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ReservedWhiteKangaroo6396 , It sounds like you don't have the right appliance for you. Sleep appliances are like running shoes, all look alike but don't fit everyone the same. For my patients with small mouths and/or very tight muscles the Narval or Micro2 is a nice choice. The Narval is the slimmest design on the market I know of. My patient's love them. But you can't reshape it very well so if your planning on having dental work plan to get another one after the dental work is complete or choose a different appliance. Ask your dentist which appliances he is comfortable using. He could have a better choice for you. Or if you have a lot of clenching and grinding your muscles may be very tight and addressing the TMJ issues may be your answer. But please don't just stop wearing it until you have another option. In my practice 1 out of 20 patients we end up with a different appliance from the one we started with. If Nike just doesn't fit you well then try Reebok!
Dr Tony
PlacidSpringGreenTurtle3564 , I hear you on the seasonal allergies and chronic sinusitis. I have the same problem right now. I live and practice in south Louisiana. For us pollen season is horrible. I would strongly suggest you see an ENT. Ask him if a turbinate reduction might be just the thing for you. It will allow your sinuses to drain better and help you get "better air" because you will breath through your nose instead of your mouth. The job of the nose is to filter, warm, and humidify the air going into your lungs. The clean, warm and moist air travels into your blood easier than dry dirty air. I had a turbinate reduction done in Jan 2016. No pain or swelling. Took 10 minutes. Went right back to work. I have all my patients who are willing have an ENT consult at the same time I start treating them with an appliance. Greatly increases the patient's success rate.
The ringing in your ears could be congestion and wax build up or an infection of your ears. Or it could be your jaw joint is swollen and compressing your ear canal. I would have an ENT take a look at your ears at the same time he looks at your nose. Higher chance its the jaw joint. But let him look anyway. When we have sleep apnea we most often breath with our chest and not our diaphragm. When you breath with your chest you must lift your shoulders. This in turn tightens your neck muscles and stiffens the TMJ or jaw joint. This is common. If the muscles of your head, neck, and even upper back are tight your jaw cannot come comfortably forward. So you have a couple of option. Easiest is to back up the appliance and bring the jaw forward slowly over weeks to months. This will give the muscles a chance to relax and heal as the apnea is controlled. But this will delay getting your jaw to a point where your tongue is out of your throat and your sleeping like a baby. And often the knots and trigger points in your muscles wont go away just by treating the apnea. This is why I have an in house massage therapist that works on all my patients before we set the bite for the appliance. Really helps our patients get better faster. You should consider seeing a massage therapist that works on muscles inside the mouth to treat ringing ear or a physical therapist, chiropractor, acupuncturist, etc. If you had surgery on your knee you would expect to need physical therapy to get the knee joint strong, loose, and healthy again. When treating sleep apnea you have to look at the muscles and health of the joint the same way. Ask your dentist who he works with to treat the muscles of his sleep apnea patient. He should have someone to recommend or if he sees a lot of TMJ and sleep apnea patients he may have someone full time or that comes to his office.
Let me know how this goes for you.
Sounds like it is a TMJ splint. This probably wont help her snoring at all or at best just a little.
Could be. Yesterday I ha a patient that we delivered a MIcro2 appliance to last week. He was having same issues you are having. And he had his wisdom teeth on the top. The lab made the appliance cover the wisdom teeth and it was uncomfortable. I took 3 minutes to cut the appliance back to the first molars and problem solved.
Welcome and its great to have another dentist offer a different point of view. Thanks for sharing. And I really appreciate your enthusiasm for the TAP appliance. You even pulled some marketing points from their website. All good information. I have found in my practice I serve my patients best when I don't limit my patient's choices to one appliance. Each appliance has pros and cons. Even the TAP is not all perfect. And every patient is different. If you read the other post you will see that there is not one perfect CPAP mask that works for everyone. Just too many variables to put everyone in the same box.
No. Not at all. A sleep appliance can help with TMJ issues. But a TMJ splint cannot position the lower jaw forward enough to help with apnea. And an upper TMJ splint can make sleep apnea a lot worse by positioning the tongue further back into the throat. Most dentists are still trained to make upper TMJ splints without testing for sleep apnea. When its the sleep apnea causing the TMJ the symptoms get progressively worse over time due to the upper TMJ splint,
Its probably one of two possible problems. Both are easy to fix. Either the appliance is set too far forward and need to be adjusted backwards until your muscles adjust to it or the appliance itself is made too far into the back of your mouth and needs to be trimmed back. If I knew which appliance you have I could help you better.
Yes I have seen this with patients that have a high pressure like your using at 15-19. I don't prescribe CPAPs so when I see this it is usually my ENT/sleep specialist that has a patient struggling with CPAP and wants to see if I can help. If the boil and bite didnt work consider a custom fabricated appliance like the Moses, TAP, or Narval that hold your upper and lower jaw together during sleep. This may solve all your problems and can be worn with a CPAP. Dr Tony
My opinion is that a patient should always hear about different options no matter what the level of apnea is! Yes they should have given you the option of an oral appliance.
Dry mouth is caused by breathing in and out through your mouth instead of breathing in through your nose and out your mouth. Or many medications cause a reduction in saliva. Your dentist will have his favorite saliva substitute to offer you and there are many on the market. But this is simply covering up the problem and not solving it. You may want to check all your meds to see if any cause dry mouth. Its also high pollen season. So if your taking antihistamines that will be adding to the problem. Besides getting a saliva substitute from your dentist or over the counter and checking your meds you could also contact your ENT. There may be some otions he can offer you so you can breath in through your nose. This will also help a lot!
