SleepDent

I am a dentist working in dental sleep medicine. I guess that the first thing that comes to mind is that you need to consider the periodontal status and bone support of your teeth. When you push on your teeth with your fingers, do they feel very firm to the touch or do they move slightly, especially the lower two front teeth. If they move, you may have lost bone support of your teeth over the years. You would need to be assessed by a dentist to see if they could be given better support in some way. If not, you may have to re-evaluate whether or not you can continue to use the appliance. If your teeth are firm and well-supported, it is possible that the impressions from which the appliance were made were slightly inaccurate. In that case, the appliance needs to be adjusted internally or, if it is too far off, re-made. These are just some possibilities. You need to see a professional. I can't diagnose it long distance. Arthur B. Luisi, Jr.,D.M.D.

Actually, thank you for getting so technical. I now have a much better perspective on how to approach the interpretation of a CPAP titration. I have read many hundreds of CPAP titration studies over the course of my career. I must say that many of them have contained sweeping generalizations about the patient based on the results of the one night. Clearly, a lot of these people need a tutorial from you as much or more than I did. I withdraw my previous observation about that CPAP titration. I do not withdraw my observation that CPAP may just be too intense for a small percentage of the population. Dr. Luisi

Granted, but should it actually be much worse that it was on the baseline polysomnogram? Is that to be expected and O.K.?

I am a dentist working in dental sleep medicine. Your post did jog my memory and what I have may or may not apply to you, but it is something. I have had some patients over the years who had good resolution of their obstructive events with CPAP and yet never got to the point of feeling rested. A fairly high proportion of the patients, who got off CPAP and got good resolution of their obstructive events with an oral sleep apnea appliance DID end up feeling rested eventually. My anecdotal(not scientifically proven) theory for these patients is that they have very sensitive nervous systems and the CPAP experience is just too intense for them. The machine resolved the breathing problems, but kept them awake in and of itself. One key to look at on your CPAP titration studies is whether your sleep staging and sleep structure got better or worse during the titration process. In many of the patients I speak of, it actually got worse. 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 Millenium Physician Group.

Have you considered an oral sleep apnea appliance?They are quite effective in eliminating snoring and can successfully treat moderate OSA in the majority of cases. Arthur B. Luisi, Jr., D.M.D., The Naples Center for Dental Sleep Medicine.

I am a dentist working in dental sleep medicine. Actually, the better oral sleep apnea appliances work very well for mild and moderate obstructive sleep apnea, that is, your diagnosed AHI would have to be less than 30. They work less reliably for patients with severe sleep apnea, with an excellent result being obtained in only 30% of the cases, but even here it is worth a try if you can't deal with CPAP. 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 Millenium Physician Group.

From what I can tell from my own patients, they would value being alert more than just being awake. You can be awake and still suffer from being in an uncomfortable state of brain fog. Patients want to be alert so that they can participate in and enjoy life fully. Arthur B. Luisi, Jr., D.M.D.

This problem with bite change caused by oral appliances is a thorny one and there is not total consensus about it within the dental sleep medicine community. Let me get a little technical at this point. Everyone has an ideal biting position wherein the muscles are best balanced and at rest. However, a person's actual bite is determined by how his teeth meet and interdigitate. The actual bite may or may not coincide with the best physiological position. Oral appliances disocclude the teeth over night, and given a period of time, the muscles may actually seek the more ideal posture, thus throwing the "normal" bite "off". It is also true that orthodontic forces from the appliance can change tooth positions a mm or 2 over time, but that takes longer unless a person has compromised tooth support from periodontal disease, at which time they should not be using an oral appliance. Morning repositioning devices attempt, with some level of success, to return your bite to what it was the day before, but in order to work, they must be used diligently EVERY Morning. Even with that, the bite will still sometimes change a bit. It may get down to a matter of priority. Will the patient accept a certain level of bite change to get the health benefits of the appliance? It is a personal decision. 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 Millenium Physician Group.

Given the economics of your situation, it might make sense to give CPAP another try. Really, what do you have to lose? There have been some substantial improvements in the masks and machines recently, and maybe you could get by with a new type. Anyway, if it bombs out again, you could feel better about laying out the money for a more comfortable appliance. Arthur B. Luisi, Jr., D.M.D.

Hello BZ. I am a dentist working in dental sleep medicine. Remember that your sleep tests record only one day in your sleep life. That doesn't mean that every single day your condition will be identical to that one night. Every one has good nights and bad nights. When you have a bad night you feel lousy the next day. If you have a better sleep night, maybe not so much. What you do each day can make a difference. If you drink heavily before bedtime, your sleep apnea will be worse. If you take certain medications, your sleep apnea could be worse, etc. To get back to the oral appliance. If it felt like a brick in your mouth, it could have been improperly selected for you. There are over 100 designs of oral appliances in the USA. Some of these designs are quite bulky and heavy. Others are quite thin and feather light. Maybe the one you got was too bulky for you, especially if you have a small mouth. It might be prudent to seek out an experienced dental sleep medicine dentist in your area to review and evaluate your appliance. It might just have been the wrong one for you. 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 Millenium Physician Group.