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Snoring while wearing MAD

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ElusiveSleep +0 points · 13 days ago Original Poster

I use an EMA brand MAD for OSA, and my bed partner says that I occasionally snore while wearing the appliance. Indeed, the duration of snoring is 50-60% of total sleep time according to the SnoreLab app.

Since snoring occurs due to limited airflow, is this an indication that the MAD is not adequately counteracting the positive pressure on the airway?

The MAD I’m using now is a replacement for one that broke about one month ago.

I have fatigue and low energy, and feel less motivation to do daily activities.

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Sierra +0 points · 13 days ago Sleep Innovater

I believe the only way to find out is to do a sleep test with the MAD in use. Hopefully the dentist participants here will comment.

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4variety +0 points · 12 days ago

@ElusiveSleep

Could you please share more about your sleep-apnea profile. 1) How long have you been using an MAD? 2) What's your AHI off treatment? 3) Is this a problem only with the new MAD? 4) Did you have a test to determine whether an MAD would be effective with you or not? 5) Have you and your sleep specialist found the optimal setting/titration for your MAD or are you still tinkering?

One thing I can comment on prior to learning more about you is this idea that snoring is inherently a bad thing. Your throat making noise isnt necessarily threatening. The only important thing at the end of the day is your oxygen-saturation levels in your blood, so if you're snoring disturbingly loud but simultaneously you're not experiencing drops in your oxygen-saturation level, then there is no problem (aside from any noise others may have to tolerate or mild inflammation of the tissue in the throat). With that said, yes, often drops in oxygen-saturation levels and snoring go hand-in-hand/correlate. My point in all this is, some people snore their entire lives and sleep soundly, never experiencing enough sleep disturbance nor being objectively diagnosed with sleep apnea due to lower oxygen-saturation levels.

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SleepDent +0 points · 12 days ago Sleep Commentator

I would take issue with one statement in this post.It is not necessarily true that if you are snoring disturbingly loud, but you are not experiencing drops in your oxygen saturation levels, then there is no problem. We now know that snoring, in and of itself, can cause sleep disturbance. There are arousals, called snore arousals, that are factored into your overall arousal index. In fact, you can have a sleep disturbance, called UARS, where there are no apneas, no hypopneas, and no snoring. If a person has some residual snoring with an MAD, that can be considered O.K. if you are not symptomatic. But since you are still symptomatic, it is not O.K.. Dr. Luisi

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SleepDent +0 points · 12 days ago Sleep Commentator

I am a dentist working in dental sleep medicine. Unfortunately, the EMA device, although a legitimate appliance to treat OSA, does not enjoy a reputation for being one of the most effective choices. I have seen some efficacy tests for the EMA and they were mediocre at best. There are better choices out there. As Sierra said, the only definitive way to see whether or not the EMA is performing satisfactorily is to wear it during a sleep test. I am assuming that it has been adjusted for maximum effectiveness, to the best of your ability in concert with your dentist. A home sleep test with appliance in place is the cheapest way to do it. It is generally no more than a few hundred dollars and medical insurance will often pay for it. It would be useful to know what brand of oral appliance you were using previously. I might be able to tell you if it has a better efficacy reputation. The high degree of snoring may or may not have significance. Never-the-less, I would not depend on your bed partner or snorelab to make a determination. The bottom line is that you are still symptomatic and that needs to be looked into. Arthur B. Luisi, Jr., The Naples Center For Dental Sleep Medicine.

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ElusiveSleep +0 points · 11 days ago Original Poster

I was initially diagnosed with OSA four years ago (age 60) based on a home sleep test. The overall AHI was 21.7 with a supine index of 30.2. Started CPAP but had difficulty with the nasal mask. Then switched to an EMA MAD, and after titration the AHI (home sleep test) was 5.

I’m thinking that a new baseline sleep test (ie, without treatment) would be prudent to determine if OSA severity has changed with age. Also willing to give CPAP another go around.

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