SleepDent

Interesting. People who are side to side grinders merit special consideration. Many oral appliances will not work well for them. Knowing that, I would especially mention the DreamTap by Airway Management. The upper and lower trays are centrally joined on a long track running laterally from side to side. The appliance can glide smoothly from side to side. Absolutely great for side to side bruxers. 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.

You are a bit confused. Both apneas and hypopneas are obstructive breathing events. With apneas, the airway is completely closed for at least ten seconds. Hypopneas are partial airway obstructions that last at least ten seconds. Both types can do you harm. Your official diagnosis is OBSTRUCTIVE sleep apnea. This means that, in the opinion of your sleep doctor, the central sleep apneas are few enough in number that they are only background noise and not to be considered during treatment. With adequate treatment of the obstructive sleep apnea, the scattered central events may, or may not go away. Oral appliance selection is very patient specific. It would really make very little sense for me to suggest some without examining you first. Arthur B. Luisi, Jr., D.M.D.

The MyTAP has all the features of a very effective oral appliance, therefore it is a great way to see if you like the OA experience at a fairly low price of entry. However, it is fairly lightly constructed and will probably last only about a year before breaking for the average person. You can then elect to go on to a more substantially build(and more expensive) appliance or get it repaired and go on. The outlay for both strategies tends to be about the same over time, but the MyTAP is a lower initial money outlay and the expense comes in dribs and drabs over time. Arthur B. Luisi, Jr., D.M.D.

That is correct. To take the explanation a step further, at the higher pressure settings, air tends to leak at higher rates out of the mouth, destabilizing the system and making the cheeks flutter, which is uncomfortable. This tends not to happen so much at the lower pressure settings, so the nasal pillows and nasal masks work better. Arthur B. Luisi, Jr., D.M.D.

Just wondering. Have you tried an oral sleep apnea appliance. They do work for some cases of severe sleep apnea. A lot easier than surgery. Arthur B. Luisi, Jr., D.M.D.

I am from Southwest Florida.

Unfortunately, you have presented us with a very thorny set of problems. You are very deep into a never-ending cycle of pain and dysfunction. There is no quick fix. There is no silver bullet. The central question is where do you start to begin the reverse the cycle and to slowly unwind it back to normalcy? No one can address it without patient contact, but I think that we could suggest some possible avenues of attack. It might make sense to try to get back on CPAP, at least temporarily. In order to do that, your sinusitis would have to be under control and that means a trip to the ENT first and a course of treatment there before re-attempting CPAP. The benefit of being back on CPAP is that it might tend to reduce or eliminate the nighttime clenching and bruxing and begin to unwind the myofascial pain and dysfunction. It might make sense to see a real, legitimate TMJ specialist. An adequate diagnostic session would take at least an hour to an hour and a half. A ten second quickie doesn't cut it. You need to know if your TMJ problems are organic or structural problems within the TMJ or due to muscular or other problems outside the TMJ. If the problems are found to be muscular, physical therapy and other conservative measures like heat, analgesics, eating soft foods, etc, might prove beneficial. Losing weight makes sense, as does the side-sleeping, and the Tmj specialist would have to decide about the jaw exercises. I do agree that the standard, flat-plane night guard or bite guard could tend to pull the lower jaw backward and make the obstructive sleep apnea worse. I couldn't ever see going back to the Narval, personally, but if you have made a lot of progress, getting off CPAP and graduating to a pull- forward device like the Tap might be a possibility. Well that is my contribution. Will be interested to see the comments from Dr. Demko, 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 Physicians Group.

I made further inquiries and was informed that this modification, regardless of its merits can not be accomplished without further regulatory approval from the F.D.A. . We are going to see if we can take some parts that have been previously approved by the F.D.A. and use them. If it is not possible, there will be considerable delay to gain approval. Will keep you informed. Dr. Luisi

Interestingly enough, I played a small part in the development of the Tap-Pap CS, and, as such, can shed additional light on the subject. When I was doing some initial testing on the Tap-Pap CS, I experienced the same problem reported by Dr. Prehn, i.e., a significant failure rate of the Tap-Pap CS due to leakage through the mouth. Actually, this was to be expected, because, like any mask employing a nasal mask with an unsealed mouth, a fair proportion of patients will mouth breathe enough to break down the system. I reported the problem to Airway Management and they are aware of it. However, I am quite proud that I actually found a fix for the problem. As you may know, the MyTap comes with an optional intra-oral mouth shield. I discovered that this mouth shield can slide over the metal column on the Tap-Pap CS, that it creates a perfect intra-oral mouth seal, and turns the Tap-Pap CS from a nasal mask to a full face mask equivalent to the custom mask described in the article. If Dr Prehn had tested the Tap-Pap CS thus equipped, the failures would have been eliminated. However, it is not available commercially configured this way right now and Dr. Prehn would not have been aware of the fix, as I am. This is potentially very important, as most dentists attempting dental sleep medicine would not have the skill or inclination to deal with making custom face masks. I personally use the Tap-Pap CS as a full face mask with great success, but nobody else knows to do it yet. I hope that this helps 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, Millenium Physician Group.

We will all certainly be better off when there is consensus on oral appliance therapy efficacy. What I try to do on this forum is to take a practical, nuts and bolts, approach to helping patients with their immediate problems. As "WiredGeorge", a sleep enthusiast, has rightly pointed out, people seldom come to this forum if they are doing well. They need help now. In the absence of solid definitions, it falls to the patients to decide what their priorities are. If someone has failed CPAP and is miserable and non-functional, is it sufficient to use an oral appliance if it allows them to sleep well at night and to be alert and functional during the day and when driving, even if the treatment is insufficient to protect them from some of the adverse medical outcomes that would be addressed by CPAP. Well, it is their life and their choice to make.And so on. 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.