[Treatment] Defeating bumper belt -- more or less over time? (CPAP Alternatives)

[Don in Austin]

I am one who absolutely can not tolerate the C-Pap machine. I have an oral jaw advancement device custom fitted by an expert sleep dentist, which bothers me hardly at all. I am 67 years old and my apnea is medium/severe. When I can stay off my back, the numbers and sleep quality are good. The problem is, I am extraordinarily resourceful at defeating a backpack filled with clothing, tennis balls, etc. etc. Currently I am using the Zzoma bumper belt, but have ordered a Rem-A-Tee. I manage to slide the Zzoma around and sleep on my back at times and this shows up a lot in the numbers I track with a pulse oximeter.

What is the experience of bumper belt users?

Over time you train yourself not to sleep on you back? This is what my sleep dentist told me.

Or, over time, you learn to defeat any kind of anti-supine device?

This is important, because I don't hear ANYTHING good about any surgical options that might apply to me, and I gave CPAP the good old college try and then some. When I can stay off my back, I have gone an entire night with a total of less than 20 seconds of O2 under 90%, and I will take that.

Thanks in advance for your experience.

Here is my update -- yesterday the Rem-A-Tee belt arrived. It has three pockets on the back that take inflatable pillows. The pillows are nice and comfortable and I kept sleeping flat on my back on top of them! But the shoulder straps are good and keep the belt from rotating as was the problem with the Zzoma. Occasionally my wife nudged me and I went to my side. With that help I stayed above 90% oxygen the whole night with the exception of two brief events where I dipped to 89. But, clearly, the belt will not work for me as provided. I put tennis balls in the pockets and checked that this morning and it holds promise. We shall see what happens tonight and of course long-term. I have seen some oximeter postings on another forum and feel lucky that my OSA is mild in comparison to what some are going through, and still feel positive about the dental device/positional approach FOR ME. Just to repeat, I am NOT anti-CPAP in general -- it sure has been a blessing for my wife's condition. And yes, I know the pulse oximeter readings are not ideal comprehensive data, but I think they give me trends. At my next appointment with the sleep doc I highly respect, I will see about a home sleep study with all the patches on the skin, sensors up the nose, etc. I don't think another lab sleep study is in the cards at this time.

Latest update. Last week I went to my sleep doc who I like very much -- not strictly a doc but a certified nurse practitioner. She will spend whatever time it takes to go over things with me and seems extremely knowledgeable. She is working with the PLMD which complicates my sleep issues. Switched to Horizant which seems promising.

I brought here a week's worth of oximeter readings and together we went over each one. She says the dental device and staying off my back (most of the time) has the OSA under control. Be advised, this is NOT my sleep dentist and she routinely advises CPAP. I am pretty consistently above 90% O2 saturation, and have been as low as 1.2 O2 events/hr -- as measured by the pulse oximeter, of course. Totally untreated I had high moderate/low severe OSA. Nighttime awakenings still occur but much less often and getting back to sleep is rarely difficult. Some of these awakenings are almost certainly PLMD and some might be blamed on my having the prostate of an old buzzard. (67) Daytime sleepiness is significantly decreased. I am not through yet, and still working on staying off my back more. I need to have my wife get out the sewing machine and work on the straps I put on the ZZoma belt.

I take a sleeping pill on a VERY rare intermittent basis if I have done a really hard bike ride in the evening or, like today, a 60 mile ride with insane hill climbs. This can leave me still buzzing @ 10Pm -- might be good for weight loss to have metabolism still ramped up, but not so good for sleep. I know sleeping pills are not good for OSA, but, on the other hand, I am less likely to find a creative way to defeat the bumper belt and turn on my back when sedated a little.

I have to respectfully but strongly disagree with those that dismiss a good custom-fitted dental device as universally worthless for OSA. It does work for me and I don't think I am the only one for which it is viable. Compliance, convenience and comfort with the dental device are non-issues for me.

My wife has much worse OSA than I do, got a CPAP and absolutely could not stand any of the plastic masks. She bought a fabric mask over the internet, and it has worked miraculously since the first night she put it on. My experience with CPAP was not as good as hers to say the least! I ask forum members to keep an open mind about non-CPAP options just as I do appreciate what CPAP can do for so many apnea sufferers.

Thanks for reading my story -- Don in Austin

[RonWessels]

I have to respectfully but strongly disagree with those that dismiss a good custom-fitted dental device as universally worthless for OSA. It does work for me and I don't think I am the only one for which it is viable. Compliance, convenience and comfort with the dental device are non-issues for me.

I don't think that anyone here would dismiss dental devices as universally worthless for OSA. What is typically said is that they tend to only be effective for low to moderate OSA, and even then with non-guaranteed chance of success. Saying that it is _likely_ not going to work for someone (which is a statistical statement) is far different from saying that it _will_ not work for that person (which is a functional statement, easily dis-proven by a single success case).

What is also said is that, without an additional sleep study while using the dental device, unlike using a data-capable CPAP device, there is no indication other than subjective feeling as to whether is is actually useful or not. But, of course, the same is said for data-less brick machines.

[Don in Austin]

I have to respectfully but strongly disagree with those that dismiss a good custom-fitted dental device as universally worthless for OSA. It does work for me and I don't think I am the only one for which it is viable. Compliance, convenience and comfort with the dental device are non-issues for me.

I don't think that anyone here would dismiss dental devices as universally worthless for OSA. What is typically said is that they tend to only be effective for low to moderate OSA, and even then with non-guaranteed chance of success. Saying that it is _likely_ not going to work for someone (which is a statistical statement) is far different from saying that it _will_ not work for that person (which is a functional statement, easily dis-proven by a single success case).

What is also said is that, without an additional sleep study while using the dental device, unlike using a data-capable CPAP device, there is no indication other than subjective feeling as to whether is is actually useful or not. But, of course, the same is said for data-less brick machines.

"No indication other than subjective feeling?" Here you disagree with three sleep specialists I have spent considerable time consulting. Granted one is a sleep dentist so perhaps biased. The other two are an ENT who specializes in sleep medicine and a CNP sleep specialist. The CNP did NOT refer me to the sleep dentist -- that was my own research and decision. All three of these practitioners feel that oximeter readings DO have significance. And these readings are very different with my regimen than they were without it. I would call this "indication." I would never dispute that a full-fledged sleep study is more comprehensive, although there are serious limitations to anything that is one night only in a far-from-home setting. Neither would I dispute the benefits of how a CPAP machine can gather data.

I would also like to remind everyone that I am not comparing a dental device to CPAP therapy, but comparing a dental device PLUS positional therapy to CPAP therapy. The comparison of dental device alone vs. CPAP is a straw man. I was not satisfied with either positional therapy or the dental alone.

I can go on Craigslist and find listing after listing for CPAP machines hardly used and for sale cheap. Possibly illegal but they are there nevertheless. I see posts on this forum from people valiantly struggling with CPAP for months. They are in the minority of apnea sufferers as most will simply give up addressing their apnea problems altogether. These are reasons why I think that options other than CPAP are best for some.

For reasons I do not quite understand, I can not post a link to this, but there is an option for a dental device, plus CPAP WITHOUT any form of mask. That is what my dentist uses for his severe apnea. Nasal pillows are attached to a rod attached to the dental device. This combination therapy is claimed to be effective for extremely difficult cases, but I found a problem with air leaking out my mouth.
The contraption was far easier to wear than a CPAP mask.

[Sleepster]

All three of these practitioners feel that oximeter readings DO have significance. And these readings are very different with my regimen than they were without it. I would call this "indication."

To me that's a valid indicator for success. The thing is, more tests could be done to get a better indication. A CPAP set at 4 cm of pressure could collect more data provided you could tolerate it long enough to get some data. A home sleep study would be better yet.

I see posts on this forum from people valiantly struggling with CPAP for months. They are in the minority of apnea sufferers as most will simply give up addressing their apnea problems altogether.

There is also a large portion of the population that tolerates CPAP very well. We don't hear from too many of them here or on other forums. I don't know if they make up more than half the population, but I would guess that if they don't they're close.

The rest of us either try harder to adapt to CPAP therapy, give up, or go to some other alternative therapy like you have. I would rather see a friend use a dental appliance and a wedge than nothing at all; the CPAP machine being in the closet gathering dust.

For reasons I do not quite understand, I can not post a link to this, but there is an option for a dental device, plus CPAP WITHOUT any form of mask. That is what my dentist uses for his severe apnea. Nasal pillows are attached to a rod attached to the dental device. This combination therapy is claimed to be effective for extremely difficult cases, but I found a problem with air leaking out my mouth.
The contraption was far easier to wear than a CPAP mask.

This sounds like the nomask. The nasal pillows are held in place by the guard that fits over the upper teeth. A CPAP machine is still needed. Air can still leak out of your mouth like it can with any other nasal pillows mask, or any nasal mask. A chin strap fixes this problem for most people.

[Don in Austin]

All three of these practitioners feel that oximeter readings DO have significance. And these readings are very different with my regimen than they were without it. I would call this "indication."

To me that's a valid indicator for success. The thing is, more tests could be done to get a better indication. A CPAP set at 4 cm of pressure could collect more data provided you could tolerate it long enough to get some data. A home sleep study would be better yet.

I see posts on this forum from people valiantly struggling with CPAP for months. They are in the minority of apnea sufferers as most will simply give up addressing their apnea problems altogether.

There is also a large portion of the population that tolerates CPAP very well. We don't hear from too many of them here or on other forums. I don't know if they make up more than half the population, but I would guess that if they don't they're close.

The rest of us either try harder to adapt to CPAP therapy, give up, or go to some other alternative therapy like you have. I would rather see a friend use a dental appliance and a wedge than nothing at all; the CPAP machine being in the closet gathering dust.

For reasons I do not quite understand, I can not post a link to this, but there is an option for a dental device, plus CPAP WITHOUT any form of mask. That is what my dentist uses for his severe apnea. Nasal pillows are attached to a rod attached to the dental device. This combination therapy is claimed to be effective for extremely difficult cases, but I found a problem with air leaking out my mouth.
The contraption was far easier to wear than a CPAP mask.

This sounds like the nomask. The nasal pillows are held in place by the guard that fits over the upper teeth. A CPAP machine is still needed. Air can still leak out of your mouth like it can with any other nasal pillows mask, or any nasal mask. A chin strap fixes this problem for most people.

Thank you for respecting my decision and giving it more credibility than Ron Wessels did. When I was trying the CPAP machine, my sleep CNP was never very happy with the results. I have had only one home sleep study and that was with positional therapy alone. That wasn't great although my first sleep doc pronounced me good-to-go. That was just one of the reasons I switched sleep clinics. I am very appreciative of good medical care and very critical and intolerant of indifferent medical care.

It is true this board will not hear from most of those who have been prescribed CPAP -- that includes those who are not determined to see it through with CPAP no matter what and those for whom it is not very daunting at all -- like my wife. But it does not seem to be disputed that the overall compliance rate with CPAP is not good. My wife is the only person I know who uses one, and I know lots of people who have them in a closet -- small sample of course, but what I have read makes it plausible that the sample is typical.

There comes a point where if I am satisfied, my three sleep specialists are satisfied, Medicare is unlikely to pay for further sleep studies, I am going to have to be satisfied -- at least for the time being.

The device with the nasal pillows attached to a rod sticking out of the dental device I know of as TAP-PAP. That is probably what I would pursue further if I felt my current regimen was inadequate. According to my sleep dentist, it is good for the most difficult cases and can be better than CPAP alone. For now, I am going to keep working on staying off my back. The ZZoma belt needs some modification.


Thank you for an understanding reply.

Don

[RonWessels]

All three of these practitioners feel that oximeter readings DO have significance. And these readings are very different with my regimen than they were without it. I would call this "indication."

I don't disagree. I would consider nighttime oximeter readings to be a very basic sleep study. My point was that, unless you found a dental device that I've never even heard of before, the oximeter is not part of the dental device. With CPAP (for example), the nighttime data is an integral part of the treatment machine. With a dental device, a separate device has to be used for verification.

With my CPAP, I get an indication every night about the treatment efficacy. Do you wear a recording oximeter every night, or do you rely on spot checks that could easily miss something?

That was my point.

[ Edit: I just saw your reply to Sleepster and wanted to address that as well. ]

I am not disputing that your treatment is working for you, and I truly apologize if I've given you that impression. In fact, I sincerely congratulate you. I'm glad you found an effective treatment that works for you. What I am disputing is what I feel is your implicit statement that this is more of a sure thing for other people than statistics indicate.

[Don in Austin]

All three of these practitioners feel that oximeter readings DO have significance. And these readings are very different with my regimen than they were without it. I would call this "indication."

I don't disagree. I would consider nighttime oximeter readings to be a very basic sleep study. My point was that, unless you found a dental device that I've never even heard of before, the oximeter is not part of the dental device. With CPAP (for example), the nighttime data is an integral part of the treatment machine. With a dental device, a separate device has to be used for verification.

With my CPAP, I get an indication every night about the treatment efficacy. Do you wear a recording oximeter every night, or do you rely on spot checks that could easily miss something?

That was my point.

[ Edit: I just saw your reply to Sleepster and wanted to address that as well. ]

I am not disputing that your treatment is working for you, and I truly apologize if I've given you that impression. In fact, I sincerely congratulate you. I'm glad you found an effective treatment that works for you. What I am disputing is what I feel is your implicit statement that this is more of a sure thing for other people than statistics indicate.

Well, we are not in as severe a disagreement as it might have seemed, I think. Let me just address a couple of things.

I don't wear the oximeter every night, but I do wear it frequently. I took a week's worth of readings to my sleep doc (actually a certified nurse practitioner, but FAR more knowledgeable than my previous "doc") arranged from best to poorest. It is very little trouble to stick the thing on my finger and put on the "watch," so it not being built in is not much of an issue to me. By far the most comprehensive study is what's done in a sleep lab, but I have serious doubts about those results because there is one isolated sample under conditions far from what one is used to. If your apneas are position dependent, all the harnessing is going to skew things.

I don't think I would use the term "sure thing" for either dental devices or positional therapy. By far, the closest there is to a "sure thing" is CPAP except that severe compliance issues render it far from a "sure thing" in the real world. Those on this board are far more determined than a good many of those prescribed CPAP and it still has not been easy for some. I am sure many have dropped out and have abandoned all treatment. I have been determined to treat my sleep problems, but the nature of my determination has been "This isn't working, so let's try something else, actually a couple of other things in combination."

As far as statistics go, I have seen almost nothing either way on a dental device combined with positional therapy. Hell, I wish I had significant weight to lose and then I could have 3 synergistic approaches going! Unfortunately-- and fortunately -- I am not more than 10-15 pounds over an ideal weight. I could take up playing that weird flute, but somehow I doubt very many people do that, although I was told there was an actual study.

Just hypothetically, let's say positional therapy reduces apneas to 1/3 of a no-treatment level. This is not so great except for very mild cases. Let's say positional therapy reduces apneas to 1/3 -- again not so good. But let's say both approaches are 1/3 x 1/3 = 1/9th. Now this might be acceptable for less than severe cases.

i wouldn't hesitate for a moment to concede that the effectiveness of dental device therapy and positional therapy will vary widely among different individuals -- worthless for some, useful for others and for some quite respectable with both combined. The real world effectiveness of CPAP is just as variable because of the sad reality that non-compliance is rampant even if my wife had ZERO problems after trying her third mask. More power to those who can conquer the CPAP compliance issues, and more power to those who are successful moving on to some other approach.

I am not here to tell anybody what to do. I only suggest that if you don't succeed keep trying and that may mean trying different things.

Ron, thanks for reading this and your good words....Don

[Sleepster]

It is true this board will not hear from most of those who have been prescribed CPAP -- that includes those who are not determined to see it through with CPAP no matter what and those for whom it is not very daunting at all -- like my wife. But it does not seem to be disputed that the overall compliance rate with CPAP is not good. My wife is the only person I know who uses one, and I know lots of people who have them in a closet -- small sample of course, but what I have read makes it plausible that the sample is typical.

I don't think it plausible. A lot of people use their CPAP machine and think nothing of it. They don't talk about and there's usually no reason someone would think to ask them about it.

Every time I talk to anyone about my CPAP therapy they almost always mention friends and relatives who also use them. Had I not approached them to inquire, I would never have known.

According to this article, compliance rates are below 50%.

http://www.uthscsa.edu/mission/article.asp?id=547

Personally, I believe that successful CPAP-users are receiving better treatment for their affliction than those who have opted for alternative treatments. That's why I always encourage folks to learn to tolerate it. Once you get past the initial adaptation phase you will know for sure whether or not your treatment is effective.

[becker44a]

. . . The problem is, I am extraordinarily resourceful at defeating a backpack filled with clothing, tennis balls, etc. etc. Currently I am using the Zzoma bumper belt, but have ordered a Rem-A-Tee. I manage to slide the Zzoma around and sleep on my back at times and this shows up a lot in the numbers I track with a pulse oximeter.

You might try lining the inside of the Zzoma belt with some of that non-slip shelf liner material. It is very high-friction, and most varieties are made as a sort of waffle-weave open textured material. My wife has sewed it together with other material and it has been quite durable, and washable too.

I've never seen how a Zzoma device is made, but the website pics seem as if the whole thing is encased in black nylon. If so, then the nylon would not be very high-friction, and the shelf-liner material could make quite a difference in its resistance to sliding around.

Could be a cheap mod to make an expensive product perform better for you.

[Brian Schulz]

I too could not cope with CPAP after 15 months, three machines and five masks as I have an anxiety problem and mouth breather. Both my Doctor and Specialist said I have given it my best shot. I have always used a back pack as my AHI is 65/hr whilst suprine and 44/hr in REM. I use three tennis balls horizontally across my back and it seems to work. I now have a SomnoDent dental sleep apnoea device for a week now and after 15 months of torture I now see a light at the end of the tunnel as the headaches are now virtually non existent in the morning and much improved and it will improve with more adjustments and my friend who has had the device for over a year assures me.
Brian