SleepDent

The experience that you report is truly pathetic. You have every right to have a copy of your report(at least in Florida, where I live, you do) and you also have every right to have it explained to you. If I were in the situation that you had, with a totally non-responsive sleep specialist and a family physician without a clue, the next people I would try to get help from would be a physician's assistant, if the sleep office had one, and/or the sleep tech that did your recording or the head sleep tech that runs the sleep lab. You shouldn't have to resort to this, but any port in a storm. Arthur B. Luisi, Jr., D.M.D..

I am a dentist working in dental sleep medicine. SnuzyQ, your post is substantially correct, but let me clarify a few points: 1. At this time, more and more medical insurances ARE paying for oral appliance therapy. In addition, once the appliance is placed, most do allow for at least a home sleep test to verify efficacy. The reimbursements are generally at an out-of-network rate but tend to be between $800-$1200. This is a recent improvement over the past few years. 2. The vast majority of people CAN successfully and comfortably wear mandibular advancement devices without significant long-term TMJ problems. I can verify this anecdotally from my own practice as well as from numerous published studies. The incidence of TMJ problems is definitely over-rated. Having said that, if a patient with TMJ problems is improperly selected for oral appliance therapy, BIG TROUBLE can ensue, as you have so correctly pointed out. As to the statements from your TMJ specialist, I have no doubt that this is exactly what he has observed. You must remember, however, that the patient population that he is seeing are the ones who have experienced the TMJ problems and that is a skewed sample. The same thing happens in my practice. My patients almost all complain bitterly about CPAP, so I could observe how much people don't like it. But I recognize that it is a skewed sample and I know that many, many people, probably the majority, are tolerant or actually happy with their CPAPs. You can't generalize from a specific kind of practice. Arthur B. Luisi, Jr., D.M.D.

Understood. Hopefully someone else can use the information. Good luck to you. Dr. Luisi

I am a dentist working in dental sleep medicine. There is another way to deal with this problem. Admittedly, it is fairly expensive, but if you are desperate for a solution and have the finances, you might consider it. It is the Tap-Pap CS. When you are wearing a mask with straps, it is inherently prone to leak because it is resting on your skin and skin is moveable and deformable. The Tap-Pap CS has nasal pillows that are held in place by an oral appliance that it supported by the teeth. The teeth are not moveable, hence no leaks no matter how you move around. If you need a full face mask, they have an intraoral mouth seal which prevents mouth breathing. See: www.tapintosleep.com. Arthur B. Luisi, Jr., D.M.D.. The Naples Center For Dental Sleep Medicine. Practice partner, dental sleep medicine, NCH Healthcare System. Practice partner, dental sleep medicine, The Millennium Physician Group.

I am a dentist working in dental sleep medicine. I am assuming that you have been properly tested and diagnosed with mild sleep apnea. It is a fairly typical response for sleep physicians to forego prescribing CPAP for mild OSA. Their thinking is that mild OSA does not have the same serious medical consequences as moderate to severe and most milds won't stay compliant on CPAP anyway(possibly true). However, it is quite possible not to sleep well and not to feel well with only mild OSA. In fact, patients with UARS have no apneas at all and typically feel miserable. It may be a good strategy to investigate an oral sleep apnea appliance, which typically works well for mild OSA and can clear up your symptoms. Arthur B. Luisi, Jr.,D.M.D.

I am a dentist working in dental sleep medicine. The scalloped tongue could possibly not be related to the sleep apnea at all. A scalloped tongue is a classic symptom of nocturnal (and daytime) tooth clenching and bruxing. However, the clenching and bruxing are a common co-morbidity of OSA, so there might be a relationship in that respect. Arthur B. Luisi, Jr.,D.M.D.

I am a dentist working in dental sleep medicine. I provide oral sleep apnea appliances, but many of my patients have also had nasal procedures in addition. I would not expect the septoplasty, or a turbinate reduction, or any nasal procedure on that level to eliminate the severe sleep apnea, in and of itself. However, it could be a meaningful step in the right direction. Poor nasal patency does contribute to the causation of sleep apnea. It also makes treatment with both CPAP and oral appliances significantly less effective and can cause them to fail outright in some cases. It is not a minor procedure, like a turbinate reduction, but it is nowhere near as major as a UPPP or jaw surgery. Oftentimes can make some sense for the patient. Arthur B. Luisi, Jr., D.M.D.

Regrettable, but happens all the time. Again, treatment quality is diluted out in the name of "economic efficiency" by the insurance companies. Arthur B. Luisi, Jr., D.M.D.

Apology accepted. Thank you. Dr. Luisi

This is a very interesting question, probably SleepTec would be the best one to answer this, but let me give it a shot. There is a huge variation between people in just how sensitive they are to sleep disordered breathing. Your AHI looks good, but there are other measures of just how effective the treatment is. If you had a laboratory attended sleep test(the better kind), someone needs to scrutinize it to see if there is other important information contained in it. For instance, there is another kind of sleep disordered breathing, Respiratory Effort Related Arousals(RERAs), which are not frank apneas or hypopneas, but can also disturb your sleep and make you tired. If you had a lot of them on your test report, perhaps you would need to take further measures to reduce or eliminate them. There are other potential things like this, but you get the drift. Arthur B. Luisi, Jr., D.M.D.