SleepDent

Actually, I think the products like Biotene have some limited usefulness, but they are not much of an answer, as per wiredgeorge. Dr. Luisi

Hi! I am a dentist working in dental sleep medicine. One requirement of a good oral sleep apnea appliance is that the patient be able to have full lip closure and seal with the appliance in place without strain. That being the case, you have a legitimate complaint in my view. If you can not attain comfortable lip closure, the chances are that the appliance is simply too big for your mouth. Oral appliances vary quite strikingly in bulk. If you tell me what you have, I can give you some idea of the relative bulk of your appliance. You need to have a conference with your dentist concerning your problem. Perhaps he can cut down the bulk of your appliance to make it more comfortable. Failing that, you may have to consider another brand that is less bulky. I do think that your mouth would be somewhat less dry with a good lip seal around the appliance. You can also try OTC mouth moisturizers, like the Biotene products. Another thing that is critically important is to be sure that you can breathe through your nose extremely well. People with excellent nasal patency tend to breathe much less through their mouths. If you have any doubt about your situation, an assessment trip to an ENT would definitely be in order. I hope that this information helps you. Arthur B. Luisi, Jr., D.M.D.

I am a dentist working in dental sleep medicine. Oral appliances work only for obstructive sleep apnea. They do not treat central sleep apnea. Your sleep study should tell you which kind that you had. An oral appliance works well for most people with mild to moderate OSA and for a smaller percentage with severe OSA. An OTC cheapie appliance WOULD NOT be a fair test. There is a very good appliance called a MYTap which dentists can fabricate in office for a charge of around $450-$650 that would be a very good tester for you. It would only last about 1-2 years, but if you are doing well, you could invest in something that would last much longer. Arthur B. Luisi, Jr., D.M.D.

Hi! I am a dentist working in dental sleep medicine. People vary widely in just how symptomatic they feel with obstructive sleep apnea. However, also keep in mind that your life is your life and you have nothing to compare it to. Oftentimes patients think that they have felt O.K. without treatment, but after four or five months of treatment, they do begin to feel significantly better and realize that they had overestimated how well they felt pre-treatment. This could happen with you. Time will tell. Arthur B. Luisi, Jr., D.M.D.

I am a dentist working in dental sleep medicine. Unfortunately, it could take a significant amount of time before you get pay-back in terms of feeling better. Severe sleep apnea causes very significant damage to many systems in your body and that damage usually has to be repaired BEFORE you start to feel better. However, each person does differ. A few patients, maybe five percent, do feel better right away. I think that the average person probably needs about two weeks before there is ANY sense of improvement and that sense will be slight. After a month you may definitely feel better, but nowhere near where you want to be. After two months, better. After three months, yippee!. But it could be much longer than even that average. The improvement tends to be uneven, two steps forward, one step back. You could have a few good nights, then one bad one, but the trajectory will be gradually upward. You need to be patient. Good luck to you, Arthur B. Luisi, Jr., D.M.D.

I am a dentist working in dental sleep medicine. I have heard complaints like yours many, many times. There is a dirty little secret about CPAP that all of the proponents conveniently fail to talk about. From a mechanical point of view, CPAP is very efficient at opening up the airway. People usually end up with very good (low) AHI scores. Unfortunately for a significant segment of the population with sensitive and hyperactive nervous systems the entire experience is just WAY TOO INTENSE. Hence the continued insomnia. Oral sleep apnea appliance therapy is a much kinder, gentler approach. There are just two reasonably sized trays on your teeth. No mask, no straps, no hoses, no forced air, no noise, no air leaks. Quiet and serene. Almost to a man, patients who have come to me off CPAP with insomnia complaints have been straightened out and can sleep. Should the sleep docs suggest an OA when patients have continued insomnia on CPAP. Sure they should- but this is the real world, not the ideal one. Arthur B. Luisi, Jr., D.M.D.

I am a dentist working in dental sleep medicine. Stories like this serve to illustrate the difficult logistics using a CPAP. I feel that people who travel a lot should investigate an oral sleep apnea appliance, even if they only use it for trips. They are small. completely portable, don't need a power source, and are unobtrusive and non-embarrassing. About 85% of the mild to moderate OSA patients can get good treatment (AHI below5, no symptoms) from a quality appliance like the TAP3. Even 30% of severe patients can get their AHI down below 5 with a TAP3, about 59% can get below 10 and about 70% can get below 20. These numbers could well be sufficient on a temporary basis even for severes. Arthur B. Luisi, Jr., D.M.D..

I am a dentist working in dental sleep medicine. Unfortunately, there is just no way to answer that question long distance and without examining you. Your original sleep dentist should and probably did record the maximal protrusion you were capable of before treatment. Without knowing that measurement you are flying blind.I will say that your body does have ways to alert you when you are overdoing the protrusion level. It may be that you are maxed out at 4-5mm. If you are asymptomatic, it may be that the 4-5 mm is sufficient for you. The only official way to know is to have either a home sleep test or a lab sleep test with the oral appliance in place. If your AHI is low or nil, you may be finished with adjustments. You absolutely need to use your AM aligner with exercises faithfully. As to the tight neck and shoulder muscles, strengthening exercises may not be your answer. That would actually tend to make them tighter. The more logical answer is that they need to be loosened up and stretched. Oftentimes a Licensed Massage Therapist or a Physical Therapist familiar with the head, neck, and TMJ area can be very helpful with that. They can often loosen up your muscles enough so that you can do more protrusion without muscular or tmj symptoms. Basically though, you need to wait for your new sleep dentist to discuss all of these things and let him or her supervise the titration of your appliance. I wouldn't suggest do-it- yourself for this. Better just stay at 4-5 mm until you have professional guidance again. Arthur B. Luisi, Jr., D.M.D.

The first logical stop, I think, is a board certified sleep physician to see of your symptoms are related to obstructive sleep apnea. They can also do a basic medical work-up and deal with some of your symptoms. From your laundry list of symptoms, I think that you are going to need input from several specialties, ENT, perhaps allergists, to name a few. If you do have sleep related breathing problems, your sleep doctor will discuss various treatment options. An oral appliance will be one of them. I wouldn't automatically go to your general family dentist for that. Dental sleep medicine is a specialty area and your dentist may or may not have adequate training in that area. Your best bet is to find a sleep dentist with expertise in both oral appliances and TMJ/jaw grinding issues. You really need to be diagnosed and treated for both issues. Clearly, the orthodontic problems would be contributory, but I think you might benefit from a complete TMJ diagnostic work-up before jumping into the ortho. Tooth grinding can be caused by sleep apnea and treatment of the OSA can often eliminate the clenching and grinding habit. Arthur B. Luisi, Jr.,D.M.D.

Hi! I am a dentist working in dental sleep medicine. First of all, a sleep test that was negative ten years ago is no longer relevant. A lot can change in ten years, as patients tend to put on more weight over time, your muscles in your breathing passages tend to get saggier and less supportive, and you get different health problems. Your sleep consultation is long over-due. It would be doubtful if your night guard is causing all of your problems, in and of itself, but it could be making them worse. The typical flat plane night guard tends to make your lower jaw move a little backward in your head and that could make your airway close up more. To keep your airway open, it is actually better to bring the lower jaw forward. This opens your airway. This is what oral sleep apnea appliances do. What you can do to help your breathing temporarily is to use Breathe Right strips to keep your nose more open and to use nasal spray, either saline, or OTC nose drops, if they do not interfere with your medications or medical conditions. As far as we know, only moderate to severe obstructive sleep apnea patients are at risk for stroke or heart attack. This means that, to the best of our current knowledge, you would have to get up over 20 breathing interruptions per hour to be at risk. Arthur B. Luisi, Jr., D.M.D.