Oral Dental Appliance

[ruach]

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

Thanks Sleeprider, I will start researching the EERS

[delta]

.. 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 used to do that since childhood, but now it doesn`t seem such a good idea, as it retracts the mabdible. Anyway,l saliva eaking or mouth breating during sleep while not having OSA, usually indicates low muscular tonus, thus, circulatory disfunctions, long day, alcohol, or... lack of sleep caused by OSA. And the snorring too, is caused and is cause of bad sleep that accumulates during decades.

Keeping the head up and the vertebral column straight is a way.

I use Respironics DreamWear full face without (m)any issues. It`s the same as Resmed AirFit F30i Full Face. They allow any head position, and leak can be prevented by the straps.

[joepublic23]

How expensive is the NightLase treatment? How effective is it? I have been researching CPAP alternatives for months and I just heard about the NightLase today. 

I have mild apnea (AHI of 6.4) but I snore a lot so I am more concerned about that for my wife’s sake. I am an extremely finicky sleeper and can only fall asleep under conditions so I can’t use CPAP. I am concerned that I will have a similar problem with a dental device. Currently I am interested in the eXciteOSA device or surgery but only things that won’t give me insomnia. 

Is NightLase helpful?

How much does it cost?

[logart89]

Hi, I'm a UARS sufferer, with a AHI of basically 0, but I have pRDI of 16 ( a normal person has a pRDI less than 5). I'm getting used to bipap ASV but i'd like to try oral appliances. I think i'm a good candidate. I don't know which oral appliance would be the best option for UARS? Narval sleep appliance, the Panthera, TAP3
SomnoDent??? I was hoping someone could give me good advice on which oral appliance would be the most comfortable and efficient for UARS sufferers.  

About the long-term effects of using oral appliances, like jaw or bite displacement, wouldn't that be mitigated or avoided by using a daytime mouth guard that puts your teeth back into place from what they moved at night?

I was thinking making a new thread in this forum about oral appliances for UARS, but wanted to hear the opinions of the people that wrote messages in this thread first.

NightLase is a cool concept.

[BigData]

I've heard predominately negative feedback about oral appliances, but have heard the rare success story using one. I have heard it can affect your bite which personally would bother me.

[Sleepster]

Hi, I'm a UARS sufferer, with a AHI of basically 0, but I have pRDI of 16 ( a normal person has a pRDI less than 5). I'm getting used to bipap ASV but i'd like to try oral appliances.

I don't think an oral appliance is a substitute for a ASV machine. Even if it were, you would have to go to considerable expense to get one, and its chances of being successful are far less than the CPAP machine.

Is there some particular problem you're having with CPAP? It takes time to adapt, but the things that bother us about it soon disappear.

[logart89]

But wouldn't the unwanted long-term effects of an oral appliance, which is basically the displacement of the jaw or bite, be completely mitigated by using another oral appliance in the daytime, so whatever movement your mouth did at night goes back to its original position with the daytime mouth guard?

I also want to use an ASV and an oral appliance, like some people complement each other, but if I want to travel, I will not bring my ASV with me, so I could still see value in an oral appliance, even if it just helps a little. Maybe I am one of those who feels much better with an oral appliance, and I can stop using ASV? Who knows. Literally, my AHI is less than 0.5, and my pRDI is the only metric that is high (above 15.1). Maybe I don't need much to get good results and might do fine with the oral appliance? Maybe it's my tongue, and I don't need a mandibular advancement oral device but rather a tongue device? Maybe a dentist that also requires a DISE study to see exactly where my problem is in my upper airways? I don't mind spending $2000 just to try.

I also want to look for a dentist specializing in UARS for my case. I imagine each individual case must have an individualized design for the oral appliance.

Thanks in advance for any insight. 

[ZacMirror]

I tried and failed with my first CPAP attempt due to high Central events being recorded (AHI typically 30 - mostly CA’s). Untreated my AHI was 32 with some CAs recorded but the majority were obstructive. I became frustrated, stressed at the results each morning and suffered anxiety around bed time. I wanted to try an alternative and turned to a MAD, made by a specialist sleep dentist. It’s a small 3D printed nylon appliance which has been fairly comfortable to use. I wore it for 6 months and took a follow up sleep study where my AHI had halved to 15. 

However I am also a tooth grinder and the problem with a dorsal MAD is that it holds the jaw forward in a vulnerable position. So when you grind, it puts a lot of torque on the jaw. I damaged my jaw and had to stop using for 1.5 weeks until it healed. My teeth were also getting sensitive but not too bad. While waiting for my jaw to recover and having no sleep at all due to no treatment, I pulled my CPAP out of the closet to give it another go.

With the benefit of some experience and a desire for a sleep, I made some changes. I set a low fixed pressure (mine is 6.5), ramp and EPR turned off.  I also had more experience in letting my breathing become more relaxed and not starting the machine until I was very relaxed and tired in bed. 

For the past 5 days I have averaged 5 hours per night and an AHI of between 4 and 10. I think I am getting more confident in the machine now and my breathing rhythm. 

In summary, MADs are effective but unless you have a perfectly symmetrical jaw structure and good teeth they can result in pain and discomfort. I would recommend a MAD if you don’t require significant projection of the jaw. The more you advance the jaw, the more vulnerable it becomes to causing a problem.