I've had a somnodent made for me in the past and used it for a good while. Issues I had: 1) it was such a bulky device that my mouth wouldn't close, which encouraged mouth breathing 2) the top part blocked the area where my tongue would normally rest against the roof of my mouth. My tongue never found a resting spot which really bothered me.
I also had other issues like jaw stuff, but I'm thinking of giving oral appliances a shot again with a much milder level of advancement. I have had nasal surgery since then and am hoping oral appliances will be a little more effective for me now. Are there any other MADs that are designed with solutions to the above problems? I'm reading about the Narval and that seems to be a good candidate. Any info is appreciated!
My only comment, off-topic though it is, is that if you have had nasal surgery, that can sometimes using CPAP much easier for you than it may have been before.
Thanks jnk. I bought a new CPAP and have been using it for 4 months. I feel great on it but the same problems I had when I used it in the past are coming back. My main issue with CPAP is terrible eye pain. I've seen eye specialists as well as worked with the providers to try different configurations. Nothing seems to help. Wish I could use it but I have to stop.
Dry eyes, or something else? I used a sleep mask eye shade for a while when I had problems with that.
Oops. I just read your old posts at another forum. I see that it is apparently something beyond merely dry eyes.
I hope you get answers to your original on-topic question, since it is beyond my knowledge and experience.
I am a dentist working in dental sleep medicine. Perhaps a good appliance for someone with your set of priorities would be the Micro2 IA. It is unique in that both the upper and lower trays are milled from a single block of clear plastic using computer aided manufacturing. I can't think of a lighter, thinner, stronger design on the market. There is no bulky advancement mechanism. To increase protrusion the trays are actually swapped for a series of more advanced ones, much like Invisaline orthdontic trays. See: www.prosomnus.com. Arthur B. Luisi, Jr.,D.M.D.
My sleep dentist told me that the resmed one is even less bulky than the Micro2. From my understanding, the Micro2 is like a lighter somnudent but I might still have trouble putting my tongue to the roof of my mouth. I didn't get to see a sample of one but I held the resmed and it seems like it would be no problem for me to put my tongue where I want, and keep my mouth closed. Would you also suggest the resmed or is there anything about it I should know?
Resmed has bought the rights to the Narval appliance ( developed in France) and this is a very nice appliance as long as your teeth are appropriately shaped. It is CAD-CAM printed, very thin and has minimal bulk near the tongue. The rods are replaced twice a year and one study showed it was more effective in those with more severe sleep apnea if elastics were used to hold the mouth more closed. EMA is also thin and , if trimmed back, is virtually undetectable.
The MicO2 also has minimal bulk inside the teeth and should be considered an option but it allows easy opening too. There is minimal published literature on this appliance.
With 150 FDA cleared appliances, there is something for everyone.
B. Gail Demko, DMD Associate Editor Journal of Dental Sleep Medicine
As an option, the Micro2 IA can be made with metal-free hooks. These small hooks can be used with orthodontic elastics to hold the mouth closed. I usually order them on the Micro2s I use on my patients. If the patient is getting good treatment with the trays opening and closing freely(confirmed via sleep test with oral appliance in place), I eventually remove the hooks. If not, we use the elastics on the hooks to gain extra efficacy. The Resmed Narval is extremely thin and light. I am aware of two potential problems with it. It is very hard to adjust if the fit is not exactly right. It either fits right out of the box or it doesn't(not much margin for error). Also the struts can stretch and break, so it isn't a very good choice for a patient with a clenching/bruxing habit. Arthur B. Luisi, Jr., D.M.D.
I understand that the Micro2 IA has a newer version that offers a turn key like approach to adjusting, rather than the interchangeable uppers and lowers. This allows for finer adjustments. What is the difference in terms of bulk? I am looking for photos online for comparison, but not finding any.
Actually, many, if not most, oral appliances are designed to allow breathing through the mouth. And many patients use oral appliances breathing through the mouth. As was mentioned in some previous posts, the mouth breathing can lead to an uncomfortably dry mouth. Sometimes it does and sometimes it doesn't. In a percentage of cases, the dry mouth can make the oral appliance intolerable to the patient, just as mouth breathing can also sometimes make CPAP intolerable to the patient. Breathing through the nose is optimal and our ideal goal with both CPAP and oral appliances is to eventually get the patient breathing through the nose, if possible. Arthur B. Luisi, Jr., D.M.D.
Dr. Luisi, I think you missed my question above. Can you please talk about the recent version of the Micro2 IA that offers a turn key for adjustment and how much more bulky this makes it?
Prosomnus is only allowing a limited number of these appliances to be made at this time. They are doing quality control and beta testing. They already have FDA approval. I have made 4 so far. I am holding one in my hand right now and comparing it to the multi appliance design. It is slightly more bulky but not enough to make a difference and still less bulky than the other wing (some call it fin) designs I am familiar with.
Dr Tony
