SleepDent

I am a dentist working in dental sleep medicine. There has been much speculation on the forum as to what treatment of obstructive sleep apnea will or will not accomplish. Opinions vary. But let's cut right to the bottom line-- total life expectancy. Several long-term, large sample cohort studies have concluded that untreated moderate to severe obstructive sleep apnea will, on average, reduce a person's life span by TEN YEARS. And after all, leading a longer, healthier life is the ultimate goal. End of story. Arthur B. Luisi, Jr., D.M.D., The Naples Center For Dental Sleep Medicine.

I am a dentist working in dental sleep medicine. I think that one of the main reasons that such a high percentage of sleep apnea sufferers probably remained undiagnosed is that many of the health care professionals who could be making the diagnosis just don't care enough to do it. Dentists are an important case in point. The dentists see the general population far more frequently than family physicians. The majority of dentists have had zero training in dental sleep medicine, especially the older ones. Many dentists who are on PPO plans face tight time constraints and are so busy looking at the bread and butter things on the exam that they have zero time to screen and examine the patients for OSA(if they even know what to look for). And, since most don't actually treat OSA, doing the diagnosis and making a referral certainly won't put any money in their pockets, so there is no economic incentive to do so. Similarly, most family physicians also have little training in sleep medicine and no particular interest in participating in the treatment. And, of course, many potential patients are either still uniformed about sleep apnea or IN DENIAL. Arthur B. Luisi, Jr., D.M.D., The Naples Center For Dental Sleep Medicine.

I am a dentist working in dental sleep medicine. Obviously, if your baseline AHI is in the 80's to 90's, you have heavy duty OSA. As a general rule, CPAP does better against very severe OSA than do oral appliances. Having said that, I have successfully treated some people with OSA as severe as yours with oral sleep apnea appliances. The first thing that you have to do is to get your oral appliance well sleep tested to see just how effective it is. A quality home sleep study like Alice Night One by Phillips would be sufficient. If your appliance comes up short, be aware that there are a few oral appliances that do notably better than average against severe OSA. The best appears to be the O2 Oasys, which has tested extremely well(90+% effective i.e. AHI reduced to below 5 with complete abolition of symptoms) against severe OSA. However, only the model with the optional tongue buttons and the optional nasal dilators does this well. The plain, standard one does not. In second place would be the Tap3 or DreamTap which would get the AHI below 5 about 30% of the time, AHI below 10 with complete abolition of symptoms about 50% of the time, or reduce AHI by 50% to less that 20 with complete abolition of symptoms about 69% of the time. Be advised that I am doing this from memory and that my percentages may be off by a few percent here and there. Arthur B. Luisi, Jr., D.M.D., The Naples Center For Dental Sleep Medicine.

I am a dentist working in dental sleep medicine. Sleeping on your side may or may not be helpful, depending on what kind of OSA that you have. If you have positional OSA, i.e., apneas and hypopneas only occur when you sleep on your back or if a high percentage of apneas and hypopneas occur on your back, side-sleeping would definitely be helpful. However, if the apneas and hypopneas occur equally in all positions, side-sleeping would not help. You can get this data from your sleep test. Arthur B. Luisi, Jr., D.M,D,

I am a dentist working in dental sleep medicine. In terms of advice, Ruby got it just right. Arthur B.Luisi, Jr., D.M.D.

And I thought that I'd heard it all on this forum. That has to be a new low. Sorry that you had to go through that.

Well, what you are repeating back to me is kind of unclear, but I guess that you have to consider the source. Everybody's lower jaw gets pushed forward during the night with an M.A.D., but, generally, the bite returns to normal the next morning. There are little morning devices called A.M. aligners that help the process. However, bite change is a valid side effect of M.A.D.s and treating dentists and the patients need to be vigilant for any developing problems. Actually, M.A.D.s could possibly used with retruded lower jaws and classically normal lower jaws, and even with protruded lower jaws IF the lower jaw can be sufficiently protruded from the original position as per my post directly above. I can't tell if you aren't processing the information that the dentist is giving you correctly or if he is unclear in his own mind. It might be a good idea to get a second opinion from another dentist experienced in dental sleep medicine if such is available in your area. Arthur B. Luisi, Jr., D.M.D.

I am a dentist working in dental sleep medicine. Actually, your statement that your lower jaw is too far forward doesn't make a whole lot of sense. I think what you are trying to say is the following: M.A.D. appliances work by moving your lower jaw forward. This forward movement does several good things, but the net effect is that the airway space in the back of the throat is opened up. The average person can protrude his lower jaw forward somewhere between about nine to twelve millimeters. However, some people can only move their lower jaws forward considerably less than that. If your protrusion potential is less than five millimeters, it probably would not be enough to open up your airway. I suspect that this was your problem. Arthur B. Luisi, Jr.,D.M.D., The Naples Center For Dental Sleep Medicine

Unfortunately, oral appliances do not lend themselves to online delivery. The patient has to be examined in office to make sure that he qualifies for an O.A., you have to take impressions of the mouth or do a digital scan, and the appliance almost always needs a certain amount of adjustment upon delivery. Arthur B. Luisi, Jr., D.M.D.

I am a dentist working in dental sleep medicine. I work in the USA, so that I am not familiar with market pricing in Canada, but, on the face of it, your pricing seems high. I am actually going to cite the prices that I charge every day. In all fairness, I think I am on the low side, but in the ballpark. Most likely, the prices others may charge in the USA may be $500-$800 more than mine, but nowhere near what you are talking about. I charge $1,450 for a Tap3 or a DreamTap. I charge $1,650 for a Prosomnus IA or CA. My most expensive is $1,750 for a Luco Hybrid. I can do an in office MyTap for as little as $650. This is a legitimate OSA appliance, although, admittedly, rather light duty. My sense of it is that pricing for OA's WAS much higher maybe ten years ago when very few dentists did them, but increased market competition has steadily driven the prices down to where they are now very competitive with CPAP, especially since you do not have the recurring bills for CPAP consumables. Arthur B. Luisi, Jr., D.M.D., The Naples Center For Dental Sleep Medicine.