Oral Dental Appliance

[Sleepster]

This is a sleep apnea board. You might think it's a CPAP board, but that's because CPAP therapy is the gold standard for treating sleep apnea. In other words, it works. Saying you can't tolerate it is easy, putting in the time and effort to tolerate it can be very hard work for some of us. But it stops being work after you adapt, and adapting can take anywhere from a few minutes to a few months.

[HalfAsleep]

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.

I don't have OSA dental appliances, but have often had bruxism appliances. I never could use two at once. In fact, I couldn't use an upper one at all. Reason? Claustrophobia! I felt like I couldn't breathe, couldn't swallow...

Also, any kind of dental implement is not a one time purchase. Every time you get a crown, you reconfigure your bite. Plus, those things wear out. I bit through one in a month, and broke my front teeth on another one.

[HalfAsleep]

My dentist warned me away from the custom made dental appliances early on in my Apnea diagnosis.  He told me that the chances of jaw displacement and chronic issues resulting from bite changes after long term use were not worth it and advised me to go the machine route instead.  This even though he admitted he could stand to make a LOT of money from making me one.

My jaw surgeon who has done over 4,000 jaw surgeries told me the same thing. Long term, a MAD will destroy your joints & bite. My advice to someone young/fit with sleep apnea & wants to use a MAD indefinitely is to just bite the bullet and look into getting corrective jaw surgery, especially if you have other bite issues. It is a touchy subject though because dentists in my experience seem to be very passionate about MAD's, so I would also agree to disagree with someone who like MAD's.

I've had corrective jaw surgery. My lower jaw was pulled forward. I would never do it again. As with any surgery, there are risks, and unexpected things can go awry. For instance, a certain percentage of folks lose sensation in the chin area. I am one of them. I believe it made my bruxism worse, not better. Jaw surgery is excruciatingly painful. Plus, my jaw had to be wired shut for 6 months. Try working with a wired jaw! This is not a minor undertaking. Insurance is unlikely to pay for it.

[Kryogen]

I agree. I will add, a lot of people suffer permanent loss of sensation.

[Kryogen]

I don't have OSA dental appliances, but have often had bruxism appliances. I never could use two at once. In fact, I couldn't use an upper one at all. Reason? Claustrophobia! I felt like I couldn't breathe, couldn't swallow...Also, any kind of dental implement is not a one time purchase. Every time you get a crown, you reconfigure your bite. Plus, those things wear out. I bit through one in a month, and broke my front teeth on another one.

OSA dental appliances also treat bruxism. You don't need both.

Some people can't get used to the feeling of some appliances in their mouth, it's ok, it's the way it is.

I will replace an occlusal splint for free if broken in the first year (but it doesn't really happen anyway). Your dentist should have replaced it for free IMO. Should not happen unless there was an issue with the product.

Should not break teeth either, so there was an issue with your splint, or your teeth, or both..... dentist should address this and have a talk about it with you.

[Kryogen]

My dentist warned me away from the custom made dental appliances early on in my Apnea diagnosis.  He told me that the chances of jaw displacement and chronic issues resulting from bite changes after long term use were not worth it and advised me to go the machine route instead.  This even though he admitted he could stand to make a LOT of money from making me one.

My jaw surgeon who has done over 4,000 jaw surgeries told me the same thing. Long term, a MAD will destroy your joints & bite. My advice to someone young/fit with sleep apnea & wants to use a MAD indefinitely is to just bite the bullet and look into getting corrective jaw surgery, especially if you have other bite issues. It is a touchy subject though because dentists in my experience seem to be very passionate about MAD's, so I would also agree to disagree with someone who like MAD's.

It's way more complicated than that, and truly cannot easily be argued over an internet forum by people who are not dentists.... even dentists have different opinions for different reasons. General dentists, orthodontists, surgeons, many different opinions for different reasons.

I personally don't know many dentists that are "passionate about MAD's". It's something that exists, and that works fine in some situations. It's part of the options that have to be evaluated for each different case.

I would never have a jaw surgery will all the risks and side effects, unless my life was miserable. There are many risks and side effects to surgery.
Now, jaw surgery is not a bad option, it's the best solution IF you have other major jaw issues and you need surgery anyway to function normally.
There are many people who have horrible jaw defects and they need surgery. A MAD would be plain dumb in that case.

Now, for someone with only a slightly retruded lower jaw, a properly adjusted MAD makes sense, and a surgery would be dumb in that case....

And for someone that can deal with a CPAP and doesn't have jaw issues, either a MAD or a surgery would be dumb....

And for someone that doesn't want surgery, and that can't deal with a CPAP, not getting a MAD would be dumb...

It just depends. Sorry, can't easily be argued.

"I would also agree to disagree with someone who like MAD's" : You do not have the knowledge to argue over that, so we can't have an argument over that. You can have your own opinion, but it's not really worth much to the debate.

[HalfAsleep]

I don't have OSA dental appliances, but have often had bruxism appliances. I never could use two at once. In fact, I couldn't use an upper one at all. Reason? Claustrophobia! I felt like I couldn't breathe, couldn't swallow...Also, any kind of dental implement is not a one time purchase. Every time you get a crown, you reconfigure your bite. Plus, those things wear out. I bit through one in a month, and broke my front teeth on another one.

OSA dental appliances also treat bruxism. You don't need both.

Some people can't get used to the feeling of some appliances in their mouth, it's ok, it's the way it is.

I will replace an occlusal splint for free if broken in the first year (but it doesn't really happen anyway). Your dentist should have replaced it for free IMO. Should not happen unless there was an issue with the product.

Should not break teeth either, so there was an issue with your splint, or your teeth, or both..... dentist should address this and have a talk about it with you.

I have worn dental splints for a few decades. I like wearing splints. There were no issues with the splints. There were no issues with the dentists. In the course of time, my splints have been repaired adjusted replaced reconfigured redesigned reinforced. There was no need for any dentist to "have a talk about it" with me, because communication with all my dentists has been free and easy with regards to the splints, and adjustments were made collaboratively. Exactly as it should be.

My top front teeth did in fact break to complement the shape of the lower mouthguard.....Teeth do crazy things sometimes.

[HalfAsleep]

I don't have OSA dental appliances, but have often had bruxism appliances. I never could use two at once. In fact, I couldn't use an upper one at all. Reason? Claustrophobia! I felt like I couldn't breathe, couldn't swallow...Also, any kind of dental implement is not a one time purchase. Every time you get a crown, you reconfigure your bite. Plus, those things wear out. I bit through one in a month, and broke my front teeth on another one.

OSA dental appliances also treat bruxism. You don't need both.

Some people can't get used to the feeling of some appliances in their mouth, it's ok, it's the way it is.

I will replace an occlusal splint for free if broken in the first year (but it doesn't really happen anyway). Your dentist should have replaced it for free IMO. Should not happen unless there was an issue with the product.

Should not break teeth either, so there was an issue with your splint, or your teeth, or both..... dentist should address this and have a talk about it with you.

I have worn dental splints for a few decades. I like wearing splints. There were no issues with the splints. There were no issues with the dentists. In the course of time, my splints have been repaired adjusted replaced reconfigured redesigned reinforced. There was no need for any dentist to "have a talk about it" with me, because communication with all my dentists has been free and easy with regards to the splints, and adjustments were made collaboratively. Exactly as it should be.

My top front teeth did in fact break to complement the shape of the lower mouthguard.....Teeth do crazy things sometimes.

[HalfAsleep]

My dentist warned me away from the custom made dental appliances early on in my Apnea diagnosis.  He told me that the chances of jaw displacement and chronic issues resulting from bite changes after long term use were not worth it and advised me to go the machine route instead.  This even though he admitted he could stand to make a LOT of money from making me one.

My jaw surgeon who has done over 4,000 jaw surgeries told me the same thing. Long term, a MAD will destroy your joints & bite. My advice to someone young/fit with sleep apnea & wants to use a MAD indefinitely is to just bite the bullet and look into getting corrective jaw surgery, especially if you have other bite issues. It is a touchy subject though because dentists in my experience seem to be very passionate about MAD's, so I would also agree to disagree with someone who like MAD's.

I've had corrective jaw surgery. My lower jaw was pulled forward. I would never do it again. As with any surgery, there are risks, and unexpected things can go awry. For instance, a certain percentage of folks lose sensation in the chin area. I am one of them. I believe it made my bruxism worse, not better. Jaw surgery is excruciatingly painful. Plus, my jaw had to be wired shut for 6 months. Try working with a wired jaw! This is not a minor undertaking. Insurance is unlikely to pay for it.

Typo..my jaw was wired shut for 6 weeks.

[moonman]

I am interested in your use of the ApneaRx appliance.
I have an issue with my sleeping position. I cannot tolerate side sleeping due to the pain because of lower extremity bypasses that stripped out my saphenous vein to use in one of the bypasses as an artery and back surgeries that numbed my calf muscle nerves. As a result I get a lot of pain during the night if I side sleep, but my Ahi is 3-10 range then. Back sleeping where I do not have the leg pain drives my Ahi up into the 50’s. I have severe jaw drop so I tape my mouth and wear a chin strap, and as a result I do not snore, but I have breathing problems with the elevated Ahi.
My Ent did a laryngoscopy and said my epiglottis is normal, with some rounding. He feels I am blocking my air way when back sleep and maybe an appliance pushing by jaw and tongue forward would help. I would like to back sleep 100% of the time.
My Pulmonologist thinks the solution is a bipap machine which has been ordered. I am skeptical since the sleep study for it, my third, was atrocious with 5 nocturnals. I did have one 151 min period at 2.8 Ahi, which is why he prescribed it using a 20/16 pressure settings.
I appreciate you taking this note. I am interested in your experience with the ApneaRx device and any other comments you might have. Thank you.
 
I have the following equipment:
ResMed AirSense 10 AutoSet CPAP Machine with HumidAir
ResMed AirTouch F20 Full Face Foam Mask