic device is not resulting in TMJ or other complications. Follow Up in 4 months at sleep clinic.
Thanks for all your great insights and sharing experience. Does anyone know the procedure to effectively convince Uniform insurance that this will be worth trying? Do I get it from my dentist then do a complaint when it gets rejected? Or try to get insurance coverage first? Or how? I have lived with sleep apnea & cpap for many years and have developed reflux. This summer I was required to be off cpap for 2 months & the reflux went away completely! Now I’m getting headaches again & know the apnea is affecting me, but I refuse to go back to cpap. I am not overweight, it runs in my family. All suggestions for dealing w insurance appreciated.
My understanding is that this does need to be done through medical insurance — basically that they need you to be under the care of a sleep medicine doctor. Obviously, dentists are part of the equation. This is why the place I go has both on staff. If I get any more insight, I’ll shoot you an email.
Hey Diane,
That is awesome. I’m so glad to hear it worked out for you. I’d say life altering is an overall positive thing!
Kate…. They ARE covered under Medical Insurance and your doctor should know the proper codes to bill for reimbursement and/or for you to check first with your insurance for your covered amounts and copays.
Thanks Dean… and BTW, today I had my followup in tandem with my Sleep Doctor and my Sleep Dentist. The sleep doctor has never seen such amazing results, however, my sleep Dentist has seen and heard of such results…when the apnea is a direct result of the tongue being the main cause of one’s apnea. If you have multiple factors, such as tonsils, tongue, adenoids etc… then you may not have such dramatic results. YOU WILL if your tongue is your main enemy….as was mine!
Greetings. My index is severe at 56 apneic events/ hr. I have had most all of the typical surgeries, tonsils, uvula, septums, even a tracheotomy. Surgery will help temp. at best and like me, most will all regress back to where they were regarding OSA. Auto adjusting CPAP has been tried several times and is not an option for me. So I find myself here looking at what oral device seems to work best.
First I would like to address Kate’s question and then I have a question of my own for Dean, however he may have only used just the one oral device, and may not be able to help me, not sure. Kate, your insurance should absolutely cover the appliance as it is covered under “durable medical equipment.” You do not need to go to a DR’s office or even be reffered, but some offices do work that way. I have found offices all over town where I live and they all will accept my insurance, all out of network and I did not need to be reffered by anyone. No MD can prescribe this device based on how it is regulated by the FDA. They can write a letter of medical neccessity and some insurance companies will want that. You have to obtain the device by a dentist at some point, either directly or through a sleep center, but you will end up at a dentist not a dr in the end.
There is a website I used to find a DDS locally, called ihatecpap.com. They refferred one DDS. I than used google and typed oral appliances for obstructive sleep apnea (your city) and found a few others. Call them all and ask if they will give you a free consult, most will. What you will need for your insurance company is the providers TAX ID # and their billing address. Once you obtain all of the relative CPT codes, your insurance will be able to tell you exactly what they will cover usual and customary. Mine pays 50% out of network. I have not been able to find any in network facility, too bad, 100% paid in network. I can give you the code for the Tap appliance which may be the same code for all oral OSA devices, not sure. The code is
” E0486 ” according to one of the providers I spoke with today. Most places charge 1200-$1800 for just the appliance, not including exam and testing which can total the bill to 2000-$3000. The place I went to today wanted $1200 for half of the total charges to start the molding process.
I am holding off to research which appliance is better. They wanted me to use the SUAD device which is adjustable and allows you to open your mouth for comfort. It prevents the tongue from falling back like most. When opening it keeps the jaw forward like others. It has a metal frame covered with a clear polymer molded to the teeth.
Dean, I was hoping you could tell me if you have tried other devices. I think you use the tap with the adjuster screw. The SUAD has metal spacers that are replaceable to give a total of 10 mm in forward movement. It has these metal struts on each side keeping the jaw forward and rubber bands keeping it closed. I read some people complaining about it on other sites and I have read people complaining they can not use the tap because it pushes their tongue to hard into the adjuster area. Stating it is hard to tolerate. I understand one can not open their mouth with the tap as well. I was hoping you or anyone else that has tried others as there are many, can give some input. The other model they had was the SomnoMed Mas.
Hopefully, others will share what they have learned so future patients will have an easier time adjusting and making the right decision for themselves. Never, Never have the surgeries. They will only hurt you in the long run. I do agree that even without trying the oral appliance yet, it has to be the first step for tolerating OSA.
Appliance CPT code E0486 1200-$1800
Exam 99205 $175
Pharyngometry 92520 $75
Lateral Cervical 72040 $75
Panorex 73055 not covered $75
My insurance covers all of the others under usual and customary, prices are based on one provider’s billing.
Scott,
Yes, I did try the TAP. It is adjustable and it was good to be able to play around with different settings (you need to work your way up to moving your jaw farther and farther out and you definitely know when you reach the most extreme adjustment). The tap did work. That said, it regularly comes out of adjustment, so you need to keep an eye on it. A small price to pay for something that helpful, but I think a different brand might work better. I’m going to test a Boyd next. It is fixed, but my guys already know where my jaw needs to be based on my experience with the TAP.
Thanks Dean. Do you use the TAP 3 or the older Tap 2?
I saw another DDS today. This guy is closing shop(normal DDS services) and focusing only on the oral appliances. He still believes the TAP 3 is the best of them. There is such a huge mark up. The lab cost is about 400, so at 2200 that he wanted, take 200 out for exam and 50 for incidentals on his part, that is a quick 1550 profit. At that rate, it won’t be long before all the dentists are doing it which would hopefully help it to be covered like a typical in network visit, 80/20.
His reasons for selecting the TAP 3 were that it eliminated the large hook on the TAP 2, and uses a smaller locking device allowing it to be more tolerated. Another change was the softer acrylic on the inside vs the harder on previous models. When I stated the problem with mouth breathing and it not being able to open, he said your lips do not always seal and air can get through. Not so sure about that. It looked really small so I would think your lips would seal closed.
He also stated he liked it better due to the easy and symetrical adjustment being at the front. One place to adjust, not two. No chance for one side to be out of whack like devices that only adjust on each side. Do you agree with all of his statements?
He did say the SUAD was a great one but some would get there cheek pinched on the inside, and adjusting it was more time consuming. It is the only one with a 2 yr limited warranty. The other DDS I went to said this(SUAD) was better for Bruxism(grinding) and he said the TAP was better he thought because most of the teeth can not touch top and bottom, but only in front at the connection. Again, any thoughts on grinding with your TAP?
He said the Somnomed Mas was good also, but not for grinders, or mouth breathers due to the further your mouth opens, the device comes disconnected which then loses the forward pressure on the lower jaw. After looking at it, you would really have to open wide for that to happen, not likely while sleeping, just my opinion.
Thanks again.
Below I am enclosing an aricle I just read that was rather interesting. Resmed is jumping into the oral appliance business partnering with Somnomed.
SomnoMed welcomes ResMed’s entry into the oral appliance market
6th October 2009, Sydney: SomnoMed Limited (ASX: SOM).
ResMed Inc. SVP Michael Farrell, global head of ResMed’s Sleep Business Unit, announced on 1 October
2009, jointly with ResMed’s European head office, that it had acquired the French dental company
Laboratoires Narval (“Narval”) in Lyon. Narval is the maker of oral appliances for the treatment of sleep
disordered breathing and sells its products principally in France.
ResMed stated in its announcement that it would offer the Narval MAS (mandibular advancement splint) as
an alternative treatment to patients who are rejecting the use of CPAP (Continuous Positive Airway
Pressure) or are non compliant in the regular nightly use of CPAP machines. ResMed advised that it would
initially concentrate on marketing the Narval device in its core market, France and in the medium term
expand into other European markets.
SomnoMed Limited Chairman Dr. Peter Neustadt commented on the acquisition, “We welcome ResMed,
the second largest maker of CPAP machines in the world, into the dental sleep medicine market. For the
last five years SomnoMed has diligently built a position as the global leader in dental sleep medicine, often
encountering skepticism and confronting arguments against the use of oral appliances to treat sleep
disordered breathing. We see ResMed’s acquisition of Laboratoires Narval as a very important, further
confirmation that oral appliance treatment has been fully recognised, is here to stay and is bound to occupy
an important position in the treatment of SDB patients, in particular for the many patients who cannot or will
not use CPAP machines.”
Ralf Barschow, CEO of SomnoMed said, “The acquisition of Laboratoires Narval by ResMed is very positive
news for SomnoMed. We are expecting that ResMed’s endorsement of oral appliance therapy will
accelerate the growth in dental sleep medicine worldwide. It will, without doubt, raise the awareness that
oral appliances are an excellent alternative therapy for sleep disordered breathing, in fact that for many
patients it should be the first line treatment. We are hoping that ResMed will join SomnoMed’s global efforts
in education and research, especially through our recently founded SomnoMed Academy.”
The Somnodent® MAS device is the most researched, clinically proven and patented dental device to treat
sleep disordered breathing, in particular obstructive sleep apnea, in the world. Over the last few years the
company has built production capabilities in 12 laboratories around the world and is successfully marketing
the device in over twenty countries.”
It is the older one. I’ll let you know how the replacement works.
Scott,
I have a completely fixed oral appliance made of a soft material. I will call tomorrow to see what the name of it is. My dentist said most patients really don’t need extreme extending of the lower jaw. Just a slight extension and the fixating of the tongue is all that is required. He takes the maximum extension the patient can go, then makes the mouth piece at 50% of that number. Why suffer unnecessary discomfort and possible problems with TMJ symptoms if your apnea is resolved at this point, then, there is no reason to extend further. If not, he would make an adjustment and find that perfect point for you. My upper appliance covers all the teeth and also semi extends into the gum area. This reduces the strain on the teeth and distributes the pressure over a greater area,(simple physics) thus lowering my risk for any disruption (movement) of my teeth. I really like my smile…and this was a concern. The lower appliance is a hard acrylic “retainer” type mouthpiece (think ex-orthodontics), which also totally protects from any teeth shifting.
The two pieces, when placed together, will keep a distinct space between the upper and lower jaw. This is because studies have shown, the majority of apnea sufferers, also clench their teeth at night or experience some level of bruxism. (it also helps for breathing easier)
The hard materials found in some mouthpieces, he stated need to be placed each night in hot water to soften slightly before placing in ones mouth. They also tend to be less comfortable and have more breakage issues.
He honestly said, there are at least 45 different options out there and new ones on the horizon. It is a for profit, money generating market…so buyer beware!
Dean….if you wish, I could email you a photo of my appliance, so you can upload it on the site as a comparison option. I will definitely get the name of it as well. (the Dentist only comes to the sleep ctr on Tuesdays)
Oh….and Scott, if you read above:
You will find my apnea index “was” a severe 66.2 per hour…and now wearing my appliance it is a MIRACULOUS 0.00 per hour! I am only 50% extended and it has eliminated my apnea!
I wake very comfortable without any jaw discomfort or pressure on my teeth that a more extreme extension might render.
It really comes down to “where” is the point at which your tongue is tethered and stabilized. LOL
Diane,
That is simply incredible that you are at zero now. I do agree with you 100% regarding the range of lower movement. I am just having trouble deciding which to go with. I have spoken with several dentists and they each recommended a different one. The SUAD, Tap 3, and the Somnomed are the three I was told to use. The SUAD and Somnomed allow you to open a small margine, the TAP 3 does not.
I guess I am just trying to hit a homerun first time at bat and not mess with trying different appliances along with the increasing expense. I think I am going to move forward with the SUAD. The dentist office seems very pleasant and helpful. I also think getting in for any adjustments will be easier with this office as well.
Diane, were you able to tell a difference right away such as the first morning regarding energy, mood, and fatigue or did it take awhile to achieve your result.
Diane,
Thanks for your words of encouragement. I was extremely impressed with the doctor I saw and my appliance is on its way! Well, in three weeks. I wanted to ask you, my disorder is not caused by my tongue as much as my having a long neck and consequently, my airway collapes easier. Do you think the appliance will still work for me?
Thanks,
Jill
Scott & Jill,
First my apologies for such a late reply. The holidays kept me busy with out of town guests.
Well Scott you sound like me when I want to purchase something. I over analyze and try to cover all the bases, but with these appliances, it will really come down to a test drive! lol! If you are happy with your dentist and you seem to work well with him….then that is a great starting point. As for being able to tell the difference using MY appliance….it is funny, the first most remarkable notice was that I was DREAMING SO MUCH! Then, I was able to accomplish more by the end of the day, my mood improved and so did the color in my face! I still felt a bit tired, but I was seeing changes! Now, I am almost at my 2 month point wearing the appliance. My headaches have greatly improved! My stamina has doubled….. I am so very happy! This HAS really made a difference. Deep down, knowing that I have eliminated such a looming risk to my health is such a blessing.
Now JILL….as for your question, I really don’t know. That remains to be seen. But if your doctor has ordered an appliance for you, he must have a sense that you could benefit from it. I sure hope so. You must do an overnight sleep study using your new appliance for your results to be confirmed.
Hope to hear from both of you that your appliances render wonderful results! Keep us posted!
I recently got a tap 3 too. It is so much better than cpap. Any thoughts though about how to stop drooling? It’s crazymaking. Ps. I live in pdx also.
I have moderate OSA and just picked up my TAP 3 from the dentist today. I think I have had sleep apnea for a long time, but nobody would ever listen to me since I’m a female in my 30′s and about 130 pounds. It’s been a long road to this point as I’ve been living with a year of chronic pain from a minor car accident and all my Dr’s are now hoping that solving my OSA will help me heal an relieve my pain (headaches, dizziness, neck pain). I tried the CPAP but could not sleep at all with it on. I tried 2 different masks and became even more exhausted because I would try it for 2 hours each nigh then give up. I also have TMJ problems that my dentist is trying to fix so when I tried on the TAP today it made my jaw quite uncomfortable. She says that will get better and to wait until I’m comforatable before advancing it. I’ve been wearing a night guard for many many years so I’m used to sleeping with something in my mouth. Having them locked together will be a new experience though. How am I supposed to talk in my sleep now…LOL. I’m trying not to get too excited in case it doesn’t work…since I’m not sure what else to try after this. This blog give me some hope. I’m really happy for those of you who have had success!
It is very important you advance slowly. If there is pain, stop for sure. Also, make sure you do the exercises that put your jaw back where it is supposed to go during the day (bite on those little pieces of rubber that come with the appliance.
Have had my TAP 3 for about 3 weeks now. Have had CPAP for almost 3 yrs and was taking it off at night, averaging 3 hrs / night. Am taking it back 7 full turns which is a bit more than 1/2 way. Have not had the home slp study yet but will be scheduling. Have BC/BS but they would NOT agree to pay for DDS or DMD to fit. Had to find a Otolyrongologist (sp?) to fit who was in Network. Had to give BC the treatment codes and it was approved with no preauth. Dr charges $1500 and BC will probably get them to reduce to $1000 and they pay 50%. Actually have looked forward to wearing it and have not taken it out at night yet. Have bruxism but dr said TAP would provide cure for both. DDS is very proficient and a partner with my sleep dr but BC did NOT care.
Sleep apnea is one of the worst things to have.
Hi, I first wrote here 11/09. Thanks for all posts. I sent for a snoremenders.com oral appliance. It came to Washington State from the UK in a couple weeks. I’m using it every night and feel much better. The best part is the stress reduction! My bed partner is finally sleeping again through the night & no longer complaining about my snoring or cpap blowing all night.
It gets washed every morning & regains shape in hot water, should last 9 months. It has saved me! How can I get a sleep study to check apneas now? I know I’m much improved, no daytime symptoms. Hooray!
Hello, I have TMJ with deterioration that is bad on one side and I have moderate Apnea….does anyone know a dentist/physician that is very knowledgeable in both, I’m finding it quite easy to find someone knowledgeable in one or the other but not both…please help, I live in Washington State and am willing to go to Oregon and Idaho if need be.
For sure it is never easy, sleep apnea, my son has it and I used to suffered also. The bad news: we live in a very small town in Australia, and we don’t really have any sleep clinic here like in Europe and the USA.
I think the oral appliance is also supposed to help with TMJ.
Obstructive Sleep Apnea – For people like you who live in a small town there are mail order options for mouthpieces. Puresleep here in the US has an FDA approved mouthpiece that they have been selling for over 10 years by mail.
Just wanted to chime in for posterity. I got fitted with a SUAD device around October 2009. It took a while to get used to it (to some extent, I’m still getting used to it). I had relatively mild apnea but still enough that it was waking me up every hour or two, often strangling on my tongue, and was near-impossible to get any sleep on my back (and due to a cervical disc issue, I cannot sleep comfortably on my side either).
I had seen the oral appliances on the internet, but every doctor I went to pooh-poohed the idea (“those don’t really work” or “it’ll permanently change your bite”). I was prescribed CPAP (like everyone else), but could not tolerate it: I describe it as being like having a squirrel clinging to your face all night long. I also confirm the other comments above (air flow waking me up, zits, etc.). After many weeks and several masks, I gave up on CPAP.
One ENT proposed a very significant nasal/sinal surgery: turbinectomy, repair of deviated septum, etc. Another ENT wanted to perform a “suspension suture” (basically they put a string through the back of your tongue, attaching it into the jaw bone so that your tongue cannot fall back into your throat). I was worried about outcome as well as side-effects of these surgeries. Since my apnea was mild, I survived for a couple more years with only a chin strap (which helped a little with keeping my tongue from falling back).
Finally, one day, I decided to take the plunge, did a web search for a dentist that offered the oral appliances, found one nearby, called for an appointment. The dentist I found does nothing but apnea appliances; she doesn’t fill cavities or anything like that.
I already had a bite guard for bruxism (clenching or grinding). She chose the SUAD for me, saying that — in her experience — it stands up to the punishment better than other types. She saw me several times over the first few weeks to start me with it “gently” and then adjust it.
I already had some mild but persistent jaw pain from the clenching when I started (and was already using a bite guard which I hated). For a few weeks, the jaw pain got a bit worse. Over time, though, it improved significantly. My own belief is that moving the jaw forward at night, then moving it back in the day time has eventually gotten it more used to moving, increased its range of motion, and eventually led to the jaw muscles relaxing. (There is a second rubber mouth piece you get that you use every morning to move your jaw back into position.)
I can’t say I “love” the way it feels. Even though it fits like a glove, it feels big and bulky when I first put it on. However, I am able to get to sleep and now I sleep for at least five or six hours at a time. Sleep is a lot more refreshing too; I never wake up choking. I had some issues with it abrading the inside of my cheek in the first few weeks. The dentist gave me some wax to cover the “sharp” spots and eventually I quit noticing it (and quit needing the wax). Using the morning piece to get the jaw back in position is not bad at all, it actually feels good.
My dentitst is a member of the American Academy of Dental Sleep Medicine. (I did not know about that until after I first visited her.) They have a web site with a “find a dentist” link at http://www.aadsm.org/
If you’re in the east Atlanta / Decatur area, I also highly recommend my own dentist, Dr. Sheri Katz.
Jeff
Unfortunately, the mail order options aren’t even sort of the same and may/may not solve the problem.
Diane,
What is the name of your oral device?
Barbara
Could someone please tell me if my lips are supposed to be stretched to the max when I have the sleep apnea appliance in my mouth? I can’t keep it in for more than 15 minutes because my lips burn and tingle so bad then feel like they have been severly chapped for days. I also somehow manage to bite the inside of one cheek and it is a ragged mess. I have tried to find some pictures of someone with the appliance in their mouth and I can’t find one. My dentist is out of town for two weeks and I am supposed to be wearing this while he is gone, and adjusting to it. No way! I have an OASYS (Oral.Nasal Airway System) Thanks to anyone who can help me out.