I have given the situation more thought. In a practical sense, using an oral appliance together with CPAP could be the best solution. I am talking about wearing an oral appliance together with your CPAP. The combination is MUCH MORE COMFORTABLE. CPAP operating pressure can typically be lowered about 50%. Mask leakage problems usually vanish with the lowered pressure. The combination is far more effective at reducing treatment AHI than either CPAP or oral appliances alone. And paired with CPAP, you can use a much more conservative level of protrusion with the oral appliance for much better comfort and much less strain on the TMJs.. I am now using the combination with people who are struggling with their CPAPS and most of them are THRILLED with the result. Arthur B. Luisi,Jr.,D.M.D.. The Naples Center For Dental Sleep Medicine.
Well, I admit that it seems that you are really boxed in. I think that you have done what you can to mitigate the situation. Your only other option is the Inspire system, if you qualify. This is significant surgery, but I can't think of anything else. Dr. Luisi
Well, you make a pretty compelling argument for the change to CPAP. Clearly, your dentist made a good faith effort to keep you going. What I would have done at the first sign that your jaw was not returning to baseline was to tell you to keep it out for a'few days at a time when that happens. When your bite gets that far off, it is difficult to recover. By what you say, I assume that your diagnosed AHI was relatively high and the'ability of the Taps to resolve it were marginal. Given this information, I believe that you did the right thing. Unfortunately, even though using the CPAP is much more work, you have to do what you have to do to stay healthy. Dr. Luisi
I am a dentist working in dental sleep medicine. Have you considered switching to an oral sleep apnea appliance. There is zero pressure required. You could also consider wearing an oral appliance WITH your CPAP. That would lower the required pressure even more. Dr. Arthur B. Luisi,Jr., The Naples Center For Dental Sleep Medicine.
I am a dentist working in dental sleep medicine. Tooth movement is a common side effect of oral appliance therapy. That should have been explained to you at the outset. Were you given a small pink appliance called an A.M. Aligner to use in the morning when you removed your Taps? This would largely eliminate the possibility of movement. I would be interested in your long term reaction to the change to CPAP. Sure, it feels good to get everything essentially for free. But how long are you going to like hauling the machine around every time you travel or leave the house. How are you going to feel when you have changed your mask, hoses, filters, etc. for the FOURTH time. And you have to keep the supply of distilled water on hand. Lastly, keeping a CPAP sanitary is REAL work. All parts of the machine must be kept scrupulously clean to avoid the chance of serious infection. You c;lean the Taps with toothbrush, tooth paste, and done. Will you be this happy two years from now? Time will tell. Please keep us posted. Dr. Arthur B. Luisi, Jr., The Naples Center For Dental Sleep Medicine.
I am a dentist working in dental sleep medicine. To Ascribe OSA mostly to obesity really over-simplifies the issue. There are huge numbers of people who are not obese who have OSA, even severe OSA. One of the main causes is anatomical. Many people are born with overly large tongues(macroglossia) and overly large soft palates that hang way down into the airway. When lying down to sleep, these things fall down into the airway and block it. I would call this the most common cause, not obesity. In children, mouth breathing caused by enlarged tonsils and adenoids can set the stage for sleep apnea since the oral cavity often develops in a smaller than average way with a high palatal vault and narrow maxilla and mandible. Poor nasal patency due to allergies or deviated nasal septa makes OSA worse. Surprisingly, orthodontic treatment can worsen OSA when the four first premolars are extracted and the teeth are pulled back into a beautiful looking occlusion. This can narrow the arches, reduce the airway space, and contribute to OSA. Simple aging can cause or worsen OSA. As we age, the airway tends to sage and lose muscle tone. This can cause it to collapse into the airway and cause OSA. Dr. Arthur B. Luisi, Jr.. The Naples Center For Dental Sleep Medicine.
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.