Tongue Holder / Retainer with CPAP does not meet expectations.

[G. Szabo]

I am reporting my experience with a silicone Tongue Holder, a low-cost Chinese product identical to AveoTSD. I wanted to mitigate the inhalation flow limitation and reduce the treatment pressure because I suspected that my tongue caused these. I was wrong. Nevertheless, I want to hear your opinion as well. 

Attachment: Tongue retainer 01. The whole night: The first session was with the trainer but without sleep; the second session was sleeping with the trainer; the third session was sleeping without the retainer. 
Attachment: Tongue retainer 02. Inhalation flow limitation with the tongue retainer during sleep (within the second session). 
Attachment: Tongue retainer 03. CA and H with the tongue retainer during sleep (within the second session). 
Attachment:  NO tongue retainer. Exhalation flow limitation without retainer during sleep (within the third session). 
Attachment:  Retainer. The device.  

Conditions for all sessions 
Strictly enforced lef-side sleep
Velpeau collar
Taped mouth (multiple taping to secure the device and prevent leaks).   
Nasal mask            

Details: 
The leaks with the retainer result from saliva flow loosening the tape. A full face mask might be more suitable to avoid this issue. It was difficult to fall asleep because as my tongue tone relaxed, the device pulled it out more, creating an unpleasant sensation. Also, it increased saliva production. When I removed the retainer after the second session, my tongue stayed longer and narrower with a shoulder on it. But it relaxed back to its original shape within  5-10 minutes. Because of the thickness of the retainer, my jaw was lowered during sleep. 

Conclusion: 
The retainer could not reduce the inhalation flow limitation, so my tongue might not have caused it. 
However, there was no exhalation limitation with the retainer,  but more data will be needed to confirm this. So perhaps my tongue pushed my palate back in the absence of the retainer?

[G. Szabo]

Some more attachments

[Sleeprider]

I have never seen one of these devices that worked, much less one I would use. Your zoomed image shows this tongue holder may have caused an expiratory palatal prolapse. So it's not a very good trade off.

[G. Szabo]

 Your zoomed image shows this tongue holder may have caused an expiratory palatal prolapse. So it's not a very good trade off.

It actually prevented the expiratory palatal prolapse, which occurred in the absence of the retainer. I attached too many screens; they might be confusing. 

Also, two European devices work: the nasal stent and the Swiss metal ring in the mouth, which prevents expiratory collapse. So, I believe it is worth trying some alternatives.

[HalfAsleep]

I guess I don’t understand the disagreement. The exhales look pretty biffed in the 4th sample.

I’m also not sure about the comment “two European devices work”. Are you meaning in your experience they work on you? I would speculate, as a matter of accuracy, they are very unlikely to work on everyone, since, it seems, not a whole lot about mouth architecture in the sleep arena does.

And that's a heck of a lot of accoutrements embellishing head and mouth! Tape and collar and plastic mouthpiece and mask? Sometimes simple is the optimal approach and safest approach IMO: all those breathing interventions look scary to me. I mean, what if you cough? That combination would be like self-intubation IMO. What if the power goes out?

[G. Szabo]

I guess I don’t understand the disagreement. The exhales look pretty biffed in the 4th sample.

The Tongue Holder / Retainer moves the base of your tongue out of the way, mitigating inhalation obstructions. However, it does not treat the palatal prolapse-caused exhalation limitation. The fourth sample is a textbook case of palatal prolapse.    

[G. Szabo]

I’m also not sure about the comment “two European devices work”. Are you meaning in your experience they work on you? I would speculate, as a matter of accuracy, they are very unlikely to work on everyone, since, it seems, not a whole lot about mouth architecture in the sleep arena does.

Suppose you consider the success stories (including my one) with the nasal stent (for palatal prolapse) published on this forum, too, and also add that its manufacturer cannot satisfy the demands, creating a longer-than-thee-month backorder. In that case, you might wish to recognize that it works for a large population of those willing to learn its usage, which is not a piece of cake, I admit.  

As for the stainless steel ring insert approved in Switzerland and Germany for palatal prolapse and snoring: They have sold over 30,000 pieces.

In my previous comment, I just expressed my humble opinion that although the USA is the leading health provider in most areas, the FDA's workflow and the strong influence of large medical corporations make it difficult to introduce some really effective European solutions.

[G. Szabo]

Tape and collar and plastic mouthpiece and mask? Sometimes simple is the optimal approach and safest approach IMO: all those breathing interventions look scary to me. I mean, what if you cough? That combination would be like self-intubation IMO. What if the power goes out?

I agree that the mouth tape has a risk. It would be best to always consider the risk/benefit balance, which can be very different for people with different health conditions.  

By the way, I have installed a power outage alarm (it's ten bucks on Amazon) and am currently working on some alarms that warn you when your instrument cannot deliver the minimum pressure.

[HalfAsleep]

Thalidomide, IUD's, fen-phen, and silicon breast implants (all with disastrous consequences) have been very popular government-approved medical interventions here and abroad. So, I tend not to value either effectiveness claims or risk assessments for popular products. Sometimes, there's a lot of wishful thinking involved.