Thank you for your inquiry Chameleon67. Actually, I would respectfully disagree with that statement. The official position of the American Academy of Dental Sleep Medicine is that oral appliances can be used to treat mild, moderate, and severe obstructive sleep apnea. Initially, the F.D.A. approved oral appliances for only mild to moderate OSA. For medico-legal purposes, the manufacturers tend to stick to that statement. Testing has shown that, although CPAP does lower AHI better than oral appliances, the medical outcomes are the same. This is because patients tend to wear the oral appliances much longer every night than CPAP users do. I have used OAs many times to successfully treat severe OSA. There are failures. About five percent of the patients are called non responders because the oral appliances will simply not produce the desired result. But to have success, you must have a highly skilled sleep dentist using the very best appliances on the market. A.B. Luisi, Jr., D.M.D.. The Naples Center For Dental Sleep Medicine.
My name is A.B. Luisi Jr., D.M.D.. I specialize in dental sleep medicine and TMJ and orofacial pain control at The Naples Center For Dental Sleep Medicine. There was an excellent discussion on this topic about four years ago and then it just petered out. I will answer your questions as best I can. Do not expect an instant reply, as I am too busy to do that, but I will answer them periodically. Thank you.
I am a dentist specializing in dental sleep medicine. The answer is, whatever appliance is best for you. Over the years, efficacy testing has shown that anterior traction devices, i.e., trays joined in the middle, show consistently better efficacy than lateral thrust devices, i.e., appliances with lateral wings the bring the jaw forward. In many. but not all cases, holding the jaws closed will also increase efficacy. That being said, you have to pick the best device for each patient. Some people are claustrophobic and just can not tolerate having the trays joined together. In that case, a device with lateral wings which allows free opening and closing could be the solution if the reduced efficacy would suffice for that patient. Some people lateral brux ( move from side to side ) at night. In that case, the appliance must accommodate it. There are many other factors to be considered. The bottom line is that a sleep dentist should have many appliance choices to be considered. A "one trick pony" with only one choice may not get the job done, A.B. Luisi, Jr., D.M.D.. The Naples Center For Dental Sleep Medicine.
I am a dentist specializing in dental sleep medicine. As to the patient's problem, one would have to ask for how many hours per night is he actually using the CPAP and are there mechanical problems, such as mask leaks, that tend to interrupt his sleep? CPAP treatments produce a real dilemma for some very sensitive patients. On one hand, it is mechanically very effective at reducing breathing problems (lowering AHI), but on the other hand, the experience is just TOO INTENSE for some people to get restful sleep. Some people just cannot cope with the feel of the mask and straps, the sensation of compressed air going into their airway, the sound of the machine, and the presence of the air hose. Just can't. For these unusually sensitive people, an oral sleep apnea appliance is an excellent option. The whole experience is just GENTLER. You just have two thin trays over your teeth and you are breathing normal room air with zero noise (hopefully). Good luck to you. Chances are you will do just fine. Let us know the outcome. A.B. Luisi, D.M.D., The Naples Center For Dental Sleep Medicine.
I would amend that a bit. Adults USED to be afraid of going to the dentist. Witth new technology and better pain control, far fewer adults have dental fear today than 30-40 years ago. Getting an oral appliance is pretty benign stuff. You just get an upper and lower impression and a special bite record. No pain. A few patients do experience gagging with the upper impression, but a skilled dentist can work around it or use digital technology. A.B. Luisi, D.M.D.. The Naples Center For Dental Sleep Medicine.
That is precisely the point, Sierra. Anyone reading some of the astounding posts that you have so generously provided to this forum over the years can tell that you are smart, disciplined, and organized. Your results are not typical. Only about fifty percent of the patients on CPAP continue to use it long term. Of course, the "failures" are the ones that I generally see. In about eighty percent of the cases, these people will succeed with an MAD. Anybody who cannot make a go of CPAP should be offered the alternative of an oral appliance consultation (and Inspire), but many sleep physicians do not bother to do so. A.B. Luisi, D.M.D.. The Naples Center For Dental Sleep Medicine.
I am a dentist specializing in dental sleep medicine. At this point, millions of MADs have been placed. The efficacy of MADs vs CPAP has been tested many times. In a 2019 the AADSM released a position paper called "Just The Facts". Let me summarize the main conclusions. 1. The medical outcomes(the positive health benefit of MADs) were equal in all categories to CPAP for mild, moderate, and SEVERE obstructive sleep apnea.2. CPAP showed superior ability to control breathing problems(reduce AHI) vs. MADs. One would the ask, if CPAP was superior to MADs in reducing apneas and hypopneas, how could the improvements in medical outcomes be the same? The answer is the differential in average wear times. On average, patients use CPAP about four hours per night. On average, patients use MADs for 7-8 hours per night. Therefore, if the MADs are less effective based on lowering AHI, the fact that patients are getting more treatment per night just about evens out the differential in efficacy .I know that this is a difficult concept to wrap your head around. Even some sleep physicians have trouble with it. But facts are facts. A.B. Luisi, D.M.D., The Naples Center For Dental Sleep Medicine.
Yes. However, the standard need not be as low as less than five. I will elaborate at a later date.
I am a dentist specializing in dental sleep medicine. The answer is YES. Initially the appliances were limited to mild and moderate cases. The original FDA approval was limited to mild to moderate obstructive sleep apnea. For medico-legal reasons appliance manufacturers still say their products are for use with mild to moderate OSA. In recent years more and more appliances have been used successfully for severe obstructive sleep apnea. This DOES NOT mean that you can go online and order a do-it-yourself cheapie appliance and expect to do well. Appliance treatment for severe cases is difficult. You need to find the best sleep dentist in your area and he must use the best appliances currently available. A.B. Luisi, D.M.D.. The Naples Center For Dental Sleep Medicine.
Actually, the conventional thinking is wrong. MAD devices are effective for mild, moderate, and severe obstructive sleep apnea. When the FDA approved MADs initially, the approved them for mild to moderate obstructive sleep apnea. For medico-legal reasons, the MAD producers still stick to that statement. In a 2019 position paper, the AADSM supported the claim that MADs are effective for mild, moderate, and severe. It has been my clinical experience that MADs can handle most cases of severe obstructive sleep apnea. I will elaborate if asked to. A.B. Luisi, D.M.D.. The Naples Center For Dental Sleep Medicine.