SleepDent

I would say that you are in the right ballpark. I would say $1400-to $3,500 depending on the area of the country and whether or not you are using a "celebrity" sleep dentist. Dr. Luisi

You are certainly welcome. I must add that they have changed the release date for the shields several times. I would not consider the present date is set in stone. I have seen and touched a working prototype, so they ARE getting there. If in doubt, you can call them for an update. Phone number on their website. Dr. Luisi

Actually, yes, I do have a solution for you. Airway Management(the makers of the TAPS) are introducing new intra oral mouth shields across the line. These are soft comfortable silicone(I think) shields that attache to the front of the Tap appliances. They seal the mouth from the inside to prevent mouth breathing and to encourage nasal breathing. This usually kills off the dry mouth immediately. Currently, they have a mouth shield that can be fitted to their MyTap product and they are developing shields for the Tap 3 and DreamTap products to be released for sale about November of this year. I can actually cobble together a temporary solution by putting the metal column form a TAP-Pap CS on the front of the Tap 3 and sliding the mouth shield from the MyTap over it. This solution works for most people. Maybe your sleep dentist would be clever enough to do that for you, too. The caveat here is that you have to have enough nasal patency to successfully nose breathe. If you don't, you need to see the ENT doctor to get improved in that respect. I hope that this helps you. Arthur B. Luisi, Jr., D.M.D.

You are absolutely correct. Dr. Luisi

Another personal observation that I can make is the following: I have had patients tested with oral sleep apnea appliances in place and they will have a certain residual AHI. Later, after they have been treated by an ENT to improve nasal patency, the same appliance will be sleep tested again and the residual AHI is usually significantly lower. It is obvious that the increased nasal patency has reduced the OSA more. Arthur B. Luisi,Jr., D.M.D.

I am a dentist working in dental sleep medicine. Absolutely, the state of your nasal patency(openness) has a bearing on the severity of your OSA. I always tell patients to think of their airway from the tip of their nose down into there lungs as a system of duct work like that in your home air conditioning. A restriction in ANY part of the duct work will increase the airway resistance in the over-all system and increase the level of OSA. In my view, treatment of OSA, whether with CPAP, an oral sleep apnea appliance, or anything else, should include a trip to the ENT doctor to assess the state of your nasal patency and to optimize it. It generally will not rid you of the OSA, but it will temper it and make it easier to use the CPAP with easier and better air flow through the nose. Arthur B. Luisi, D.M.D.

Certainly it may be a factor that you just need more sleep than that. Many people really need 8-9 hours to feel rested. Also, remember that it takes time to fully recover and regenerate from untreated obstructive sleep apnea. It commonly takes one, two, or three months to feel rested every day, even with treatment. It could take even longer than that. Dr. A.B. Luisi, D.M.D.

I am a dentist working in dental sleep medicine. Have you considered an oral sleep apnea appliance instead of the CPAP? Many of my patients have come from an unsuccessful try at CPAP due to panic attacks/claustrophobia. The majority have been able to successfully transition to an oral sleep apnea appliance. In all fairness, a few patients are so claustrophobic that they can not even tolerate the appliance, but that is a tiny minority. Dr. A.B. Luisi, D.M.D.

You have certainly got it right. Without awareness at the professional entry level, patients often never get to the specialists that they need. In fact, general family dentists are the ideal professionals to screen for OSA. They often see patients every six months and get an opportunity to view them intraorally. I am not particularly proud of it, but 11-12 years ago before I got into dental sleep medicine due to an off-hand remark from a friend who happened to be a sleep physician, I barely knew what the word apnea meant and didn't have a clue what to look for. Most dentists have gotten zero training in dental sleep medicine in school and have zero interest in the field. Thus they don't even screen for it. This is a real public health loss. Dr. Luisi

I couldn't agree more. One would think that dentists who are placing oral sleep apnea appliances would be cognizant of the TMJ environment in which they are attempting to place them. And, furthermore, would have gotten more training in TMJ in order to cope. But many times, that just is not the case because general dentists are encouraged to take a few courses and then incorporate dental sleep medicine into their practices as just one more of many services. I think that this approach is a real loser and both the patients and the reputation of oral appliances suffer greatly. Dr. Luisi