Forum · Just got an oral appliance

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[-] IntuitiveSapphireZebra3375 +0 points · 2 months ago

Been on CPAP for several years now. It helped, but I was not much of a fan. Took the plunge and got an oral appliance. It is set to 'low' (for lack of a better term) for now. Used it last night for the first time. Found it more comfortable than CPAP (I had been using a dreamwear nasal pillow mask, found it the most comfortable of all the ones I had used). Slept pretty well. No drooling or jaw pain. It does have a slight 'plastic' taste. They give you an insert to bite down on first thing in the AM after you take it out (to help realign your jaw). Anyone had long term success w/ their oral appliance?

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[-] SleepDent +1 point · 2 months ago

Hi IntuitiveSapphireZebra3375, I am a dentist working in dental sleep medicine. As to the plastic taste, the appliance is brand new and sometimes a little bit of the acrylic monomer will leach out until the plastic ages a bit. That could account for the plastic taste. It will probably go away over time. There is also a new universal cleaning agent called Prodentclean that might help. See": www.Prodentclean.com. I know that you are looking for patient feed-back, but I can tell you that I personally know hundreds of patient who have done well long term on oral sleep apnea appliances. Isn't it a amazing just how much more comfortable it is than CPAP. It is a real pity that the sleep physicians as a group are relatively unsupportive of oral appliances. They could be helping a large number of patients who could really benefit. a.b.luisi,d.m.d.

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[-] Ruby +0 points · 2 months ago

I'm glad you are finding relief with the oral appliance. Each person is different and what works for one does not always work for another. I have two friends that have tried the oral and it did not work for them. It is so much trial and error and insurance isn't always willing to let you try different things.

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[-] SleepDent +1 point · 2 months ago

One major problem with the oral appliances is the extreme lack of really competent, really experienced sleep dentists. These oral appliances are VERY difficult to deliver well and proper appliance selection is critical because there are a lot of bad ones on the market. What is happening is that a lot of regular general dentists are taking a few courses and adding dental sleep medicine to their practices as a new profit source. They are not doing a particularly good job, there are many failures that could have been averted, the patients are not well served and the reputation of oral appliances suffers. I have ten years of experience and do dental sleep medicine on an almost full time basis. At this point, my long term success rate with mild-moderate OSA patients is 85% and I am even doing fairly well with severe patients. There is a steep learning curve and you have to do a lot of cases to get there. I do have some sympathy for the other dentists because they probably don't have much sleep appliance volume and they are trying to make a living. The take away here is to try to find a really experienced full-time sleep dentist and a lot of the so-called "Trial and Error'' goes away. a.b.luisi,d.m.d.

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[-] PersistentMagentaRoseZebra4626 +0 points · 2 months ago

I started on CPAP mid last year. Went well at first but ran into major problems...

I then started to consider going for an oral appliance. Unfortunately, due to many negative posts I read on another forum, I became convinced that an oral appliance could never possibly work. I felt like I had no real options left. I was absolute distraught and terrified...

CPAP became impossible. I had to try something else. My oral appliance arrived last week... and it 100% works.

I wasn't too sure the first couple of nights (I had been off CPAP for a couple of weeks and therefore I was quite sleep deprived). However, by the morning after night 3 it was clear to me it was working. I was able to get up full of energy and stay up for the entire day (as compared to the previous few months of being essentially bedridden).

I am absolutely furious at the posters at this other forum who are constantly negative towards oral appliances. They make an effort to scare people into believing they don't work. I do wonder why are they SO hostile towards oral appliances? Are they paid money by the CPAP manufacturers?

Don't fall their nonsense! If you are struggling with CPAP at least try an oral appliance. Of course it may not work (just like CPAP doesn't work for all). But if it does work you will be so happy you switched!

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[-] DrTonySoileau +0 points · 2 months ago

Try not to get too mad at the negative post on the other forum. Some patients want a McDonald's fix and treating sleep apnea takes time for some cases. And these patients are frustrated because they are not sleeping perfect the first night. Its understandable even if its frustrating. Or maybe they are sleeping fine but the insurance did not pay anything so it cost them $2-4,000 and to them a good night sleep for the rest of their life is not worth this amount. So instead of getting mad at the insurance company they say negative things about the dental appliance and/or the dentist. Its simply the world we live in. The people on this forum seem to be more commuted to having their sleep apnea treated and open to different ideas.

Dr Tony

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[-] IntuitiveSapphireZebra3375 +0 points · 2 months ago

4 nights in and I'm glad I switched. I have a great dentist I am working with (I use her as my regular dentist too). She got into the oral appliances as her son has sleep apnea. She came recommended by a local sleep apnea support group. Cost was $2.500. That covers everything and follow-ups. I had to pay out of pocket and will be partially reimbursed by my insurance. You work your dentist and health insurance (I had to get pre-approved for the device) , as it is a 'dental' procedure that some health insurance covers. I have the Somnomed device.

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[-] SleepDent +0 points · 2 months ago

Dear IntuitiveSapphireZebra3375, Let me tell you, if you think that the ignorance and prejudice surrounding oral sleep apnea appliances is bad now, you should have seen how blisteringly bad it was 10-12 years ago when I first tried to introduce them into my area. The sleep doctors almost threw me out of their offices, but at least they did it with a smile. Things are much better now, but we have a long, long way to go before they get a fair shake. Dr. Luisi

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[-] IntuitiveSapphireZebra3375 +0 points · 2 months ago

Been using it over a week now and glad I switched from CPAP. No jaw pain. More comfortable than CPAP IMO. Plastic taste is all good. Went in for my first checkup. Everything looks good. Dr. moved it one click forward. I move it another click at the end of the week if I don't have any issues. Insurance is going to pick up about $1,300 of the cost.

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[-] SleepDent +0 points · 2 months ago

Sounds like things are going according to plan. Keep up the good work! Dr. Luisi

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[-] Ruby +0 points · about 2 months ago

Everyone is different and that's exactly why there are so many mask types, appliances and machines. When you find something that works, then go for it and don't worry what others say. Congrats on finding what works for you.

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[-] NiceSilverBison1316 +0 points · about 2 months ago

I've had an oral appliance for a few months now, after trying several CPAP machines for over a year. Although I had good results with CPAP therapy, I found it to be just too much of a hassle. The oral appliance takes some getting used to, but it is so much simpler. There are no hoses restricting your movement during sleep or air blowing in your nose or mouth and no electricity required. After use, I just use retainer tablets to clean and disinfect the appliance, then let air dry. Initially, I had some jaw pain while the ligaments in my lower jaw got used to it, but it went away quickly. On my first sleep study, with no advancement of the lower jaw, my AHI was 7.2. This was higher than my 2 to 4 AHI with CPAP, but still not terribly high. I have since advanced my adjustment to my lower jaw to lower my AHI. I have found that I am a mouth breather when I fall asleep and that precipitates my sleep apnea episodes. I also do some teeth grinding during the night, so I now use a chinstrap (ruby red harness) to prevent my mouth from opening during sleep. This combination seems to work for me and I am looking forward to my next sleep study in July.

PS: I am using a TAP 3 Elite oral appliance. Welcome to the forum Dr. Luisi! You are a welcome addition.

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[-] SleepDent +0 points · about 2 months ago

Thank you NiceSilverBison1316! Your TAP3 Elite is a great appliance, the most effective that currently exists. Be very careful about what cleaning agent you are using. What you said sounds non-standard for a TAP. It could shorten its lifetime. AirWay Management that makes the TAP now sanctions a new cleaning agent, Prodentclean. See: www.Prodentclean.com. The dental sleep medicine community is no longer sure that it is useful or correct to compare CPAP AHIs directly to oral appliance AHIs. These are two different modes of treatment. We shouldn't think of them as CPAP and CPAP lite. I asked for a declaratory letter from the American Academy of Dental Sleep Medicine and they stated that there are no generally accepted AHI numbers to judge oral appliance therapy by at this time, but it is probably neither correct nor practical to use the classic standards used for CPAP. Now, I know this is going to be controversial with this community and I might set off a firestorm, but bring it on. Dr. Luisi

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[-] wiredgeorge +0 points · about 2 months ago Sleep Commentator

Interesting that a professional desires to make the definition of Apnea-hypoapnea some sort of sliding scale based on method of treatment. If you stop breathing for 10 seconds, I am not sure whether the means of therapy should mean the effects of apneas or hyphoapneas would be different. If you cease breathing with a dental appliance in your mouth for 10 seconds or longer, I can't perceive how the medical effects of low Sp02 would be different than on positive air pressure therapy. Are you suggesting the effects with a dental appliance will be less or different or that Sp02 drops will have less effect? CPAP AHI? Oral Appliance AHI? An apnea or hypoapnea is the cessation of breathing so why are you making a distinction?

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[-] SleepDent +0 points · about 2 months ago

Your point is well taken. Basically, in 2015 the AASM and the AADSM had a big joint conference on oral appliance therapy. They went through all the test data for medical outcomes in all categories for both CPAP and oral appliances. The outcome was that, for all medical outcomes, there was no statistical difference between CPAP and oral appliances with the exception of oxygenation levels, where CPAP showed a significant superiority to oral appliances. Admittedly, this is confusing. Does not jive with our current model of the pathogenisis of OSA. I can not give you a definitive answer, but I do have a theory. From my own experience with CPAP patients my sense of it is that the problem with CPAP is that it is just too intense for people to sleep with comfortably. From the mechanical point of view, it eliminates apneas and hypopneas quite efficiently, thus improving oxygenation. On the other hand it also tends to disrupt the patients sleep with noise, mask leaks, strap pressure on the face, unpleasant sensation of air pressure in the airway, etc. The oral appliance is just a gentler experience. I think that the slightly lesser treatment efficacy of oral appliances may be offset by less overall disruption in the patients sleep, giving a better over-all experience for many people. This is the best I can do, we are struggling to understand it, just like you are. Dr. Luisi

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