Oral Dental Appliance

[Marillion]

I used the ApneaRx (amongst others.) It did not cure my snoring nor I suspect my Apnea. But it DID greatly alter my bite for most of the day. Horrible feeling. Never again...

[theunk]

I want to share a good news story regarding Mandibular Advancement Appliances.
I have been on CPAP therapy since the late '80's. CPAP was my best friend, took it everywhere. About 5 years ago, I started finding that I was not getting a quality sleep. I have a fairly good overbite. The mask was holding my lower jaw back. In an wake sate, sitting or standing, with my closed normally; any attempt to inhale rapidly caused my throat to collapse. If I move my lower jaw forward, a quick inhale is effortless. In discussing with my pulmonary specialist, he had nothing to offer.
I started looking into alternatives.  
My overbite 27mm - was not effectively treated using products such as SnoreRX or SleepPro. This may be why many have experienced extreme jaw discomfort. If I move my lower jaw 1 mm forward, I start to feel the misalignment. I tried 25mm for awhile and really messed up my bite. I was stuck for awhile and had to use a SnoreRX. I inverted it and survived for a few days. I think they are OK for a more "normal" bite.
My first experience in Nov 2013, was with a Somnomed appliance. It certainly positioned my jaw to open the airway. I started feeling much more refreshed in the morning. For about a year my biggest issue was discomfort from sucking my cheek linings into the hard plastic. Otherwise, I was sleeping great.
In the fall of 2014, I came across a device called Panthera Digital Sleep Apnea Device. It is made of a nylon compound. Is adjusted by changing the length of the titration arms. Similar to the Resmed Narval. 

In January 2015 I had a Level 1 Polysomnography using the appliance. 
Sleep Efficiency: 96%
Total Sleep time 7hrs 48 minutes
Hypopneas: 6
Apnea index: 0/hour
Apnea-hypopnea index: 0.77/hour

AHI in:
NREM Sleep: 0.8/hour
REM Sleep: 0.8/hour

My last Sleepyhead readings from Oct 2013, over 371 days:
ResMed S9
Average Hours/night: 6:51
Compliance: 98%
AHI: 0.32
Obstructive Index: 0.11
Hypopnea Index: 0.06
Clear Airway Index: 0.15

Average Pressure: 13.38
Average EPAP: 11.38

Pros:
I am still sleeping very well. 
The Panthera offers no relief from sucking my cheek tissue into the various nooks and crannies.
Maintenance is minimal. Cleaning is a brushing followed by soaking all day in Novadent - a 7 day cleanser. 
No hose
No mask
Travelling is a dream. Can even use it on the plane.
Reduced costs of ownership. I believe this device (Panthera) could have a very good life expectancy. The only wearing parts are the titration arm connections. They will usually provide 2 pairs with the unit. No mask or hoses to replace. 
Can be used even when not sleeping a long as you are not eating or talking. Then, if you fall asleep on the couch, you do not wake up with a roaring headache. 

Cons:
I can not think of any serious ones. Sometimes I wake up with some stiffness in my jaw, but very seldom over the past 4 years.
Non device related CON
The Somnomed provider was a dentist who had switch to full time Somnomed services. He had some monitoring equipment to help with monitoring. The Dentist who provided me with the Panthera is a dentist who has sleep apnea. He does not provide any monitoring equipment or serious followup services. This is not a CON for the appliance, but a caution 

My titration arms are 27mm. Going to 25mm really messed me up, so in jaw alignment terms a couple of millimetres is a lot. The SnoreRX starts very close to 0, so just figure what that amount of offset would do to me???? 
I also found that using CPAP with the MAD made me feel less refreshed.
I was able to give my CPAP to my stepson. This is making a huge difference in his life.

So there are some positives in this treatment, but it has to be done properly, and you have to be a good candidate. My new pulmonary specialist commented that it was nice to be able to see well into a patient's throat for a change, so I assume the physical characteristics of the patients throat of consequence.
Last year I had a series of Fotona Nightlase treatments. This has helped tighten up what is called the oral mucosa tissue - back of throat. This has help my breathing round the clock and I can go one night with out my MAD, but notice a deterioration after 2 nights. The therapist presented treatment as an addition to, not a replacement for CPAP or MAD therapy. It makes sense, but also comes with a cost. But, there really is not a better investment in your overall well being.  When I was first diagnosed with sleep apnea, I discussed the whole idea with a fellow who was running his CPAP at 20cm. He said "You can sleep or you can die." Pretty scary statement, but like so many, I had started down a pretty hellish path already. That was over 30 years ago. That is a long time to be married to a pump!

Regards

[xctraveler]

I have a custom dental appliance. I had it made for travel to places where power for CPAP was marginal or unavailable. I have had a sleep test with and without it a year ago . It is better than nothing, but does not come close to the benefit of CPAP. I have moderate apnea and average .2 events per hour on CPAP. The test with the oral appliance was 6 events per hour, less than half of the events with nothing, but not great. YMMV

[ardenum]

I use this with my Full face mask:

https://goo.gl/whEd5B

And something like this when I'm on Nasal:

https://goo.gl/nrvXUs

Do remember that I use these together with my bipap.

[fitmart]

Friend, I was in your exact shoes about 1 year ago.  Panicked about getting the machine and searching for other options.  I tried about every apnea gimmick out there and even filmed some youtube videos of my experiments.  I wish to offer you some advice in this area.

1.  If you are considering using a dental appliance, before forking out $2000 for the dentist, I recommend the Sleep Silent device found at Amazon.
It is fairly comfortable and is adjustable so you can increase the advancement as needed until you have addressed the apnea.

2.  You are not going to know if these items are actually working unless you are tracking your sleep with an oximeter.  Go get one!

3.  I personally had great success by purchasing a soft cervical collar from Walmart.  this helps hold your chin up and therefore opens the airway.  It didn't cure my apnea, but it did cut it in half.

4.  You mentioned adding a "few pounds".  This is certainly something you should be addressing.  I hear so often of people who have developed apnea due to weight are looking for any way to fix their apnea, while completely ignoring the contributing cause.  Weightloss is best achieved by improving what you eat, not dieting.  Best book on the subject is "Eat Right for Life" by Dr. Anne Kulze.

5.  Finally, I am going to share with you what another member of this forum shared with me when I was stressed about getting on a CPAP. 
..."Just go get the life changing machine!"...

6.  If you do get a CPAP, come straight back here to learn how to set your own pressures, monitor your apnea, and take charge of your life.

[newmar]

Glad to hear proven positive results with oral appliance. I understand the skepticism of MADs, since CPAP is the gold standard, but clearly there is solid evidence that MADs can work for some people.

In January 2015 I had a Level 1 Polysomnography using the appliance.
Sleep Efficiency: 96%
Total Sleep time 7hrs 48 minutes
Hypopneas: 6
Apnea index: 0/hour
Apnea-hypopnea index: 0.77/hour

AHI in:
NREM Sleep: 0.8/hour
REM Sleep: 0.8/hour

My last Sleepyhead readings from Oct 2013, over 371 days:
ResMed S9
Average Hours/night: 6:51
Compliance: 98%
AHI: 0.32
Obstructive Index: 0.11
Hypopnea Index: 0.06
Clear Airway Index: 0.15

Average Pressure: 13.38
Average EPAP: 11.38

[ruach]

I have been using PAP for over 5 years and next month I am scheduled to have an overnight study to see if an oral appliance might help me. 

This thread has been very informational, and I hope I am one of the few that it helps . . . 

I was told that if the overnight sleep study shows that the make-shift appliance helps me that a prescription will be made and then I will be given a list of approved/certified Dentists to make the appliance for me. Additionally they gave me a list of contraindications to consult with my dentist to see if he feels I could be a good candidate.  

My Sleep Doctor wouldn't have given me this referral if I were newly diagnosed with Sleep Apnea, and I believe because they could show that I have tried PAP therapy first, that my insurance will cover the cost of the dental appliance. 

On a side note, my sleep doctor also made some adjustments to my PAP settings, and if the new settings help me sleep better, I can cancel my overnight study for the dental appliance.

[Sleeprider]

I have been using PAP for over 5 years and next month I am scheduled to have an overnight study to see if an oral appliance might help me. 

This thread has been very informational, and I hope I am one of the few that it helps . . . 

I was told that if the overnight sleep study shows that the make-shift appliance helps me that a prescription will be made and then I will be given a list of approved/certified Dentists to make the appliance for me. Additionally they gave me a list of contraindications to consult with my dentist to see if he feels I could be a good candidate.  

My Sleep Doctor wouldn't have given me this referral if I were newly diagnosed with Sleep Apnea, and I believe because they could show that I have tried PAP therapy first, that my insurance will cover the cost of the dental appliance. 

On a side note, my sleep doctor also made some adjustments to my PAP settings, and if the new settings help me sleep better, I can cancel my overnight study for the dental appliance.

In your case, it appears you are using an ASV auto, which at least infers a central or complex apnea issue.  I am puzzled aow an oral appliance could be helpful in cases that are not predominately obstructive.  It would be educational to me if you could start a thread and discuss some of the specific issues and results of using an appliance.

[ruach]

ruachI have been using PAP for over 5 years and next month I am scheduled to have an overnight study to see if an oral appliance might help me. 

This thread has been very informational, and I hope I am one of the few that it helps . . . 

I was told that if the overnight sleep study shows that the make-shift appliance helps me that a prescription will be made and then I will be given a list of approved/certified Dentists to make the appliance for me. Additionally they gave me a list of contraindications to consult with my dentist to see if he feels I could be a good candidate.  

My Sleep Doctor wouldn't have given me this referral if I were newly diagnosed with Sleep Apnea, and I believe because they could show that I have tried PAP therapy first, that my insurance will cover the cost of the dental appliance. 

On a side note, my sleep doctor also made some adjustments to my PAP settings, and if the new settings help me sleep better, I can cancel my overnight study for the dental appliance.

In your case, it appears you are using an ASV auto, which at least infers a central or complex apnea issue.  I am puzzled aow an oral appliance could be helpful in cases that are not predominately obstructive.  It would be educational to me if you could start a thread and discuss some of the specific issues and results of using an appliance.

Good point on the Centrals - my doctor thinks my Centrals (mixed sleep apnea) was caused from using the PAP device, so next month IF the night study shows if the dental appliance can help me, I will post about my experience if they do refer me to actually get the dental appliance

[Sleeprider]

Centrals can result from flushing too much CO2 From the breathing circuit. There is an ingenious solution called Enhanced Expiratory Rebreathing Space that solves this problem very inexpensively http://www.apneaboard.com/wiki/index.php...ace_(EERS)

Treatment of positive airway pressure treatment-associated respiratory instability with enhanced expiratory rebreathing space (EERS) https://www.ncbi.nlm.nih.gov/pubmed/21206741