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Oral Appliance queston and other questions

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ric7744 +0 points · over 2 years ago Original Poster

Hi, I was diagnosed with mild sleep apnea had a 10.7 AHI. I tried Cpap and different masks, I just can't sleep with the air blowing in on me. I tried everything. I saw a Sleep Dentist and they are going to do Impressions for a oral appliance this Thursday. She discussed a few different appliances with me and I am not sure which one she settled on but I think is a Somnodent Herbst because I grind. What have you guys used and which ones seem to be the best one's? My other question is I had a home sleep test and the actual apnea event were 2.4 central to .7 obstructive the rest is Hypopnea's. I do feel symptoms of apnea. I don't really snore much but I have woken up with a snort sound before. Should I be worried that the Hypopnea's are Central and Oral Appliance won't work? My sleep Doc says I have Mild Obstructive problem. When the sleep doc put in a temporary sleep appliance I could feel I breath much clearer. Thanks for the help

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Kinikea +0 points · over 2 years ago

I have the MyTAP and am very happy with it. It seems to be a more economical way to try out a oral device. Plus, it can be fitted to you right on the spot. I am not an expert, by any means, but I am very happy with this device.

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SleepDent +0 points · over 2 years ago Sleep Commentator

The MyTAP has all the features of a very effective oral appliance, therefore it is a great way to see if you like the OA experience at a fairly low price of entry. However, it is fairly lightly constructed and will probably last only about a year before breaking for the average person. You can then elect to go on to a more substantially build(and more expensive) appliance or get it repaired and go on. The outlay for both strategies tends to be about the same over time, but the MyTAP is a lower initial money outlay and the expense comes in dribs and drabs over time. Arthur B. Luisi, Jr., D.M.D.

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SleepDent +0 points · over 2 years ago Sleep Commentator

You are a bit confused. Both apneas and hypopneas are obstructive breathing events. With apneas, the airway is completely closed for at least ten seconds. Hypopneas are partial airway obstructions that last at least ten seconds. Both types can do you harm. Your official diagnosis is OBSTRUCTIVE sleep apnea. This means that, in the opinion of your sleep doctor, the central sleep apneas are few enough in number that they are only background noise and not to be considered during treatment. With adequate treatment of the obstructive sleep apnea, the scattered central events may, or may not go away. Oral appliance selection is very patient specific. It would really make very little sense for me to suggest some without examining you first. Arthur B. Luisi, Jr., D.M.D.

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ric7744 +0 points · over 2 years ago Original Poster

Thanks for the replies, My Sleep dentist seems competent, she had pretty much every device out there, she seemed to like Somnodent Herbst for me, she said that is has a shorter metal bar so less bulk, I think the other one she liked for me was the micr02 bit she wasn't sure about it because I seem to be a side grinder. I hope she it right. I wear a nightguard on the upper for grinding and it never bothered me so I am hopeful that a appliance won't either.

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SleepDent +0 points · over 2 years ago Sleep Commentator

Interesting. People who are side to side grinders merit special consideration. Many oral appliances will not work well for them. Knowing that, I would especially mention the DreamTap by Airway Management. The upper and lower trays are centrally joined on a long track running laterally from side to side. The appliance can glide smoothly from side to side. Absolutely great for side to side bruxers. Arthur B. Luisi, Jr., D.M.D.. The Naples Center for Dental Sleep Medicine. Practice partner, dental sleep medicine, NCH Healthcare System. Practice partner, dental sleep medicine, The Millenium Physician Group.

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ric7744 +0 points · over 2 years ago Original Poster

The good thing is I am not as bad a grinder as I used to be. My old nightguard had lots of wear but the newer one has lasted a long time. If I wear out the Appliance eventually that is fine, I will get another. I don't think I could ever do cpap.

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HappyandSad +0 points · over 2 years ago

I started using an oral appliance 8 months ago under the direction of a dental specialist. We gradually advanced the appliance 1 millimeter at a time (to 3 millimeters) until I could tell that I felt rested the next morning. I had another overnight sleep study and had lowered my episodes from 24 to 7, so I was very pleased. The clinic requested that I have the appliance advanced another half millimeter to hopefully bring me down to a number less than 5, so I did. This is the "happy" part of my story, as I could not tolerate the cpap at all, and this was working fine. The "sad" part is that my jaw isn't returning to its original position in the morning. I had exercises to do each morning, and I will confess that I wasn't totally diligent about doing them, but I did not realize that this would be the result: My bite has changed significantly, and it has affected my speech somewhat. Friends say they wouldn't have known if I hadn't told them, but this really bothers me. The dental specialist sent me to a physical therapist specializing in the jaw, and I worked with her for a while, but nothing changed. My regular dentist suggested I move it back one millimeter to see if that helped, so my dental specialist did that. I've been doing my exercises regularly, but so far no change. The dental specialist told me that this happens to some people, and I might have to decide to just live with the change in bite or stop using the appliance and hope my jaw returns to its original position or perhaps get braces if I do stop using it. Has anyone else had this issue and, if so, had success correcting it?

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Kinikea +0 points · over 2 years ago

The MyTAP has a "repositioner" that is like a retainer (sort of) that you put in your mouth for around 15-30 minutes in the morning when you take out the MyTAP. This is supposed to bring your bottom teeth/jaw back into place. I does not work 100% but close to it. I had a night guard too and found using a oral device to be an easy transition. I have been using the device since early March, 2018.

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SleepDent +0 points · over 2 years ago Sleep Commentator

This problem with bite change caused by oral appliances is a thorny one and there is not total consensus about it within the dental sleep medicine community. Let me get a little technical at this point. Everyone has an ideal biting position wherein the muscles are best balanced and at rest. However, a person's actual bite is determined by how his teeth meet and interdigitate. The actual bite may or may not coincide with the best physiological position. Oral appliances disocclude the teeth over night, and given a period of time, the muscles may actually seek the more ideal posture, thus throwing the "normal" bite "off". It is also true that orthodontic forces from the appliance can change tooth positions a mm or 2 over time, but that takes longer unless a person has compromised tooth support from periodontal disease, at which time they should not be using an oral appliance. Morning repositioning devices attempt, with some level of success, to return your bite to what it was the day before, but in order to work, they must be used diligently EVERY Morning. Even with that, the bite will still sometimes change a bit. It may get down to a matter of priority. Will the patient accept a certain level of bite change to get the health benefits of the appliance? It is a personal decision. Arthur B. Luisi, Jr,D.M.D.. The Naples Center for Dental Sleep Medicine. Practice partner, dental sleep medicine, NCH Healthcare System. Practice partner, dental sleep medicine, The Millenium Physician Group.

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