[Equipment] oral appliance instead of CPAP?

[singergal67]

I've been using CPAP for 2 months for mild apnea. Adjusting to CPAP treatment is not going well and I've only been able to achieve the minimum 4 hours per night usage 11 nights out of 53.  I'm considering asking my dentist about an oral appliance instead of CPAP to keep my airway open. Has anyone tried this? Did it work?

[FrankFuss]

I too had trouble with CPAP and ended up in the hospital for an anxiety disorder because of it.  I then tried an oral appliance.  It has been a while ago and I don't remember the exact numbers, but the oral appliance tended to cut my AHI in half from what it was without it.

However, central apnea was part of my problem, so I again tried the CPAP with the hope of treating my central apnea.  The secret to getting used to the CPAP was to use it during the day while I watched TV and for naps.  It took a while and I was eventually able to get a good night’s sleep with the CPAP.  I now use the CPAP successfully, but it did not start out that way.

[Lucid]

Hi, singergal67.  I consulted my medical and dental professionals about a mandibular advancement device.  They were concerned that it was less effective than CPAP and could irritate the temporal mandibular joint and cause chronic pain.  

If you download OSCAR and post charts here, experienced users can provide advice on how to adjust your settings to improve comfort and effectiveness of CPAP.

[singergal67]

Frankfuss,
      I'm sorry you had such a difficult journey. Hopefully you are getting good sleep now. A 50 percent reduction in events would put me just slightly over normal value so if I keep having problems with the CPAP it might be worth asking my dentist about it. Last night CPAP went great though so maybe I've got it figured out.  

Lucid,
     Good point about possible joint pain, I hadn't considered that aspect.

[Deborah K.]

It takes most people a good while to really adjust to using a pap machine.  I was able to sleep plenty long quickly, but it was a few months before I slept really well.  Everyone is different, but most people need significant time to feel really comfortable sleeping with a foreign object attached to their face.  Stay with it.  It's worth it!  

[singergal67]

Thanks for the encouragement. I guess I naively thought I would start sleeping better right away with the CPAP.

[FrankFuss]

I guess I naively thought I would start sleeping better right away with the CPAP.

That was the same expectations I had.   My wife did so well with CPAP therapy, I thought it would be as easy for me.  It was a rude awakening when it was not.  Again, my secret was to get use to breathing with the CPAP during the day while reading or watching TV, then sleeping with the CPAP became more natural.

[SnoNoMo]

My kid used an over the counter anti-snore type of mandibular advancement device on a two night camping trip. It worked in that her O2 stayed high all night, according to her apple watch (which doesn't measure super often). The downside is that her jaw took about an hour to work normally after waking. She'll continue to use it for things like camping trips but not otherwise.

[Spr0ut]

I began treatment for OSA with a mandibular advancement device.  I like it and it does work for me.  In two home sleep studies it does roughly cut my AHI in half.
 
The device did not relieve my symptoms, but I still wear it every night.  You can read my treatment thread for my history, for me medication is what has provided symptom relief.
 
I went to a dental practice that only does sleep treatments and I found them to be very engaged and attentive to my treatment journey.  It can take quite a while to receive your device.  First was an appointment to discuss options, evaluate insurance, and a physical exam to see if your structure is conducive to successful treatment with a device.  Second was a full mouth scan for digital model of my teeth and mouth.  A lab then custom makes the device.  After receiving the device there is an acclimation period, and then finally advancing the device can begin, which is what provides the physical mechanism to reduce AHI.
 
I started the process at the beginning of the year and in March the device was proving relief with follow up home sleep studies.
 
For me the device and appointments at the dentist were more expensive than PAP therapy and appointments, but medical insurance did cover everything.
 
I like the dental appliance because it is small and very portable.  The maintenance and upkeep are simple and quick.  If I have the device with me, I can use it, there are no other dependencies.  I am currently wearing it while trying APAP.
 
There is a risk of teeth and jaw realignment, but from your original mouth scan you also get an aligner that you use every day for 30 seconds.  The aligner makes sure your teeth and jaw return to their original position.  The instructions I received are that if I do not have or use my aligner, even for a day, then I should not use my mandibular advancement device.  So far I have had no issues.

[singergal67]

I downloaded Oscar and my problem seems to be dependent on position. When I am on my side I  sleep great with the CPAP and have almost no events. Due to some pain issues I have to sleep on my back sometimes and last night on my back for 2 hours I thought i didn't sleep at all but it looks like I dozed and was awaken repeatedly by central events. At one point there was 16 non obstructive events in 30 minutes. So maybe neither CPAP or oral appliance will work and I just need to address underlying hip pain to sleep on my side.