Are Sleep Apnea oral appliances & sleep apnea mouth pieces underrated?

[Dawnstar]

I think the answer is that effective devices are painful, in that they require misalignment of the jaw, with substantial pressure on the teeth. Putting a mask over a jaw that is already in pain seems like a presciption for more pain.

[ardenum]

I think the answer is that effective devices are painful, in that they require misalignment of the jaw, with substantial pressure on the teeth. Putting a mask over a jaw that is already in pain seems like a presciption for more pain.

Wrong. You lot just have had improperly made devices. I've been using Both cpap and a protrusion device for over 3 years and I never had any pain. Gotta remember, if there are quacks that treat sleep apnea that know nothing of it, there must be bad dentists too.
A properly made device would never misalign anything, it would keep the teeth aligned while providing apnea support.

[Dawnstar]

My device was made by an endodontist, who specializes in making such things, and is presumably certified at doing so.

[Marillion]

I think the answer is that effective devices are painful, in that they require misalignment of the jaw, with substantial pressure on the teeth. Putting a mask over a jaw that is already in pain seems like a presciption for more pain.

Wrong. You lot just have had improperly made devices. I've been using Both cpap and a protrusion device for over 3 years and I never had any pain. Gotta remember, if there are quacks that treat sleep apnea that know nothing of it, there must be bad dentists too.
A properly made device would never misalign anything, it would keep the teeth aligned while providing apnea support.

I think you are quite wrong to assume that.  Simply by the way it works, these devices WILL change the alignment of your jaw and teeth over time.  It is exerting pressure on your jaw and teeth to try to open up a larger space in your throat! You may become used to that change in alignment over time, but that doesn't change the fact that your teeth and jaw alignment does change.  Whether that becomes a problem in the short or long term can vary for some individuals.  If you look up information about them you will quickly come to realize that for many people it does become a serious problem over time with many cases of TMJ disorder being reported after extensive use.

What I don't understand is that if someone is already using a CPAP or such machine to treat their sleep apnea...why on earth would you also use an oral device??  It seems completely unnecessary to me and you are introducing an element of risk that is simply not needed to treat your apnea.  But to each their own I guess. 

[ardenum]

What I don't understand is that if someone is already using a CPAP or such machine to treat their sleep apnea...why on earth would you also use an oral device??  It seems completely unnecessary to me and you are introducing an element of risk that is simply not needed to treat your apnea. 

Cpap and a mouthpiece work differently. Pressure from the cpap isnt enough to move the jaw forward and open the airway, thats pretty easy to understand. Also It's not enough when your tongue collapses. Both are complimentary to each other. In my case my throat muscles relax, my tongue and jaw collapse to the back, just the pressure puts me into 20's AHI, with the mouthpiece below 5, Best results I get under 1 with a tongue retaining/jaw forward device combo.

Where the risk?

[Sleeprider]

I wonder how many expensive mouth pieces or MADs could be replaced or improved upon by using a $15 soft cervical collar? Nearly all ofmthenobstru took targeted by MADs is the same stuff (chin tucking) we address with a collar or wedge.

[ardenum]

I wonder how many expensive mouth pieces or MADs could be replaced or improved upon by using a $15 soft cervical collar?  Nearly all ofmthenobstru took targeted by MADs is the same stuff (chin tucking) we address with a collar or wedge.

I guess if your spine is fine, then a soft collar is perfect. Ive got some instabilities in my cervical part and suprisingly a soft collar causes considerable pain if I wear it, as in worse then a tooth pain or kidney stone pain.

[BC3B]

The best software to look at your data is SleepyHead there is a download link in my signature  you need to ensure there is an SD card in your machine when you sleep with it otherwise data is missing. If there was not  a SD card supplied get the cheapest one you can from wallmart or similar any size from 2Gb to 32Gb will do the job.

My Machine is supposed to be uploading the data to DME..  Is there not a way to utilize this data?  Why would that data not be the best source to analyze if so?  Are there not programs that interface and interact with this data upload on my behalf?  Do I get access to the final product which my DME is getting from my machine?  

I have not yet addressed with them...  I just remember them giving me the "option" no to turn it on.  But at the same time upselling it as "They only see it and that I could too if I wanted"...

???

[Marillion]

What I don't understand is that if someone is already using a CPAP or such machine to treat their sleep apnea...why on earth would you also use an oral device??  It seems completely unnecessary to me and you are introducing an element of risk that is simply not needed to treat your apnea. 

Cpap and a mouthpiece work differently. Pressure from the cpap isnt enough to move the jaw forward and open the airway, thats pretty easy to understand. Also It's not enough when your tongue collapses. Both are complimentary to each other. In my case my throat muscles relax, my tongue and jaw collapse to the back, just the pressure puts me into 20's AHI, with the mouthpiece below 5, Best results I get under 1 with a tongue retaining/jaw forward device combo.

Where the risk?

Let me explain a different way...  If your CPAP is adjusted properly, you do NOT need to move your jaw forward or put pressure on your teeth.  Like I said earlier, the mouthpiece is redundant and unnecessary IF and only if the settings on your CPAP or APAP are set up properly and you have the correct type of machine.  If your CPAP is not set up properly or you have the wrong type of machine for your needs, you will get AHI numbers in the 20 range.  

If you want us to look at your CPAP results and make suggestions please download Sleepyhead and post your data in a new thread.  My original sleep test resulted in an AHI of around 45.  I average .2 to .4 now and just the other night for the first time I received a 0, using the same machine you are.  It took a few changes to the settings over a period of time with some time spent acclimatizing to each setting to achieve this.

As to where the risk is using mouthpiece devices...  Please re-read my last post.  Changing your jaw alignment and bite lines are rarely without consequences.  You may or may not be affected in the long term.  I choose not to take that risk and I think I have said all that I wish to on the matter.

[willo]

Given how poor CPAP compliance is, though, for the patients who need them, I do think we need more and better options for treatment...

We do have more, but we don't have better.

Research has been done to show the effectiveness of an oral appliance. Yes, you can wear one during a sleep study, or you could even wear one while using a CPAP machine. You could set the pressure at 4 cm (the lowest possible setting) and see how many apneas you experience.

Likewise, research has been done to show the effectiveness of CPAP therapy.

The results show CPAP to be more effective.

I think some researchers have concluded that, given how many people are failed by CPAP therapy (can’t tolerate it), the real world effectiveness may be inverted, in spite of using CPAP being more effective than using oral devices (or throat exercises, etc.) I saw a scholarly paper proposing this theory recently, but don’t have the link at hand.

I want to be clear: I’m a new CPAP user. I am working hard to be compliant. A few weeks in, I am in compliance with almost 100% nightly usage and >4 hours per night on all but one night of use. 

I’m delighted that there are people who are fully treated using CPAP. I just don’t think CPAP as it is today is sufficient to treat the full body of patients who require it at this time.

As an engineer, IMHO, any system that results in a high percentage of users failing to get what they want/need is a system that wants improvement! (46-83% failure to adhere, according to https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2645251/)

For myself, the lifestyle impacts are huge, and the results of my treatment are subtle thus far. I’m in compliance, and I plan to remain so, but I’m finding it harder, not easier, to keep using the machine as I go along because it is making my life subjectively worse in spite of making my “breathing during sleep” objectively better. 

(My personal list: I can’t hear my asthmatic child breathe at night over my CPAP; I’ve lost intimacy with my partner; my partner is bothered by the white noise that I need to cover the sound of the CPAP which bothers me; my skin is irritated and causing me pain; caring for the machine parts is onerous; travel, my favorite hobby, will be negatively impacted by lugging the machine...)

I’m not knocking CPAP. I think anyone prescribed it should give it their best efforts. I want desperately to live a healthy life and stick around for my kids and family. HOWEVER, I’m eagerly following every alternative treatment available and being suggested for the future in research. That’s what interested me in this thread.

My treatment experience will be uniquely mine, as is true for every patient. Those who aren’t currently having their apnea resolved by CPAP need and deserve better options for them.

Respectfully,
—willo