SleepDent

Your story is illustrative of a common problem. A significant segment of the population has UARS(upper airway resistance syndrome). These patients test with few or no frank apneas or hypopneas. Unfortunately, medical insurance will usually not pay for treatment under these circumstances and physicians may dismiss the patient as "O.K." medically. Well you are O.K. in the sense that you will not get a heart attack or a stroke like you might with obstructive sleep apnea, but these patients are often quite symptomatic. miserable, and non-functional. As a sleep dentist, I do get to see some of these people after they get cut loose by the physicians. It is a real gap in treatment coverage and a significant public health problem. Arthur B. Luisi, Jr., D.M.D.

The anterior open appliance sounds like a really plausible approach, but. as we know, what sounds plausible is not always viable in real life. Have you seen any efficacy data on these anterior open design appliances? I have looked at the Moses, the Oravan OSA, and the Luco Hybrid and, so far, have come up empty for online published efficacy results. Also, they seem to open up the bite significantly vs. the typical appliance. Have you observed any patient comfort complaints due to the more open VDO. Arthur B. Luisi, Jr., D.M.D. ..

As an option, the Micro2 IA can be made with metal-free hooks. These small hooks can be used with orthodontic elastics to hold the mouth closed. I usually order them on the Micro2s I use on my patients. If the patient is getting good treatment with the trays opening and closing freely(confirmed via sleep test with oral appliance in place), I eventually remove the hooks. If not, we use the elastics on the hooks to gain extra efficacy. The Resmed Narval is extremely thin and light. I am aware of two potential problems with it. It is very hard to adjust if the fit is not exactly right. It either fits right out of the box or it doesn't(not much margin for error). Also the struts can stretch and break, so it isn't a very good choice for a patient with a clenching/bruxing habit. Arthur B. Luisi, Jr., D.M.D.

Well, it probably meets legal and ethical requirements on some minimal level, but, in my view, you deserve better. You need to sit down with a board certified sleep specialist for a complete initial interview covering your entire medical history and all of your potential sleep problems. Personally, I would not trust a sleep test administered by a dentist for an initial diagnosis, even if it was interpreted by a board certified sleep specialist who never met you. In my experience, the tests administered by regular sleep labs, either in lab or at home are more reliable. I am not implying that your dentist didn't do it right. I am not in the position to judge that. But if you were one of my family members or relatives, I personally would do it the more professional way. However, after you get an official diagnosis, there is no reason not to use your dentist for the appliance if you are convinced that she has had adequate training in dental sleep medicine. Arthur B. Luisi, Jr., D.M.D.

I am a dentist working in dental sleep medicine. The proper protocol, as per the American Academy of Dental Sleep Medicine, is that dentists are not qualified to make a definitive diagnosis of obstructive sleep apnea. They may screen for OSA, but if it is suspected, a physician must make the diagnosis. The best type of doctor to consult is a board certified sleep specialist. Typically, they will be pulmonologist/critical care specialists with an extra certification in sleep medicine, but they could have had basic training in another area. They will give you a better laboratory or home sleep test than a dentist is trained to do and will also screen you for about 100 other possible sleep disorders. After they give you the diagnosis, THEN you can consider an oral appliance, CPAP, or other methods of treating your OSA. Arthur B. Luisi, Jr., D.M.D.

Actually, your situation is quite interesting in that we need to figure out the most practical solution for you. Of the three appliances, the EMA is the simplest in design, the thinnest, and the most light weight design. You would already be aware of the problems with the connectors stretching, breaking, and needing relatively frequent replacement. It is also the least durable design of the three, but appears to have been adequate for your purposes. The Micro2 is the newest design of the three and , so far, the feed-back that I have gotten is that it is very comfortable to wear--- significantly more comfortable than the DreamTap. Obviously, I don't know the pricing in your area, but, usually, the EMA is substantially cheaper than the other two-- and it should be. I think a good case could be made for you to stand pat with what has worked for you in the past and just go back to the EMA again. However, you need to decide just how much of a pain the EMA connector problems have been to you and whether or not you want another dose of them. So far, the precision design of the Micro2 has made it very easy for me to fit-- the easiest ever. However, it does have lateral wings in the cheek areas to control the mandibular protrusion that make it quite a bit bulkier in that area than the EMA. So far, my patients have not complained about it, but that could possibly be a problem area for you. In summary, I think that the Micro2 would be an easier transition from an EMA than the DreamTap was and would be a good calculated risk as a way to ditch the connectors. However, we humans each have our own idiosyncrasies and one can never be completely sure without trying. Arthur B. Luisi, Jr.,D.M.D.

You need to be aware that it often takes a long time to lose that feeling of tiredness, even with adequate treatment. It often takes two, three, even six months to become less symptomatic. You may need to be patient. Arthur B. Luisi, Jr., D.M.D.

I am a dentist working in dental sleep medicine. Whenever a patient who formerly did not have a dry mouth suddenly gets one, the first thing that I think about is a change in medication. Many, many medications have dry mouth as a side effect. Have you been given any new meds recently? If so, you may want to review them with your pharmacist or doctor to determine whether they may be the problem. Arthur B. Luisi, Jr.,D.M.D.

I am a dentist working in dental sleep medicine. The latest iteration of the Micro2 is the IA model. The standard configuration has a flat biting surface allowing the mouth to be fully closed to block air flow. Please understand that this device does allow you to open and close the mouth. If your mouth voluntarily hangs open, then you will get air flow through the mouth. It can be optionally equipped with metal-free hooks that allow the mouth to be kept shut with orthodontic elastics and you might want to consider getting those. Arthur B. Luisi, Jr.,D.M.D.

I am a dentist working in dental sleep medicine. If the oral appliances were not effective, I wouldn't have a job for long. In my office they cost anywhere from $650 to $1650 or more. Do you think the public is stupid enough to just throw their money away on them? I can assure you that they are not. Many hundreds of thousands are in daily use in the USA and around the world. They are not for everyone, just as CPAP is not for everyone. A dentist experienced in dental sleep medicine can assess you as a candidate and tell you what your chances for success would be. Arthur B. Luisi, Jr.,D.M.D.