01-12-2015, 02:26 PM
Myerson EMA review
brief background: Couldn't make CPAP work for me for a couple of reasons. I was fine with wearing a mask--having worked in surgery for years I have no problem with a mask. But my stomach just couldn't tolerate it, after trying all possible adjustments, modifications, and medical palliatives. My OSA was killing me, though, so I finally tried a mandibular advancement device, despite the bad press they get, and it has done wonders. I think they are under-rated as a product. I decided to spring for it when I found I could get a Myerson EMA. The "give" inherent in the rubber band approach seemed like a good idea, and it wasn't so expensive as others and I could afford it. This post is to report on my experience.
I would recommend the EMA as a first foray into the use of dental appliances but I wouldn't recommend this model as a permanent solution and I would caution you about the company, Myerson, which has a spotty record in my experience.
On the one hand, their customer service is very good at getting an appliance made and the rubber bands shipped to you in short order. I was desperate to acquire the device and with a little prodding from my dentist they expedited my order and I had mine in just a week after fitting. That part was great--and it was almost right and functioned well enough that I could tell that it was going to help me once all adjustments were made.
The parts that are not so great, are due partly to Myerson practices and partly to those in combination with the "post office effect." Myerson refuses to talk directly to patients, requiring you communicate through your dentist's office for all details and orders of rubber bands. That is sort of understandable, except it causes some problems. I needed some custom fitting for my appliance. You know how the post office effect works....in this case, I discuss what I need with my dentist, I think we understand each other and we're "on the same page". That info goes through the dental technician and through the office manager and over the phone and fax to the laboratory and their are more links in the chain there, and....of COURSE something got lost along the way, and the appliance I got was close but not exactly what I needed. I used it for a week, found that it was going to help if it were more-properly fitted, and went back to the dentist to try again. Myerson said they couldn't fit a replacement using the impression (why not? the impression was just fine..the impression was not the problem). So I had to have an appt to get another impression, and this time the dentist and I were on the same page, the configuration of the appliance was well defined. But Myerson said they couldn't make a new one till I sent the old one back. With considerable prodding from my dentist's office manager (bless her!) they relented and let me keep using the first one so I could get some sleep, while waiting for the second one. The second one came in and...they had OVER-modified that one. It turned out okay, though, because the dentist was willing to take about an hour (!) of appt time to carve it down for me and make it work. That's the one I'm using now.
Problems were not over, though.
The process of adapting to this device involves using rubber bands of various lengths and degrees of firmness. A set of longer rubber bands achieves less mandibular advancement, and you start with that, and as your jaw gets to accommodate it you then start using shorter and shorter bands, till you arrive at either....The length that will give you enough advancement to treat your OSA, or till your jaw won't take any more, whichever happens first. The device came with a 90-day trial. During the 90 days I progressed slowly through some shorter and shorter lengths, and also experimented and found that only the moderately-firm bands would work for me--the stiffer ones were just too rigid. But that was okay with me--not worried. When they ship the device to you they provide a somewhat incomplete variety-pack of bands to try, with only a couple each of a few lengths and two of the possible durometers (firmness). They shipped bands of length 21mm, 19mm, 17mm, and 14mm. You start out with the 21's, with the assurance that you can get the others and also the intermediary sizes of 20,18,16....if you need them.
I found that I DID need the intervening sizes. To make the jump from 21 to 19 was just more than my jaw could take. So I ordered and paid for 20's ($30 per pack in each durometer). The 20's worked fine, I adjusted to that for a couple of weeks, and progressed to the 19's for a few weeks and. Then I needed the 18's because 17 was too much of a jump. I ordered packs of 18's (same prices). I used the 18's for a couple of months and slowly got to tolerate that. Now I went to the 17's and at this point my OSA seemed to be pretty effectively treated. I had another sleep study done and it showed that it was helping a LOT--but I would be better off if I could progress to even shorter bands. I wanted to progress to 16's and all the way to 14 if I could. My 90 day trial period was up, and I was committed.
I tried to order 16mm bands and was told I couldn't get them. They don't make them anymore. No I couldn't get them, my 90 days was up, and no I can't get my money back. In fact, they'd stopped providing 16's,18's,20's and all the even numbers. Meanwhile, after several weeks of using the 17's I found that my jaw was getting sore and I was going to need to back off to the 18's--which I can now no longer order. I backed off to the 19's, which I CAN get, and I find that while it is better than nothing, it really is not a complete treatment of my OSA and I'm having symptoms again.
In a conference call to them to find out about even-numbered bands (where I found out they do NOT talk to patients!) I got to find out that some of their people in customer service are really great, and some of them...well let's just say some people think customers are a burden.
Some other details: if you look at the Myerson website they still claim in their promotional literature that you can get any size bands that you want--which is not true. Also, I was told that the bands will last 4 to 6 weeks before needing to be replaced, but I've found that after about 10 days they have gotten stretched out enough that they are not really effective, and they need to be replaced. Each time I replace a set and put on fresh ones which are not so stretched out, it's like making the jump from 21 to 19 all over again, and my jaw needs to learn to accommodate it again. It's NOT a huge problem, but do understand that for consistent treatment you might need to change bands every week or so, and order replacement band bags a few times/year.
Bottom line for me is that, yes, it has been worthwhile to use an oral appliance, it has done wonders, and yes actually if I had it to do over again, I would try the Myerson EMA first--because I could afford it. For other people, though, I would suggest considering a couple of things before deciding on a device type and provider: Find out for sure in advance whether insurance will pay for it (I found out that mine WOULD, and did, whereas initially they had said 'no'). If insurance will pay, and/or you can afford it, go with a more expensive and better model, as the rubber band concept, while seeming to be good, actually seems to be a little 'iffy'. So discuss with your dentist any need you might have for having a compliant (less rigid than a TAP) device and see what models are available.
Another snippet of info: Another dentist that I consulted with about these devices mentioned to me that they had tried maybe 6 or 8 different manufacturers and laboratories as providers for different models. He said he found that only one of them had not given them problems with getting orders wrong, etc. (It wasn't Myerson--he doesn't carry them as he is dubious about the rubber band concept.) So....find out as much as you can about the many different models available, find out what experience your dentist has had with both the devices and the labs. Find out something definitive about insurance. Also consider going to more than one dentist. Here's why: one dentist I went to professes to have lots of experience with mandibular advancement devices, but as it turns out, has only fitted a few of each and has never worn them himself, and did not really comprehend why a person might be desperate for OSA treatment--after months of delays and snafus and broken promises and cancelled appts and dallying on insurance, I finally pulled the plug on him and went to a different dentist and had my device in only a week--and they took care of the insurance FOR ME!. It turns out, THAT dentist and the office manager too, use them themselves and completely understand what you're going through and understand, first hand, your need for effective treatment.
Bottom line: Dental appliances: yes, good and effective. I suggest trying them. get as good a one as you can afford. discuss things completely with a good experienced and compassionate dentist. go into it with complete info and your eyes (and mouth) open.
I would recommend the EMA as a first foray into the use of dental appliances but I wouldn't recommend this model as a permanent solution and I would caution you about the company, Myerson, which has a spotty record in my experience.
On the one hand, their customer service is very good at getting an appliance made and the rubber bands shipped to you in short order. I was desperate to acquire the device and with a little prodding from my dentist they expedited my order and I had mine in just a week after fitting. That part was great--and it was almost right and functioned well enough that I could tell that it was going to help me once all adjustments were made.
The parts that are not so great, are due partly to Myerson practices and partly to those in combination with the "post office effect." Myerson refuses to talk directly to patients, requiring you communicate through your dentist's office for all details and orders of rubber bands. That is sort of understandable, except it causes some problems. I needed some custom fitting for my appliance. You know how the post office effect works....in this case, I discuss what I need with my dentist, I think we understand each other and we're "on the same page". That info goes through the dental technician and through the office manager and over the phone and fax to the laboratory and their are more links in the chain there, and....of COURSE something got lost along the way, and the appliance I got was close but not exactly what I needed. I used it for a week, found that it was going to help if it were more-properly fitted, and went back to the dentist to try again. Myerson said they couldn't fit a replacement using the impression (why not? the impression was just fine..the impression was not the problem). So I had to have an appt to get another impression, and this time the dentist and I were on the same page, the configuration of the appliance was well defined. But Myerson said they couldn't make a new one till I sent the old one back. With considerable prodding from my dentist's office manager (bless her!) they relented and let me keep using the first one so I could get some sleep, while waiting for the second one. The second one came in and...they had OVER-modified that one. It turned out okay, though, because the dentist was willing to take about an hour (!) of appt time to carve it down for me and make it work. That's the one I'm using now.
Problems were not over, though.
The process of adapting to this device involves using rubber bands of various lengths and degrees of firmness. A set of longer rubber bands achieves less mandibular advancement, and you start with that, and as your jaw gets to accommodate it you then start using shorter and shorter bands, till you arrive at either....The length that will give you enough advancement to treat your OSA, or till your jaw won't take any more, whichever happens first. The device came with a 90-day trial. During the 90 days I progressed slowly through some shorter and shorter lengths, and also experimented and found that only the moderately-firm bands would work for me--the stiffer ones were just too rigid. But that was okay with me--not worried. When they ship the device to you they provide a somewhat incomplete variety-pack of bands to try, with only a couple each of a few lengths and two of the possible durometers (firmness). They shipped bands of length 21mm, 19mm, 17mm, and 14mm. You start out with the 21's, with the assurance that you can get the others and also the intermediary sizes of 20,18,16....if you need them.
I found that I DID need the intervening sizes. To make the jump from 21 to 19 was just more than my jaw could take. So I ordered and paid for 20's ($30 per pack in each durometer). The 20's worked fine, I adjusted to that for a couple of weeks, and progressed to the 19's for a few weeks and. Then I needed the 18's because 17 was too much of a jump. I ordered packs of 18's (same prices). I used the 18's for a couple of months and slowly got to tolerate that. Now I went to the 17's and at this point my OSA seemed to be pretty effectively treated. I had another sleep study done and it showed that it was helping a LOT--but I would be better off if I could progress to even shorter bands. I wanted to progress to 16's and all the way to 14 if I could. My 90 day trial period was up, and I was committed.
I tried to order 16mm bands and was told I couldn't get them. They don't make them anymore. No I couldn't get them, my 90 days was up, and no I can't get my money back. In fact, they'd stopped providing 16's,18's,20's and all the even numbers. Meanwhile, after several weeks of using the 17's I found that my jaw was getting sore and I was going to need to back off to the 18's--which I can now no longer order. I backed off to the 19's, which I CAN get, and I find that while it is better than nothing, it really is not a complete treatment of my OSA and I'm having symptoms again.
In a conference call to them to find out about even-numbered bands (where I found out they do NOT talk to patients!) I got to find out that some of their people in customer service are really great, and some of them...well let's just say some people think customers are a burden.
Some other details: if you look at the Myerson website they still claim in their promotional literature that you can get any size bands that you want--which is not true. Also, I was told that the bands will last 4 to 6 weeks before needing to be replaced, but I've found that after about 10 days they have gotten stretched out enough that they are not really effective, and they need to be replaced. Each time I replace a set and put on fresh ones which are not so stretched out, it's like making the jump from 21 to 19 all over again, and my jaw needs to learn to accommodate it again. It's NOT a huge problem, but do understand that for consistent treatment you might need to change bands every week or so, and order replacement band bags a few times/year.
Bottom line for me is that, yes, it has been worthwhile to use an oral appliance, it has done wonders, and yes actually if I had it to do over again, I would try the Myerson EMA first--because I could afford it. For other people, though, I would suggest considering a couple of things before deciding on a device type and provider: Find out for sure in advance whether insurance will pay for it (I found out that mine WOULD, and did, whereas initially they had said 'no'). If insurance will pay, and/or you can afford it, go with a more expensive and better model, as the rubber band concept, while seeming to be good, actually seems to be a little 'iffy'. So discuss with your dentist any need you might have for having a compliant (less rigid than a TAP) device and see what models are available.
Another snippet of info: Another dentist that I consulted with about these devices mentioned to me that they had tried maybe 6 or 8 different manufacturers and laboratories as providers for different models. He said he found that only one of them had not given them problems with getting orders wrong, etc. (It wasn't Myerson--he doesn't carry them as he is dubious about the rubber band concept.) So....find out as much as you can about the many different models available, find out what experience your dentist has had with both the devices and the labs. Find out something definitive about insurance. Also consider going to more than one dentist. Here's why: one dentist I went to professes to have lots of experience with mandibular advancement devices, but as it turns out, has only fitted a few of each and has never worn them himself, and did not really comprehend why a person might be desperate for OSA treatment--after months of delays and snafus and broken promises and cancelled appts and dallying on insurance, I finally pulled the plug on him and went to a different dentist and had my device in only a week--and they took care of the insurance FOR ME!. It turns out, THAT dentist and the office manager too, use them themselves and completely understand what you're going through and understand, first hand, your need for effective treatment.
Bottom line: Dental appliances: yes, good and effective. I suggest trying them. get as good a one as you can afford. discuss things completely with a good experienced and compassionate dentist. go into it with complete info and your eyes (and mouth) open.
