Mandibular Advancement Devices - is your mouth supposed to be closed ?

[vrapche031]

Hi,

I got a SomnoGuard AP MAD and 2 days ago went to get it adjusted for me to my ENT. Yesterday I tried it for the first time and I couldnt fall asleep with it because I had a feeling that my mouth was full of saliva which I couldnt swallow, which was uncomfortable. 

It also felt like an effort to keep my mouth closed because the device is rather big on the front side. And I could easily still lower my bottom jaw from it so I was afraid that during the night I will just do that, the top part was sticking with my teeth. 

Are we supposed to sleep with our mouth open while wearing a MAD?   I tried using it with a nasal CPAP and from time to time I had leaks from my mouth, which was annoying. 

Any advice on the saliva thing maybe? I need to test it for a month to see if it helps with my sleep apnea and then I would get a custom one from a dentist - Want to have that for traveling and for the nights where I just need a break from CPAP

[Sleeprider]

I have never seen a mandibular advancement device satisfactorily resolve obstructive sleep apnea, and know them to be expensive torture devices designed to extract the maximum amount of cash from your bank account while delivering suffering, pain and poor sleep. I may not be the best person to answer your question.

[vrapche031]

I have never seen a mandibular advancement device satisfactorily resolve obstructive sleep apnea, and know them to be expensive torture devices designed to extract the maximum amount of cash from your bank account while delivering suffering, pain and poor sleep. I may not be the best person to answer your question.

I have moderate sleep apnea, almost mild ( 21 events during the sleep study in a lab ) and my ENT who is also my sleep specialist thinks that MAD will help me. 

Actually, I switched to this sleep doc because the hospital doctors where I had my sleep study were completely unreliable and not available for anything after the sleep study. I made the switch after 3 months of not being able to sleep at all with different masks, so back then I thought MAD would maybe be my only option. 

Now I am fine with the CPAP but I want to have a 2nd option for travelling. My sleep specialist got me to buy this cheap over the counter MAD to test it out, if it helps with my apnea then we will get a custom one. They also told me that if I get a sleep test with a MAD and it shows that it helps, that my insurance will cover the custom MAD ( I life in Germany ). She has done it with multiple patients and it always worked, as long as they did a sleep study with a temporary MAD in advanced to show the results.

[Sleeprider]

Although I'm a skeptic of the MAD, I look forward to hearing how this works out and the results of the sleep test. What is the criteria for a successful demonstration of the MAD? Best of luck.

[Deborah K.]

There are several special travel cpap machines you can buy.  Most folks just take their regular cpaps along with them when they travel.  I wonder if you would find your trips somewhat ruined by the MAD disrupting your sleep as you will never fully adjust to it if you use it mostly for travel.  Just some things to think about.  You might sleep better if you simply allow yourself to fully adjust to cpap use, and then stick with that.  I hope you find success with whatever you decide to do.

[vrapche031]

Although I'm a skeptic of the MAD, I look forward to hearing how this works out and the results of the sleep test.  What is the criteria for a successful demonstration of the MAD?  Best of luck.

Apparently the only thing they need is me to show them that the number of events goes down drastically. 

There are several special travel cpap machines you can buy.  Most folks just take their regular cpaps along with them when they travel.  I wonder if you would find your trips somewhat ruined by the MAD disrupting your sleep as you will never fully adjust to it if you use it mostly for travel.  Just some things to think about.  You might sleep better if you simply allow yourself to fully adjust to cpap use, and then stick with that.  I hope you find success with whatever you decide to do.

I had my weekend trip with my CPAP last weekend and it was a pain. The machine is big and awkwardly shaped ( Prisma SMART - shaped like a triangle ) so it doesnt fit in my trolley. So I need to always carry another carry on bag just for that. 

Tonight I again tried the MAD - I tried sleeping with the mask and MAD together but unfortunately I kept opening my mouth because the MAD is big and had leaks through my mouth. Later in the night I tried just the MAD but at some point I woke up and it wasnt in my mouth anymore. My front teeth felt very sensitive and they hurt in the morning. 

I will still continue trying it out since I could get a free custom one if it helps, cant harm to get it even if I wont use it. But I think that I will have to plan on getting a smaller more portable CPAP for traveling. The issue is that I also need a pillow because I currently sleep on a CPAP pillow which is the only one I tried so far where it doesnt push my mask around and its comfortable.

[tiredofbeingtired]

It depends on the device. They come in a lot of different shapes and sizes. The one you have looks like it keeps your mouth open a bit. On the Somnomed website it mentions that the AP2 is designed for mouth breathing - so not what you want if you want to keep your mouth closed.

If you want to keep your mouth closed look at the Somnodent Classic or Somnodent Fusion. They let you completely close your mouth so that you can use a CPAP machine as well without any issues.

Unless CPAP resolves all of your apnea using a MAD alongside CPAP is a no brainer. Most people find them much more more agreeable than CPAP and most people on this forum don't even find CPAP that bothersome. Not only will it usually help your apnea but it will keep your teeth in place as well. Even if you don't notice it CPAP over time will almost always push your upper teeth and jaw back a bit as this study shows: https://schlafapnoe-heilen.de/wp-content...f_CPAP.pdf

https://somnomed.com/en/dentists/somnode...t-classic/
https://somnomed.com/gb/dentists/somnode...on/fusion/. <-- I would steer clear of the optional soft lining in this one. Most dentists I've talked to have said it's better to have your teeth locked in place to prevent movement.

[vrapche031]

It depends on the device. They come in a lot of different shapes and sizes. The one you have looks like it keeps your mouth open a bit. On the Somnomed website it mentions that the AP2 is designed for mouth breathing - so not what you want if you want to keep your mouth closed.

If you want to keep your mouth closed look at the Somnodent Classic or Somnodent Fusion. They let you completely close your mouth so that you can use a CPAP machine as well without any issues.

Unless CPAP resolves all of your apnea using a MAD alongside CPAP is a no brainer. Most people find them much more more agreeable than CPAP and most people on this forum don't even find CPAP that bothersome. Not only will it usually help your apnea but it will keep your teeth in place as well. Even if you don't notice it CPAP over time will almost always push your upper teeth and jaw back a bit as this study shows: https://schlafapnoe-heilen.de/wp-content...f_CPAP.pdf

https://somnomed.com/en/dentists/somnode...t-classic/
https://somnomed.com/gb/dentists/somnode...on/fusion/. <-- I would steer clear of the optional soft lining in this one. Most dentists I've talked to have said it's better to have your teeth locked in place to prevent movement.

Thanks for your detailed answer, I dont know why I just didnt check this on their website on my own. 
The one that I just started using is only for 4 weeks, then I will have a sleep study and see if it gets rid of the apnea. If it does - I will get a proper custom one made.

I will need to sleep without the CPAP for a couple of days to try the MAD I guess. But I just started sleeping through the full night with the CPAP 2 weeks ago roughly, so its not easy to stop now since its already making a difference

[gumleafau]

I agreed with your comment on mandibular devices for treatment of sleep apnea. 
My wife have syringomyelia and sleep apnea and opted for such device because of light weight and 
easy to carry when travelling.
However, after about twelve months wearing the device, she tossed it into the rubbish bin in frustration!
It's did not work, and I noticed that her jaw bone was pushed forward slightly from wearing it!
Looking back, the money she spend on the device, she could go have gone and buy a 
new cpap machine instead!
She is now using a Resmed vauto bilevel cpap machine with special pillow and soft cervical collar.
Her sleep apnea is under control, and she is happy and having good night sleep most of the time!

[tiredofbeingtired]

That is a good point about them moving your jaw forward. That is the most annoying side effect I found. And in some people it can cause TMJ pain because of this. I found after several months my lower jaw no longer returned to it's normal position so that my bite changed where my front and bottom teeth met in the middle giving me what looked like a crossbite. Was still worth it for the improvement in apnea but it's something to be aware of. My bite did go back to normal when I stopped using it though.