What are your thoughts on dental Daytime Nightime Appliances (DNA)?

[NoddingHacker]

I have seen MADs being mentioned frequently as alternatives for mask treatment (even by Dr Christian Guillert, the guy who coined the term OSA). Upon further research I stumped upon DNAs. To those who don't know what they are, here are a few links:

https://www.kellyerice.com/vivos-dna-mrna-system/
https://oralsystemiclink.net/patients/pr...our-airway

DNAs (Daytime Nighttime Appliance) are like braces that reshape your jaw, increasing the space in your throat which allows for proper airflow that may help (or even cure) your sleep apnea. They also claim to have cosmetic benefits like by making your face protrude forward more (which is a factor in facial aesthetics).

The field is called Epigenetic Orthodontics. Did anyone ever hear of DNAs or Epigenetic Orthodontics? Their claim of curing sleep apnea while making you more attractive in the process sounds too good to be true. On the other hand, I have stopped counting on my doctors to be well informed on the best therapies for me. So what do you say?

[greyham]

I recently started using a Vivos mRNA Appliance to treat my severe obstructive sleep apnea. It combines the expansion function of the DNA appliance with mandibular advancement. I previously tried a SomnoMed MAD, but it only reduced my AHI from 39 to 31. I've been on CPAP for almost 12 months and while I do feel a lot better, it hasn't eliminated my daytime fatigue. I'm hopeful that the mRNA will give me my health back, but it's early days as I've only been wearing it for 8 weeks and I expect the full treatment to take 2 years.

Cheers,
Graham

[weiss27md]

There are many causes for fatigue besides sleep apnea, like thyroid disorders and mthfr disorders. There are also many different things that can cause sleep apnea including chronic nose breathing and certain nutritional deficiencies.

[NightOwl42]

I've been considering the following course of treatment for mild- to moderate-sleep apnea.

1. Oromyofascial Therapy (OMT). Basically a fancy name for mouth, tongue, and jaw exercises to create better tongue position and encourage nasal breathing, also as preparation for the next step. ~$1,200
   
2. Frenulectomy (tongue tie release). A quick snip at the base of the tongue to allow it more reach, so it can sit at the top of the palate correctly. $600
   
3. Palate expansion device, Vivos is one model. $4500-8500
   

It's unlikely that my health insurance will cover this approach.

I saw an ENT surgeon, he put a scope in my nose to check airway, and said that from his perspective, I was not a candidate for any kind of surgical intervention, and was skeptical that #3 would be effective.

There are some small studies on this approach, but no one seems to have great data yet.

I wanted to pick up on this thread and ask if anyone else had experience with this course of treatment.

[greyham]

I saw an ENT surgeon, he put a scope in my nose to check airway, and said that from his perspective, I was not a candidate for any kind of surgical intervention, and was skeptical that #3 would be effective.

There are some small studies on this approach, but no one seems to have great data yet.

I wanted to pick up on this thread and ask if anyone else had experience with this course of treatment.

I'm curious whether your ENT identified the location of your obstruction during the scope, and what types of surgical intervention he evaluated you for? If all he considered was soft tissue surgeries like UPPP, tonsillectomy or adenoidectomy, those have a relatively low success rates particularly if the underlying problem is craniofacial dystrophy and a retrognathic maxilla. Did he consider SARPE, SMARPE, DOME, MSE or MMA surgery? If not, a maxillofacial surgeon or an airway focussed dentist or orthodontist may be able to offer a different perspective.

There is a lot of skepticism about the DNA Appliance from practitioners with no experience with it, but it seems this is true of all the treatment options for addressing retrognathia: the proponents of each approach often disparage approaches that they don't have personal experience with, rather than simply saying that they haven't tried it before and referring you to someone who has. I felt there was sufficient evidence that the DNA Appliance could work to correct the underdeveloped jaws causing my severe obstructive sleep apnea to commit two years of my life to pursuing it. I'm currently 7 months in and you're welcome to check out my progress on my blog. I'm reasonably optimistic but I know it's going to take time... If your OSA is "only" mild-moderate, you may be an even stronger candidate and get a result sooner than me.

Good luck!
Graham

[NightOwl42]

Graham,

Thanks for your detailed response. The ENT was very reasonable, and pointed out that he works in one domain, and dentists work in another. He didn't dismiss the possibility that a DNA appliance would work, and he thought oromyofascial therapy showed some promise as well. Though he didn't think I had enough of a tongue-tie to merit surgery. I haven't discussed, nor considered, any other surgery.

From his perspective, also, since my CPAP machine is effective at managing my condition, he is not inclined to support other interventions.

I think my largest concern here is paying for the appliance, if I can't get the ENT to request a pre-authorization. 

He also said he didn't think the insurance company would cover it even if he did.

The dentist I saw, who did the fancy 3D scans, offered two options. One is $4,500, not sure the manufacturer, and the other is the $8,500 Vivos. She thought that for my case, the less expensive device would be just fine.

I should note, I am a CPAP user, but I don't tolerate it that well, regardless of what any data shows, and it would be worth the above costs to be rid of it forever.

[greyham]

I should note, I am a CPAP user, but I don't tolerate it that well, regardless of what any data shows, and it would be worth the above costs to be rid of it forever.

I hear ya. It may be worth checking whether your insurance would cover the appliance if your doctor reports that you don't tolerate CPAP. I'm in Australia and mine didn't so I paid myself.

Cheers,
Graham

[trenton78]

I wouldn’t pay $8500 for something that MIGHT work. I‘ve already wasted too much money on CPAP-alternatives to take that risk.

[Sleeprider]

I just have to ask, have you tried non-invasive CPAP first? Neither surgery nor dental appliance seem to provide the efficacy and simplicity of CPAP. I see your profile shows a Prisma Smart. Is there a reason that you are pursuing surgical or dental alternatives?

[jaswilliams]

Nightowl42 you say you don’t tolerate CPAP well what does that mean ? Even the good surgical interventions only tend to reduce apnoea by 50% soyou could have all that pain and risk and still need a Cpap device afterwards