Question about oral devices (MAD's)

[Cutter]

[parts of this thread were copied from our old forum]

ncnlife wrote:

Apr 24 2006, 10:36 PM Post #1

I am currently considering purchasing an oral device for my sleep apnea. I was just wondering if anybody has experience with any brand. I will probably get either the Tap II, PM Positioner, or Silencer. Any information would be greatly appreciated. Right now I am leaning towards the PM Positioner because of cost/comfort. Maybe worried about reliability compared to other brands because of the design? Prove me wrong please.

 

ConnCarl Wrote:

Apr 25 2006, 05:14 PM Post #2

Welcome to Apnea Board, ncnlife.

I would suggest that you research very carefully before purchasing any mandibular advancement device, or MAD for short.

I am especially wary of folks who tout MADs as a substitute for PAP therapy. Some MADs, when properly fitted, can significantly reduce a patient's AHI, but not as effectively as PAP.

My own experience with a MAD was poor. The device was fitted so tightly, I had to take painkillers before bed because my teeth ached. Even so, it fell out within minutes every time.

Good luck! Carl
"You knew the job was dangerous when you took it, Fred." - Superchicken

 

ncnlife wrote:

Apr 25 2006, 10:20 PM Post #3

Thanks for the info. Let me give a little background on my individual case. I am 25 years old, 6 feet tall and 164 lbs. I had a septoplasty and turbinate resection. This was very successful and I believe my main problem is with my tongue blocking the airway. Muscle tone in the airway could be a problem as well. My AHI is on the border of mild/moderate. Even a 50% reduction would bring me to almost normal levels. I am going camping for 2 weeks soon and figured it would be a good time to give the MAD a shot as I will be in the mountains and not able to use my CPAP.

Would you mind telling me what device you used? The dentist I talked to said that his Tap II with the triple laminate has come off his teeth also. Another said that his PM Positioner very rarely comes loose, and that he thinks it is beneficial that it is a MAD that is heated in hot tap water before applied to get a proper seal.

 

ConnCarl Wrote:

Apr 27 2006, 05:46 PM Post #4

A 50% reduction in your AHI is, in my opinion, a very aggresive goal for a MAD. I think that 25-30% is probably a more realistic number.

You might want to consider a compact CPAP device that can run on DC power, such as the P-B 420 series. It's a pretty simple matter to cobble together a couple of wet-cell battery packs and come up with a portable CPAP system for camping or hiking.

I can't recall the brand of the MAP device I used, but I'll have to see some pretty compelling clinical results before I ever try one again. For me it was just an expensive piece of plastic.

Carl
"You knew the job was dangerous when you took it, Fred." - Superchicken

 

FTLOSM Wrote:

May 23 2006, 09:19 PM Post #5

Newbie Question sorry on this

I just finished 1st study that showed i stop breathing during sleep, but what determines if you get a cpap or a mad?

I go for a second sleep study (I presume to fit the cpap the tech had mentioned during first visit), but what makes them say ok lets try a mad vs a cpap etc?

Thanks for any input and or direction on how they choose which is right for each patient.

Bill

 

ConnCarl Wrote:

May 31 2006, 06:01 PM Post #6

Bill, I've never heard of anyone coming home from a sleep lab with a MAD.

I hate to parrot the company line, but, as they say, "CPAP is the gold standard". From an efficacy standpoint, CPAP throws rocks at any MAP out there. It is very easy to support a CPAP recommendation, but very challenging to support one for a MAD.

Then there's the distribution channel. MADs are distributed almost exclusively by dentists. Your sleep lab is more likely to have a close relationship with a DME distributor than with a local dentist.

Finally, CPAP is a wonderful thing to sell. A CPAP patient needs lots of product to sustain his or her therapy...at a minimum, hoses, filters, masks, and machines. It's largely a self-perpetuating industry, and everybody makes money.

Even the patient isn't exactly in tears. Usually, the insurance company picks up a big part of the tab. If they don't, savvy buyers can often find equipment available at a steep discount.

Hope this helps! Carl
"You knew the job was dangerous when you took it, Fred." - Superchicken

 

jbird wrote:

Dec 27 2010, 09:19 AM Post #7

OTHER COMMENTS:
I use an acrylic/plastic mouth piece
Try contacting somnowell. I am. No guarantee. Just looks like it may work....

[shutterbug sue]

ncnlife wrote:

Apr 24 2006, 10:36 PM Post #1

I am currently considering purchasing an oral device for my sleep apnea. I was just wondering if anybody has experience with any brand. I will probably get either the Tap II, PM Positioner, or Silencer. Any information would be greatly appreciated. Right now I am leaning towards the PM Positioner because of cost/comfort. Maybe worried about reliability compared to other brands because of the design? Prove me wrong please.


I have used an oral appliance for the past 5 years. I have severe OSA so the device alone isn't enough. I use it along with my CPAP machine with full face mask so I can use a lower pressure setting. The combination works better than either one alone.

They need to be custom made at a specialty dentists office which makes them very expensive. The first one I had lowered my jaw and thrust my jaw forward too much. I had horrible jaw pain that lasted for about an hour after it was removed in the morning and was unable to eat until the pain went away.

I wasn't able to tolerate that one very well so the dentist remade it and now it is much more comfortable, although is doesn't work as well to open the airway because it doesn't lower my jaw as much or thrust it out as far.

I would never use the oral appliance alone without CPAP because of the severity of my OSA, but it is my understanding that it works well for mild sleep apnea.

The things I don't like about the oral appliance is that it causes excess salivation & drooling.

My oral appliance is made of hard plastic and has some wiggle room and makes a little noise when the top and bottom come together that is a little annoying.

It's very easy to keep clean. All I have to do is rinse them off in the morning and drop them in some warm water with an efferdent tablet.

This is the oral appliance that I have:

SomnoMed MAS - Dorsal Fin Appliance
The SomnoMed MAS - Dorsal Fin Appliance is a custom-made device, consisting of upper and lower dental plates with a unique patented fin-coupling component, which allows normal mouth opening and closing. If required, a part can be added to make the device adjustable. This feature provides incremental and adjustable levels of lower jaw advancement, which improves the effectiveness and comfort-level of treatment as the jaw is moved only as far as is required to alleviate snoring and reduce OSA. Key features and benefits of the device include: Permits normal mouth opening Allows speech and drinking Provides full lip-seal Easily adjustable Safe and effective Clinically proven Custom-fitted Additionally, the SomnoMed MAS - Dorsal Fin appliance is made from durable fade-proof acrylic that retains its shape and color for at least four-five years and is covered by a three year manufacturer's warranty.

[truckerdad57]

If you are a US commercial motor vehicle operator, pilot, rail worker, mariner or anyone who has medical certification for duty regulations. AVOID ORAL APPLIANCES at all costs.

Current guidelines do not allow medical certification as "under current and effective treatment" with 0ral appliances due to the lack of compliance data capabilities.

[shutterbug sue]

If you are a US commercial motor vehicle operator, pilot, rail worker, mariner or anyone who has medical certification for duty regulations. AVOID ORAL APPLIANCES at all costs.

Current guidelines do not allow medical certification as "under current and effective treatment" with 0ral appliances due to the lack of compliance data capabilities.

Very interesting, I didn't know that.

My daughter is an Air Traffic Controller in the Air Force and she can't take any medication at all when she does her job, not even an aspirin. Once she had to take antibiotics and they sent her home. She couldn't work the whole time she took the antibiotics because they didn't know how the medication would effect her mentally and jeopardize her ability to do her job.

[Jenny]

This is the oral appliance that I have:

SomnoMed MAS - Dorsal Fin Appliance
The SomnoMed MAS - Dorsal Fin Appliance is a custom-made device, consisting of upper and lower dental plates with a unique patented fin-coupling component, which allows normal mouth opening and closing. If required, a part can be added to make the device adjustable. This feature provides incremental and adjustable levels of lower jaw advancement, which improves the effectiveness and comfort-level of treatment as the jaw is moved only as far as is required to alleviate snoring and reduce OSA. Key features and benefits of the device include: Permits normal mouth opening Allows speech and drinking Provides full lip-seal Easily adjustable Safe and effective Clinically proven Custom-fitted Additionally, the SomnoMed MAS - Dorsal Fin appliance is made from durable fade-proof acrylic that retains its shape and color for at least four-five years and is covered by a three year manufacturer's warranty.

I'm using the SomnoMed MAS, but have not found the "sweet spot" yet. I'm out to 3.5 mm. I'd be interested in knowing how far you have advanced to? Thanks very much for your reply.

[PaulaO2]

If you are a US commercial motor vehicle operator, pilot, rail worker, mariner or anyone who has medical certification for duty regulations. AVOID ORAL APPLIANCES at all costs.

Current guidelines do not allow medical certification as "under current and effective treatment" with 0ral appliances due to the lack of compliance data capabilities.

Would you please PM (private message) me a link or two where it states this? I like to keep track of stuff like this.

[shutterbug sue]

This is the oral appliance that I have:

SomnoMed MAS - Dorsal Fin Appliance
The SomnoMed MAS - Dorsal Fin Appliance is a custom-made device, consisting of upper and lower dental plates with a unique patented fin-coupling component, which allows normal mouth opening and closing. If required, a part can be added to make the device adjustable. This feature provides incremental and adjustable levels of lower jaw advancement, which improves the effectiveness and comfort-level of treatment as the jaw is moved only as far as is required to alleviate snoring and reduce OSA. Key features and benefits of the device include: Permits normal mouth opening Allows speech and drinking Provides full lip-seal Easily adjustable Safe and effective Clinically proven Custom-fitted Additionally, the SomnoMed MAS - Dorsal Fin appliance is made from durable fade-proof acrylic that retains its shape and color for at least four-five years and is covered by a three year manufacturer's warranty.

I'm using the SomnoMed MAS, but have not found the "sweet spot" yet. I'm out to 3.5 mm. I'd be interested in knowing how far you have advanced to? Thanks very much for your reply.

I have no idea how far it's been advanced. It was advanced 5 turns by the dentist when I first started using it and he told me to continue advancing it one turn every week until it was out as far as possible before it became too uncomfortable.

I'm not using the oral appliance any more because I got an AutoSet machine (with a range of 9-12 instead of a set pressure of 10) and finally found a full face mask that is comfortable and doesn't leak. I also got a pulse oximeter. According to my sleep data results I found that I don't need it now.

[Jenny]

OK, thanks. I have moderate apnea and am hoping that the appliance might enable me to go hose-free one day. If not, then I know it will at least enable me to lower the pressure. But my sights are set on it working completely.