Oral Dental Appliance

[RandomPilar]

I was diagnosed with moderate sleep apnea earlier today. I've spent the majority of the day as a stresscase and haven't stopped worrying. I have a very young family with kids that need me to be active and involved without the excuse of fatigue. It's a daily battle for me but at least I now know what my problem is. Anyway, I was very pleased and comforted to find this forum. 

I had a recent sleep study and am at 18 apneas per hour, within the range of 15-30 that they told me about. Two years ago I was  around 7 and mild. They said a few years older, a few more pounds, and regular work and family stress could be making it worse. So it needs treatment at this point. 

I've been wearing an over the counter Apnea RX Appliance for the past few years to treat what was previously thought to be mild OSA. It's comfortable and aids with snoring but has obviously not fixed my OSA at all. However, as I'm very comfortable with an oral device, my doctor suggested I get a custom oral appliances instead of CPAP. I am a mouth breather and very clostophopic, so a mask would be challenging. He said CPAP is the best method, but given my comfort with oral appliances and moderate OSA, this made sense for me. For all these reasons, they want me for an oral appliance. 

Does anyone have experience with these?

Do they work?

Are they worth the expense?

CPAP is largely covered by my insurance and would only cost me a few hundred dollars out of pocket. The oral Appliance is apparently $2,000-$2,500 and not covered. It would be a huge expense, but I feel it would be much easier for me to mentally accept as treatment. If it would give me a good night rest consistently I'd pay the amount right now. But I'm worried it might not work. 

They do have a test they can run beforehand via a sleep study and electronic plates to see if the oral Appliance would work in my case, which is a bit reassuring I suppose. But nothing is guaranteed. 

Any feedback would be so greatly and genuinely appreciated. Thank you.

[CB91710]

Oral appliances are rarely effective, and most often result in jaw displacement, even creating TMJ issues.
I tried an appliance before I went to the sleep doc, and I could not close my teeth into a chewing position for several hours after waking up.
Often times I would wake up to find the appliance on the pillow, and it only works if you can keep your mouth closed, since opening can cause the position to shift out of place on the teeth.

New machines and masks can be very unobtrusive, but mouth breathing is a challenge.
I use nasal pillows for the CPAP, and a combination of a loosely fitted soft cervical collar (OTC from the local drug store) and a technique called "tongue suck" where you place your tongue on the roof of your mouth and apply gentle suction (begin practice now).. that has really helped with my mouth leaks.

I do keep a Nasal mask handy for when my nostrils are irritated (pimples and such), and I also have a full face mask for when I have a cold and am congested.

[trish6hundred]

Hi RandomPilar,
WELCOME! to the forum.!
There are many masks out there so don’t let that discourage you from using CPAP therapy. There are masks that are very minimal so they aren’t chlostraphobic. CPAP therapy is the best treatment for sleep apnea.
Hang in there for more answers to your questions, good luck with your decision.

[Sleeprider]

Most of us get past the "stigma" of CPAP very quickly, and nothing matches the comfort and effectiveness. Give it a fair shot and talk to your family about the importance of it working for you. As you have said, your financial risk for using CPAP is negligible, and the alternative is much higher. If you make a good try and work with the forum, I doubt you will ever consider the fall-back of a dental device.

[Sleepster]

CPAP is largely covered by my insurance and would only cost me a few hundred dollars out of pocket. The oral Appliance is apparently $2,000-$2,500 and not covered.

Don't just guess that you won't tolerate CPAP. Try it and see. Dental appliances are far less likely to be effective. You're risking your own life here, so ultimately it's up to you if you are willing to take that risk.

The insurance company will pay more than $2500 for your CPAP, so the fact that they are willing to pay for that but not for the dental device is a pretty big clue as to the relative effectiveness of the two treatments. But it is all about statistics. Dental appliances work for far fewer patients than do CPAP machines, and there's no telling whether you yourself will fall within that much smaller group or the much larger group.

I have moderate apnea and had a lot of trouble adapting to CPAP therapy. It was one of the most difficult things I've ever gone through in my life, but those few months of pain were more than worth it because it has changed my life. I used to be dead on my feet and was dragging myself through life. Now I feel like I have a new life to live.

[Missingsleep]

I tried the oral device and felt like I was in "Silence of the Lambs". I found it extremely uncomfortable and it had other side problems as well.

[disnynerd]

I used a TAP3 and it really messed up my jaw. I wish I had never tried it.

[Kryogen]

CPAP first

Oral appliances are something else that can be done in some cases for some patients in some situations of mild obstructive cases where the CPAP isnt tolerated, or is not enough. It's not a first line of treatment, and it's not perfect, but it can help in some cases.

[Homerec130]

If you are thinking about going with an updated oral appliance, talk to your dentist first. I had a doctor recommend one and talked to my dentist and he told me in no uncertain terms not to go that route. He felt it would cause too many problems with my jaw. I have been on CPAP for over 6 years and it works.

Homer

[Kryogen]

I have been on CPAP for over 6 years and it works.

This is why your dentist sees no reason to get an oral appliance, and he's right...

(english 2nd language)

A properly made oral appliance, done by a dentist with knowledge in those appliances, can and does help in some cases.
It's not the first line of treatment, so get a cpap first.

I wouldn't use an over the counter device, or a device not made under the supervision of a dentist, or made by a dentist that has no clue about apnea (like most dentists).
If you need an oral appliance, talk to a dentist that actually has training in sleep apnea appliances.

Examples:

If one person has a badly retruded lower jaw, and has horrible obstructive apnea because of that, and that person needs really high pressures, and does not tolerate that well, that person could get an oral appliance with slight mandibular propulsion, and require much less pressure and then tolerate the whole therapy better.

There are side effects to everything in life, obesity, medication, etc. Yes, long term wear of a mandibular advancement device will have some side effects, but in the end, if it's 95% benefit and 5% side effects, it's worth it.

I personally know a dentist, who is a friend, who sleeps with a bipap, and an oral appliance. I don't know all the details because I never asked him, but he's a dentist and he has an oral appliance, so it's not as bad as you think.

Just my opinion, and I'm a dentist, and my wife is a dentist.