SleepDent

I am a dentist working in dental sleep medicine. The Tap is designed to work with contact only in the front where the hook is. That is to say, the back part of the trays should not be contacting each other at no matter what position of your lower jaw is in. If the back parts of the trays are making contact or interfering with the free movement of the trays, it could cause the pain in your jaw muscles that you described. Arthur B. Luisi, Jr.,D.M.D., The Naples Center for Dental Sleep Medicine.

I am a dentist working in dental sleep medicine. Just reminding the forum that, for some people, an oral sleep apnea appliance could be the ultimate travel machine. Nothing is smaller, nothing is lighter, and nothing is more comfortable. Arthur B. Luisi, Jr., D.M.D., The Naples Center For Dental Sleep Medicine.

I am a dentist working in dental sleep medicine. I do not have a referral to make in L.A., but I can give you some research leads. First look on the AADSM(American Academy of Dental Sleep Medicine) web site under the "Find-A-Dentist" feature to locate some members in the L.A. area. Being a member in the AADSM does not guarantee that the dentist would be highly experienced, but it at least indicates some special interest in the field. Then I would call some sleep disorders centers in L.A. and ask some of the sleep physicians which dentists they routinely refer OSA patients to for oral sleep apnea appliances. Triangulate the two sources to come up with some potential names of dentists to pick for a consultation visit. Arthur B. Luisi, Jr.,D.M.D., The Naples Center for Dental Sleep Medicine, Naples, Florida.

I am a dentist working in dental sleep medicine. I think that you bring up some very good points. Both CPAP and oral appliances are relatively new modes of treatment. The truth is that we really don't know what happens if people are on these treatments very long periods of time(20, 30, 40, 50 years or more)because no one has ever done it. Never-the-less, common sense would tell you that you would be better off with treatment than without it. At the risk of angering all the CPAP loyalists out there, I would say that oral appliances have a considerably shorter list of potential side effects than does CPAP. It is true that oral appliances can cause tooth movement and bite alteration over time. However, in most cases, the effects are mild enough to be barely visible, although there are a small percentage of people who get more severe problems. Of course, our present time horizon would probably be under 20 years and no one would know for much longer time periods. On balance though, oral appliances are less invasive than CPAP and would probably be a better choice for a young person with a potentially long treatment life, as long as he was in the mild to moderate range. Arthur B. Luisi, Jr., D.M.D.

I am a dentist working in dental sleep medicine. People need to remember that snoring is a noise caused by the vibration of intraoral tissues due to restriction in the airway. While not as harmful as OSA(as far as we know currently), it is definitely not optimally good breathing. Therefore it is in the best interest of the patient to deal with it rather than just masking the sound or moving into another bedroom. Arthur B. Luisi, Jr., D.M.D.

Your questions are overwhelmingly difficult to answer and I wouldn't know where to start, but let me go at this from an entirely different angle. On my job for 13 years, I have come to know many hundreds of sleep apnea suffers both treated and untreated. I have seen the before and afters in real life. In general, the treated versions of the people look better, act better, have more energy, can focus better, and are happier than their former untreated selves. I would rather be one of the afters than one of the befores. Having observed this, I would find it hard to believe that the treatment did not have some value for these people. Arthur B.Luisi, Jr,, D.M.D.

One thing that is seldom talked about, maybe because it is too negative, is that, after a certain amount of time untreated, OSA patients may no longer make a full recovery. That is the real incentive to try to get people into treatment early and well. We are well aware of the multiple types of damage that untreated OSA inflicts upon the body. And we know that, with adequate treatment, the body begins to repair itself. Never-the-less, it is not a foregone conclusion that, BAM, a person finally decides to get treatment and then snaps right back to normal again. This is one reason that some people finally see the light, and get treated, and get real health benefits, but never feel really well or rested again. Very sad. Arthur B. Luisi, Jr., D.M.D.

I am a dentist working in dental sleep medicine. It is pretty hard to answer a question like this long distance. It would definitely be helpful if we knew exactly what brand and type of oral appliance you have and exactly what was done to it during the adjustment. However, probably the best advice is to just discontinue using it and call your sleep dentist quickly for another go round of adjustments. Arthur B. Luisi, Jr., D.M.D., The Naples Center For Dental Sleep Medicine.

As far as we know, at this time, mild sleep apnea does not seem to impose the serious average decrease in life span that untreated moderate and severe apnea does. Physicians tacitly acknowledge this in that they generally push harder to get people with moderate and severe cases into effective treatment than they do with the mild people. One caveat though, I have been in this business fourteen years, and the tendency has been to push the concerning symptoms lower and lower into the AHI range as the research unfolds, so I wouldn't be totally complacent in the mild range. Also, some milds tend to be quite symptomatic. Arthur B. Luisi, Jr., D.M.D.

I think that your over-all approach has merit. And I would agree that, compared to other conditions, the treatment of apnea is relatively unsatisfactory in that you are asking people to endure comparatively unpleasant situations like compressed air blowing through their nose and intra-oral trays pulling their jaws forward when they need peace and quiet to sleep. Remember that the treatment of apnea is in its relative infancy, having started only in the 1980's. Being an honest person, I readily acknowledge that people have every right to be less than enthusiastic about their present options. It is unfair for health care professionals to pretend that the apnea patients's situation is good and that what is asked of them is easy and routine. It is not. If a person is very symptomatic and non-functional with the apnea, and the treatment makes them feel much better, at least that is reinforcing. When a person is not symptomatic or mildly so, asking them to endure the treatment for a theoretically better health outcome becomes harder. I get that. Arthur B. Luisi, Jr., D.M.D.