SleepDent

I am a dentist working in dental sleep medicine. Unfortunately, your high AHI numbers do place you in a dangerous situation and there is real urgency to get your treatment started right away. Assuming that you have only obstructive sleep apnea, propping yourself up on two pillows at night at a 45 to 90 degree angle at night might help a little(emphasis on A LITTLE), but there is really no substitute for proper treatment. Arthur B. Luisi, Jr, D.M.D.

I am a dentist working in dental sleep medicine. Yes, both the upper and lower trays should snap onto your teeth and be held firmly enough in place that they should not come off at night. Personally, I did not use the Narval appliance when they were available in this country. However, my colleagues have told me that they have found that they either fit correctly right out of the box or not and it is very hard, if not impossible to adjust them. If Narval is no longer honoring the warranty, I don't know what recourse you have other than working out some kind of equitable arrangement with your dentist to place an alternative appliance. Arthur B. Luisi, Jr.,D.M.D.

I am a dentist working in dental sleep medicine. Yes, your results are significant. There is a common misconception that, if you do not formally meet the definition of obstructive sleep apnea, you are O.K.. That is not necessarily true. I am not going into the formal definition of apneas and hypopneas at this time, but many times the interruptions in sleep do not meet the criteria, but still make the person tired. This is called UARS(upper airway resistance syndrome). In addition, the PLMs, in and of themselves, can interrupt your sleep, and tire out your body enough to cause fatigue. UARS can often be treated with oral sleep apnea appliances and by improving nasal patency. CPAP can also be used, but for a condition this mild, the compliance rate is not always particularly good. With successful treatment, the PLMs are often eliminated or greatly reduced without specific treatment. If not, the PLMs can be dealt with by specific medical treatment(medication). Arthur B. Luisi,Jr, D.M.D.. The Naples Center For Dental Sleep Medicine. Practice partner, dental sleep medicine, The NCH Healthcare System. Practice partner, dental sleep medicine, The Millennium Physician Group.

Actually, my comments were partially based on the study cited below by Sierra. I probably should have cited it, but hats off to Sierra for doing so. Arthur B. Luisi, Jr., D.M.D.

I am a dentist working in dental sleep medicine. It may be worth reiterating that oral sleep apnea appliances work mechanically and not through air pressure. That is to say, you breathe unpressurized room air in the natural way. Maybe something to consider for those folks with OSA and glaucoma. Arthur B. Luisi, Jr., D.M.D.

I am a dentist working in dental sleep medicine. This is a very interesting question. In fact, I have never seen it posed before. I can give you a general answer that may also be applicable in this case. The general principle is that you never aim pressurized air at a fresh(unclosed) surgical site inside the mouth. In addition to pain, you run the risk of introducing an air embolism into the body. This goes for an extraction site, a surgical site, or a newly placed dental implant. Some sources would be a dental air syringe and a high-speed dental drill. Since CPAP air is, indeed, pressurized air, I would think that the same would hold true for that, speaking logically. Arthur B. Luisi, Jr., D.M.D.

I am a dentist working in dental sleep medicine. Patients need to understand that severe sleep apnea causes many negative changes in the body over time. Fortunately, successful treatment of obstructive sleep apnea does allow the body to eventually repair the damage, but it takes time to do so. The sequence is: 1. Damage gets repaired. 2. Patient begins to feel better. That means that it could take one, two, three, four, five, six or more months to get the payoff in feeling better. So, be patient, stick with your treatment, make sure your health professionals have optimized your treatment, wait for the payoff. Good luck to you! Arthur B. Luisi, Jr., D.M.D.

I am a dentist working in dental sleep medicine. It is possible for the airway to collapse and to create sleep apnea in all sleeping positions.--- On the back, on the stomach, and sleeping on both sides. However, not every patient actually has airway collapse in all positions. Typically, sleep apnea is worst when sleeping on the back because the force of gravity is worst in that position. There is a variant of OSA called positional sleep apnea. This is when the patient had sleep apnea only when sleeping on the back, or when he has more apneas on the back than in the other positions in a ratio of at least two times as many. Arthur B. Luisi, Jr., D.M.D. The Naples Center for Dental Sleep Medicine. Practice partner, dental sleep medicine, The NCH Healthcare System, Practice partner, dental sleep medicine, The Millennium Physicians Group.

Actually, I was not addressing purplefan's problem specifically, I was just talking about the general problem of sore chest muscles due to CPAP. You could make the point that, since it was her post, I should have addressed her problem, but I was just looking for a teachable moment here. Point well taken. Dr. Luisi

As an aside. This is one of the very positive benefits of using an oral sleep apnea appliance. Since you are breathing normal unpressurized room air, there is no strain on the chest muscles or the alveoli in the lungs. This can be important for relatively frail people who have difficulty breathing against the CPAP pressure and for people with COPD. Arthur B. Luisi, Jr., D.M.D.