SleepDent

Its highly likely that it will be enough. In my experience, everything that you do tends to help at least a little bit. Most likely, the surgeries got you closer to the finish line and the Tap will push you into the end zone. Good luck to you. Arthur B. Luisi, Jr., D.M.D.

Well, that is certainly a depressing statistic. If that is the case, one must assume that large numbers of both CPAP and oral appliances users eventually conclude that it is more trouble than it is worth. I would speculate that it is the less symptomatic patients that may be doing so. At least, in my own practice, the very symptomatic patients, who can then perform and feel much better using either CPAP or OAs tend to stick with it. They get a lot of positive reinforcement for putting up with the discomfort of treatment. I can understand why many people with other chronic diseases and conditions tend to have better rates of compliance. How tough is it to pop a couple of pills a day? I guess the take away is that we need to continue to find new ways to treat OSA that are more comfortable and require less commitment, if such ways are possible. Arthur B. Luisi, Jr., D.M.D.

The high level of success with CPAP in reducing the AHI to acceptable levels is, indeed, tantilizing. But, as one of my earliest patients said, no matter how good a treatment is, it won't help you if you can't stand it. Of course, the big problem is the compliance rate, especially over time. And CPAP does have a long list of potential side effects, certainly a much longer list than oral appliances have. I might sound cavalier in saying this, but there has to be a better way. And I am not saying that oral appliances are that better way. Arthur B. Luisi, Jr., D.M.D.

I am a dentist working in dental sleep medicine. OSA patients often underestimate the time that it is going to take to abolish their symptoms, even if they are getting adequate treatment. Remember, your untreated OSA damaged your body in a variety of ways and it takes the body quite a long time to undo that damage. First the damage is repaired and then you start to feel better. Your symptoms will not go away in a straight line. It is more like two steps forward and one step back. You will have your good days and your bad days. But always, there will be slow progress forward. It could take up to six months or longer for your symptoms to fully resolve. This is admittedly on the long side of normal, but it happens. Good luck to you. Arthur B. Luisi, Jr.,D.M.D.

I my clinical experience, I have also found that there is a wide variation in how far forward patients can advance their mandibles. The clinically significant number is the range of motion from maximum retruded position(as far back as the patient can move the lower jaw) to maximum protruded position(as far forward as the patient can move the lower jaw). I have seen this vary in my practice from 0mm(no movement possible) to around 15-16 mm. The average is probably about 8-10mm(have seen studies quoting averages in this range). Generally, more range is better than less. Arthur B. Luisi, Jr., D.M.D.

I reviewed both studies and also a third, Journal of Dental Sleep Medicine Vol:03 Number:04 10/10/2016. Does CPAP Pressure Predict Treatment Outcome with Oral Appliances. My take-away would be this: Clearly, lower CPAP pressure is predictive of success with oral appliances, to some extent. I would keep this in mind and probably discuss it with patients. Do I feel comfortable enough with it to put a number(13) in a list of factors for OA success on the forum at this time. Probably not. It is a judgement call. Arthur B. Luisi, Jr., D.M.D.

Certainly, It is different factors in different people and to different degrees. Some of the factors could be: deviated septum, enlarged nasal turbinates(little hills inside the nose), chronic rhinitis(nasal congestion) due to allergies and/or sinus problems, congenitally small nasal passages, enlarged tonsils, Macroglossia(big tongue) just like OSA, large, floppy soft palate and uvula(just like OSA), retognatha(small lower jaw), and others. The net effect is that the air is forced through a restricted airway system, the total pressure goes up, and it gets hard to breathe. Different people need different fixes, although both CPAP and oral appliances will sometimes overcome the resistance in a band-aid type of approach. Arthur B. Luisi, Jr.,D.M.D.

I am a dentist working in dental sleep medicine. What you describe sounds like Upper Airway Resistance Syndrome(UARS) to me. People have the mistaken impression that, if they are not having any apneas, things are necessarily all right. That is a mistake. When people have apneas or hypopneas, they create arousals from deep sleep that make you tired. In UARS, there is still an abnormally high resistance to air flow in your breathing passages. This makes your body work so hard to breathe that, again, it awakens you from deep sleep and makes you feel very tired. These arousals are shorter than the ones from apneas and hypopneas and are called spontaneous arousals. These are recorded in most lab sleep studies and may or may not be recorded in home sleep studies. Arthur B. Luisi, Jr., D.M.D.

I am a dentist working in dental sleep medicine. There is no question that it is a tough break to have address obstructive sleep apnea with Sjogren's Syndrome. Most likely, you are already aware of oral moisturizers, like Biotene, and they are a relatively ineffective solution, but, for the sake of completeness, I will mention it. Have your considered oral sleep apnea appliances? The benefit here is that there is no pressurized air coming into your nose and throat and, of course, that air flow is a major consideration with the dryness. You will have somewhat less dryness with an OA if you normally breathe through your nose. If you mouth breathe, you will again have some dryness problems with an OA, but not on the scale of CPAP. A few OA's, the Tap3 and the DreamTap will soon come with optional intra-oral mouth shields that will seal off you mouth from the inside and prevent the dryness of mouth breathing. In that case though, you might need to see an ENT doctor to make sure that you can breathe well enough through the nose. I would also think that it would be possibly beneficial to review your medications with your doctor and/or pharmacist to see if any of those are compounding your dryness problems. Good luck to you. Arthur B. Luisi, Jr., D.M.D.

Obviously, It would be nice to know just how many people in the USA actually use oral appliances to treat OSA. Unfortunately that figure is not available. I do have some idea about what the production figures are for some of the more popular appliances. If one takes the often quoted success rate at 50%, I would estimate the number of people using oral appliances at 250,000 to 500,000 and probably closer to the higher end than the lower. Arthur B. Luisi, Jr., D.M.D.