CPAP Epic Fail.....Dental Appliance Questions

[bigbearclaw85]

5 days on nasal CPAP and I am getting much worse. Jaw pain increasing, sleeping worse, panic attacks, air leaking from mouth. I'm sleeping so poorly I had to quit CPAP for a day to sleep better. My apnea is mild but its causing me to grind at night so I need to correct it. I also have low testosterone and the meds make your apnea worse. I am going to try switching to a full mask or nasal pillows next I guess.

I am very interested in using the dental appliance and wanted to chat with people who use it and see what they think. I have a friend who uses a dental appliance and swears by it. I just wanted a few more opinions before I give up on CPAP and make the switch.

My sleep doc discouraged using the dental appliance because it can cause TMJ. At this point I am going to end up with TMJ anyways from grinding so much from apnea and being stressed by the CPAP. I need to do something to get rid of this pain because custom night guards for just grinding don't help.

Any help is appreciated. Thanks!

[Shastzi]

I have used an athletic dental appliance in the past ($20) and it stops the bruxing. (grating your teeth)
I was having problems with the mask straps being so tight they shoved my jaw backwards and caused me some pain by morning.
I already have TMJ so I don't need to make it worse, right?

Other problems:
Without knowing your machine make & model and set pressure
no one here can do much to help you sort out the problems you're having.
Get that posted up here and the folks can help direct you down the right path.

Cheers!

[bigbearclaw85]

I will get that info for you regarding the machine. I tried 3 different over the counter boil and bite guards and 1 custom from a dentist. They didn't cut down on the pain at all. If you ask the dentist they will swear by the dental appliance. If you ask the sleep doc they want you to use CPAP because its continuous cash for the sleep center with mask replacements. I wanted to get some opinions from actual people using the dental appliance and if they experienced any side effects or success. I only have 1 opinion at this point who happens to be my friend but he hasn't been using it long. My buddy sleeps like a baby using the dental appliance.

[Shastzi]

I use the double sided Brain Pad appliance. I can only get those from that amazon place.
You soak it in boiling water and custom mold it to your top & bottom teeth.
The ones you get in the OTC drug store are usually no good.
The dentist wants to sell you his $1500-$3000 thing that does the same thing.
(Why buy a Rolls Royce when all you need is a Ford F-150?)

The Sleep specialists want to sell you their stuff but once they have your money (insurance $$) they have NO
incentive to help you optimize your therapy.

You are in the right place.
That is why this forum exists and why your are here.
Asking questions to find out what works.

Stick with it and don't give up, Keep asking the questions and we will be able to
get you comfortable. It takes time to nail down all the trouble spots sometimes but it
IS doable and it IS worthwhile because your reward is a longer more trouble free life quality.

Cheers!

[DeepBreathing]

G'day bigbearclaw85, welcome to Apnea Board. I can't help with the dental appliance but Shastzi has already given you good information and maybe other members can chime in as well.

However I have to say five nights isn't really enough to decide for or against using CPAP, despite the early problems. Some of the problems you describe may be (relatively) easily solved by adjusting your machine or changing your equipment (eg using a chin strap to help with mouth-leaking). The two main problems with a dental appliance from my point of view are that they don't treat all apneas and secondly they provide no data so you don't really know if you're getting optimum treatment.

Can you provide as much information as you can, so that we can provide some informed advice? Do you have your sleep study results? If not, ask for them. We need to know at least the following details - apnea index (AI), hypopnea index (HI) and apnea - hypopnea index (AHI). What percentage of your events were obstructive apneas and what proportion were central apneas. Snoring? Any other comments on your "sleep architecture".

If you did a titration study, what were the prescribed pressures? What make, model and variety of machine do you have (be very specific)? What make and model of mask are you using? (Again, be specific). And can you give some detailed description of the problems you're experiencing?

I know this is a lot to ask when you've only just begun, but this is a pretty technical discipline, and very specific information means we can offer some well-informed advice. At the end of the day you may decide that CPAP is not for you, but at least you'll have a better idea of the options available. If you end up getting the dental device and it works for you, that's great - but CPAP is regarded as the gold standard of apnea treatment.

[bigbearclaw85]

My sleep apnea is extremely mild but its enough to aggravate me and make me grind at night. I ignored it because the doctor practically laughed at how low it was. Since the regular grinding mouth guards don't relieve my pain I'm going this route. My AHI is literally only a 6.5. Not everyone grinds from sleep apnea but I clearly do. If the pain wasn't so brutal I would just ignore my mild apnea.

I sleep so bad on the machine that I can barely function during the day like I have severe apnea. The machine says my apnea is improved but it doesn't know that I'm waking up constantly throughout the night for some reason.

Another factor is my low Testosterone and I can tell the meds are making my apnea worse. I haven't had another study with a new AHI on meds but they set my machine to 8 pressure.

I just got off the phone with someone my testosterone doc knows who uses the apnea dental appliance. He has been using it since 2008 and is on his 3rd one cuz they wear out after a few years. He swears by the dental appliance and said it took his apnea from 85 AHI to 1. His apnea is very bad compared to mine clearly lol. My one friend has mild to moderate apnea and has been using dental appliance for 3 months only but said he's sleeping like a baby now. He said he sleeps through the entire night now and didn't hear his alarm one time this week from sleeping so good.

I know the CPAP is the gold standard for treatment but realistically most people can't tolerate it. Out of all the people I know personally with apnea I can only find one who actually uses it religiously. The rest of my friends can't handle the machine and it collects dust in their closet. I have only tried it 5 days and quit for a night because I'm losing more sleep on it. I feel more rested today with a little less jaw pain today after not using the machine. Most of the people I talk with say that first night on machine gives them so much rest but I am having the opposite effect.

I think I am going to keep trying this with another mask. If I keep opening my mouth and air is shooting out of it then I guess I need a full mask. I hear people do well with the nasal pillows but I'll gather the info on all my stuff and post later.

[PaulaO2]

The dental appliance works by pulling the lower jaw forward. This then also pulls forward much of the base of the tongue and other tissue that contributes to the blocking of the airway. For people with very mild sleep apnea, it is a decent alternative to CPAP. If not done right, it can cause jaw issues over time. The primary problem with dental devices is there's no real way to track if the device is actually working. The only thing is to use a finger oximeter and see how the blood oxygen rate does overnight.

In the meantime, while you are looking at alternatives and gathering opinions (which is a good thing!), sit up during the day with the mask on and the machine on. Get used to how it feels, what your body does, how to adjust to it. Wear it all while watching TV or reading or something like that. Then lay down with it. Toss, turn, relax, just feel how it is, what happens in that position. Learn to relax with it. It's not something to be tense about.

If you don't like that mask, there is a plethora of masks out there. No two are alike, even if they look alike and are of the same type. See if your supplier has a mask trial policy and try out other masks.

Depending on what your pressure is and how you feel with it (too much, too little), you can also have your doctor adjust it. Yes, you can do it yourself but you're just 5 days into it so you need to keep in contact with the doc at this point, especially since you are having so much trouble.

Now, you said the sleep center is selling you the supplies? Find another supplier. That's conflict of interest.

[bigbearclaw85]

I fall asleep with the mask but I can't stop myself from waking up constantly throughout the night. I'm not sure why I'm waking up. My wife tells me I'm still snoring and air is shooting out of my mouth.

[bigbearclaw85]

Every time I call the office the lady says to stick with it cuz its too soon to tell. I hear what ya'll are saying but I'm getting no sleep and need to function during the day and work a job. I gave the machine rest last night and will try it again tonight. I will try wearing it during the day while watching tv.

[PaulaO2]

Ah. Typical new user problem. Do you have an old ACE bandages around? Take one and wrap it around your jaw and head, like they used to if you had the mumps. You want it tight enough to hold your mouth closed when you relax but not so tight you cannot chew with effort. You want to be able to open your mouth in an emergency.

This is a poor man's chin strap. Try this for a night or two. If it works, and it helps keep your mouth closed, then you can get a real chin strap and use that. A full face mask (FFM) will also work but they tend to leak and are hard to fit. Try the chin strap first. It is quite possible that after a month or so, you can stop using the chin strap. What is happening is the air is blowing your mouth open. There's a trick to somehow another train your tongue to do something with the roof of your mouth but I've never managed to do it. Others can explain it better so I won't even try.