SleepDent

I am a dentist working in dental sleep medicine. I can assure you that obstructive sleep apnea is not trendy, it is potentially tragic. I have dealt with a large number of OSA patients. The condition has cost some of them their jobs, their marriages, their quality of life, their very lives. Now, having said that, let's put things into perspective. There is a huge difference between a patient who has very mild sleep apnea and is not symptomatic and moderate to severe patients with severe symptoms and the potential for life threatening medical problems. You need to know where you fall on the scale of severity. If you are on the very mild end, you certainly need not panic and be extremely concerned about it. But be advised. The yellow warning flag is now out there. Untreated sleep apnea never goes away spontaneously and it usually gets worse as people age. Remember, there are other options besides CPAP, including oral sleep apnea appliances, weight loss, positional therapy, minor nasal procedures, to name a few. Have your health care professionals explain them all before making any conclusions. Good luck to you. Arthur B. Luisi, Jr., D.M.D.

Please see my post about UARS on the thread "No sleepapnea". Arthur B. Luisi. Jr., D.M.D.

I am a dentist working in dental sleep medicine. Be aware that oral sleep apnea devices come in many shapes and sizes. There are over 100 on the market. It may be that the device you have, although effective, may not have the optimal comfort for your mouth. It may also not be fitted to your mouth as comfortably as possible. I would recommend seeing an experienced sleep dentist in your area to review the comfort of the device and explain your other possible options. Arthur B. Luisi, Jr., D.M.D.

Hi! I am a dentist working in dental sleep medicine. Unfortunately, it often takes quite a while to get improvement in your fatigue. The OSA has damaged your body over time and that damage must be repaired before the symptoms improve. It can take two weeks, a month, even two or three months or even more to get the payback. So far, you are doing a great job. Be patient and don't get discouraged. The payback over time will be well worth it. Sometimes patients get what I would call rebound fatigue. You are more relaxed and sleeping better, but it kind of brings out your latent fatigue. It can be pretty unpleasant. I would also urge you to work with your DME and/or sleep physician to see if you can get your treatment AHI down even more. Theoretically, anything under 5/hour is considered "normal", but some patients need to be even lower for best symptom resolution. Good luck to you! Arthur B. Luisi, Jr., D.M.D.

It just occurred to me that, in this entire discussion, noone has brought up the most important innovation that the Micro2 IA brings to the table. It makes adjusting the appliance simple, intuitive, and foolproof. I tend to be a very practical person. Many OSA patients are elderly and not particularly sharp mentally(pre-treatment). They are tired and sleepy. With devices with mechanical adjustment systems, they often tend to struggle--- do I turn the key clockwise or counterclockwise?, how many turns per night?, oops, I lost my count, have I turned it five times, or eight times?, I am I going backwards or forwards, and on and on. With the Micro2, if you want to go forward 1mm, you take out the tray with the big ONE on it and put in the tray with the big TWO on it. Couldn't be easier. Not one of may patients has had trouble with adjustments. This is no small thing. Arthur B. Luisi, Jr., D.M.D.

Actually, I have only fitted the design with multiple trays, so I can not comment on any other design. Dr. Luisi

Dr. Demko, I totally agree about the problem of uneven quality of the same oral appliance from different labs. The way I solved it with the Taps is to only use the master lab, that is Airway Lab in Dalllas, Texas. They design the appliances there and all the top officials are on site. They seem to have a pretty decent handle on quality control, although there still is the infrequent lapse. I tend to go with the parent company for each appliance and not the franchises. I have done a few EMAs over the years for patients who had them previously and liked them, but it is not my favorite. I have cited the strap problem, which may now have been corrected. I also found that the buttons that hold the straps not to be that robust and tend to break off at times. Also, the strap adjustments are at one mm intervals, which is pretty coarse. The Taps adjust at . .25 mm intervals and there are others that adjust in as small as .10mm intervals. In all fairness though, the Micro2 also adjusts at 1mm increments and I have done O.K. with that, so maybe the coarse adjustment intervals aren't that big a deal. Not sure. Arthur B. Luisi, Jr.,D.M.D.

Actually, many, if not most, oral appliances are designed to allow breathing through the mouth. And many patients use oral appliances breathing through the mouth. As was mentioned in some previous posts, the mouth breathing can lead to an uncomfortably dry mouth. Sometimes it does and sometimes it doesn't. In a percentage of cases, the dry mouth can make the oral appliance intolerable to the patient, just as mouth breathing can also sometimes make CPAP intolerable to the patient. Breathing through the nose is optimal and our ideal goal with both CPAP and oral appliances is to eventually get the patient breathing through the nose, if possible. Arthur B. Luisi, Jr., D.M.D.

Please note: The above post has been totally changed and is essentially new, not edited. Dr. Luisi

This is a very difficult question. First let's consider what we do know: We know that there is a strong association between untreated obstructive sleep apnea and nocturnal clenching and bruxing. Some literature that I have read puts the association as high as 50%, but that is not a settled issue and I shall not attempt to defend that figure. We also know that successful treatment of obstructive sleep apnea with CPAP, oral appliances, or other modalities will often lessen or totally eliminate the nocturnal clenching and bruxing. Again, that is not an absolute and there are many exceptions. There are many causes of TMD, but clenching and bruxing are probably the most common. If a person's TMJ pain is simply due to excessive muscular strain and tension on the muscles of mastication, it is possible to resolve those symptoms and proceed to oral appliance therapy for obstructive sleep apnea eventually in many cases. The problems that you describe, particularly the posterior open bite, indicate that your problems have progressed to the stage where you actually have structural problems within the TMJ itself. These are called intracapsular problems. I would agree that you should not undertake oral appliance therapy at this point because it would compound your problems. However, I would not agree that no one in that position has ever been treated well enough to ever be an eventual candidate for OAT. In some cases, dentists extremely skilled in TMJ therapy have been able to perform a procedure called disk recapture and do some other things that might make OAT possible, but again, I do agree that it is limited in scope to a small percentage of cases. Bottom line is that I would agree with Dr. Demko that CPAP or some other mode of treatment is a better bet for you than OAT at this time. Arthur B. Luisi, Jr., D.M.D