SleepDent

Very good advice. I am 100% in agreement with this one. Arthur B. Luisi, Jr.,D.m.D.

I am a dentist working in dental sleep medicine. Perhaps a good appliance for someone with your set of priorities would be the Micro2 IA. It is unique in that both the upper and lower trays are milled from a single block of clear plastic using computer aided manufacturing. I can't think of a lighter, thinner, stronger design on the market. There is no bulky advancement mechanism. To increase protrusion the trays are actually swapped for a series of more advanced ones, much like Invisaline orthdontic trays. See: www.prosomnus.com. Arthur B. Luisi, Jr.,D.M.D.

I am a dentist working in dental sleep medicine. I am sure that some health professionals do warn the patients about the dangers of napping without treatment. I do oral sleep apnea appliances. One of the first things I tell the patients is to never go to sleep without the appliance and if they are in a situation where there is a chance they could fall asleep, not matter HOW REMOTE, the oral appliance should be in place. Arthur B. Luisi, Jr., D.M.D.

I think that the strongest case that can be made for treatment of severe OSA in the absence of significant symptoms is long-term cohort studies showing that people with severe OSA that is untreated will live, on average, ten years less than comparable people without OSA. Arthur B. Luisi, Jr., D.M.D.

I am a dentist working in dental sleep medicine. There is a very special mask variant called a Tap-Tap CS that is specifically designed for those with extremely high treatment pressures and intractable leakage. It can only be used by people with natural upper and lower teeth in reasonably good shape. An oral sleep apnea appliance is used to hold a nasal pillow mask. There is no full face mask and no head straps. Any leakage through the mouth is controlled by a patented intraoral mouth shield(seal). The oral appliance usually enables the use of a somewhat lower treatment pressure and leakage is nil. I have used some on patients and it works pretty well. See Airway Management web site, www.tapintosleep.com for further information. Arthur B. Luisi, jr., D.M.D.

Actually, I would not make that assumption. Going from a state of treatment to no treatment cold turkey puts a tremendous strain on your body. Unfortunately, there are verified instances where a patient missed ONE night of CPAP after twenty plus years and paid the ultimate price for doing so. Arthur B. Luisi, Jr., D.M.D.

Actually, it is incorrect to state that oral appliances can never be used for severe obstructive sleep apnea. A smaller percentage of people with severe sleep apnea will get very good results, but that doesn't mean none. If you use a DreamTap, which is probably the most effective appliance for severe OSA and use excellent technique, you can probably get an excellent result in about 30% of the cases, a fairly good result in about 55% of the cases, and a minimally effective result in close to 70%. The AASM recommends that CPAP be the first treatment tried for severe OSA, but then says OAs may be tried if the patient is CPAP intolerant. Arthur B. Luisi, Jr.,D.M.D.

Well, I actually agree with your dentist that the other devices are not as effective as the TAP. That is my personal feeling based on the testing data that I have seen and my personal anecdotal experience in my office. However, you may not necessarily need THE most effective device to get adequate treatment. I have had the same talk with my own patients many times over. It is not unusual for people with high levels of anxiety and a degree of claustrophobia to be uncomfortable with their mouths held shut. I would do the sleep test and work with your dentist in good faith to see if you can get used to the TAP. What I happen to be doing for my own patients right now with this problem is to switch them to a Micro2 AI appliance which is very thin and comfortable and allows you to open and close the mouth at will. If people can get used to ANY OA, it would be this one. Test data on the Micro2 is much more limited than the TAP, but what I have seen is reasonably good. I would look at it this way: if you can wear an appliance like Micro2 and it works well enough-- fine. If it doesn't work well enough, OAs may not be for you. Again, I have not had the benefit of examining you and this information is given to suggest possible avenues of conversation between you and your health care providers and is not to be used as a substitute for in person medical attention. Arthur B. Luisi, Jr., D.M.D.

HI! I am a dentist working in dental sleep medicine. The Dream Tap is one of the most effective oral appliances out there, but is not for everyone. It does hold the mouth closed. However, there is breathing space built into the anterior part of the appliance, so that you can get air exchange if you mouth breathe. If you find it insufficient, there are ways for your dentist to increase the air space. You also mention anxiety. Although most people actually sleep with their mouth pretty closed, the fact that you can not open may be giving you a feeling of claustrophobia. In that case, you may want to discuss going to another appliance design like the Micro2 IA that allows your mouth to open fully when you sleep. That might help. However, be aware that losing the feature that keeps the mouth closed may compromise the efficacy of the appliance to some extent. More often than not the loss of efficacy is minor and can be tolerated, but sometimes it can be significant. If your breathing has worsened over time, it may also be that you have over-protruded the appliance past your most effective "sweet spot" and may have to work with your dentist to essentially start over again with the titration to relocate it. You should get some useful feed-back from you upcoming sleep test with oral appliance in place. Arthur B. Luisi, Jr., D.M.D.

Hi! I am a dentist working in dental sleep medicine. I understand your dilemma. I have had the same problem with my patients who have a full upper denture. Theoretically, people really should have at least eight teeth in both the upper and lower arch. Most oral appliances are designed to fit on teeth only, but a few can be adapted to full upper dentures. I have done a few like that myself. The problem usually is that the denture has to hold the lower jaw forward to open the airway and that generally puts excessive pressure in the tissues in the front of the maxillary gum ridge just below the lower lip. I have found no way around it, thus far. Some people just tolerate it, if they can and, others go back on CPAP. The only better answer I know is to support the upper denture with some dental implants. That can work, but is quite expensive to do. You need to consult your dentist about it. Arthur B, Luisi, Jr,D.M.D.