Breathing with Provent Combination Therapy

[PTKen]

Hello. I am new to this forum, so I will give a little background about my situation first. I have severe obstructive sleep apnea. My AHI without treatment is 51. I have a CPAP machine, but I just can't use it. I've tried long and hard, but finally gave up.

Recently I went to my doctor to get a prescription and try Provent. It worked beyond my expectation, reducing my AHI to 13!!! While that is a vast improvement, I still have mild sleep apnea when using Provent and I spend about 4% of the night with oxygen saturation below 90%. So my doctor recommended I try combination therapy with Provent and an oral appliance.

I just got fitted for my oral appliance last week and have been trying to use it for the past five nights. This, finally, brings me to my question/problem:

I can't breathe! The trick to falling asleep with the Provent is to breathe through my mouth while falling asleep, then once I fall asleep I naturally close my mouth and breath through my nose. The oral appliance makes that nearly impossible. I tried sleeping with just the oral appliance and the trick seems to be to keep my mouth closed and breathe through my nose as I fall asleep. If I keep my mouth open, there is so much saliva generated that I'm basically swimming, not to mention it's just awkward and uncomfortable.

It doesn't take a genius to see that there is an problem here! Does anyone else use the combination of Provent and oral appliance? How do you manage breathing while falling asleep? Does anyone else have any suggestions? I'm feeling much better since starting with Provent, but I'd like to find a full treatment for my apnea.

Thanks in advance for any suggestions!

Ken

[trish6hundred]

Hi PTKen,
WELCOME! to the forum.!
I'm sorry you had such a rough time with CPAP but unfortunately, that is the best way right now to treat sleep apnea.
From what I've read, mouth guards and such don't have a great track record and Provent is newer but I don't hold out much hope on that either, but mine is not the only opinion, so hang in there for more answers to your questions and best of luck to you.

[PaulaO2]

I thought provent had gone out of business?

I think in the long run you will find that Provent is not going to work for you. But I'm glad they did a sleep test with you wearing them. One of the few that exist.

The problem with Provent is there's no way to track its efficiency except via oximeter. That combination doesn't always work because many folks do not have large drops during apnea events.

You didn't come here to ask for advice on how to get used to CPAP so I won't give you any.

Dental devices are iffy at best and damaging at worst. Again, no way to track how well it is or is not working except via sleep study or oximeter.

Without a mouth seal, Provent is not going to work. So unless you can get your mouth closed and keep it that way, the only thing "working" for you is the dental device. You can try a chin strap to see if that helps.

Speaking of oral appliance, have you looked into the oral CPAP mask?

[PTKen]

Thanks for the replies so far. I need to clarify a little:

Although Provent has gone out of business, I have learned that the company will be sold and the product will continue into the future (at least that's the plan). In the interim, there are enough supplies in stock to last current customers for years. I personally bought a one year supply so I'm okay for now.

As far as Provent working or not working, my sleep study showed that it is working very well for me, so I plan to continue with it. It's easy to put on and comfortable to sleep with.

My question really is only about how to fall asleep with "both" Provent and the oral device at the same time (I can sleep with them separately). Once I figure that out and use them for a few weeks together, my doctor will order another sleep study (and if I can manage that, I'll post my results here if people want to know how it worked out). My problem has been finding a technique to fall asleep with both of them together since it is difficult to breathe with both. If it turns out after the next sleep study that the oral device does not help, I just won't use it.

Thanks,
Ken

[DocWils]

You face the difficulty that I have heard from other provent patients, which is the difficulty of taking an inbreath through the nose - it takes time to get used to it. Some have solved this by increasing the number of holes in the device, but I cannot recommend it, only suggest that some have had positive results with it.

An AHI of 13, although mild, is still too high for healthy sleeping, and you may not get the desired results form using Provent in any combination.