SleepDent

I am a dentist working in dental sleep medicine. The fact that you have both obstructive and central sleep apnea is significant and can have a bearing on your treatment. Oral sleep apnea appliances treat only obstructive sleep apnea and not central sleep apnea. When oral sleep apnea appliances are placed into patients with both central and obstructive sleep apnea(called mixed sleep apnea), the interaction is complex and not totally predictable. The appliance could have a positive effect or it could accentuate the central sleep apnea, which might be dangerous for the patient. Any attempt to use an oral appliance should be made with extreme caution and be closely monitored via sleep studies with the oral appliance in place from the outset. a.b.luisi,d.m.d.

I would definitely agree with that. It is becoming increasingly obvious that sleep clenching/bruxing and TMJ problems are very strongly associated with obstructive sleep apnea. The association could be as high as 50% according to some studies that I have read. This knowledge has not yet filtered down into the general dental community. When dentists think bruxing/tmj, they should be thinking sleep apnea, too. Actually, even "simple" snoring without apneas is also very underestimated. Snoring alone puts the body under significant strain. We now know that elimination of snoring with oral appliances often results in better sleep and less daytime sleepiness for the patient(AND the bedpartner). We have thought that snoring alone would have negligible cardiac effects, but even that belief is being re-examined. a.b.luisi.d.m.d.

I am a dentist working in dental sleep medicine. If you have generally liked the features of the TAP, but feel that the tongue is somewhat cramped and restricted, be aware that there is a new version called the DreamTap that has a modified design which increases tongue room dramatically. Maybe you could work something out with your dentist to trade up to that. a.b.luisi,d.m.d.

Now, even though I do use the Tap for the majority of my patients, I am not a one trick pony. I recognize that individual humans do have enough variation that one size does not fit all. For instance, some people just can not stand the feeling of having their mouth held shut. It makes them claustrophobic. For others, the TAPs just feel too bulky, even though they are on the slim side. They may need something like an EMA. But, if I do use something else, I will tell the patient that they are sacrificing some efficacy for the other features and may not get as good a result. And if somebody has a favorite appliance and their sleep test with oral appliance in place showed good efficacy, I am happy to do a new one like it. But there is a serious issue here that needs to be addressed. Patients do not know that different appliance designs can and do have very different efficacy rates. Many manufacturers don't do the research to validate the effectiveness of their products, relying on an F.D.A. clearance, which is basically a sham. It is incumbent on every sleep dentist to do their due diligence to assure the efficacy of the appliances that they are presenting to the patients. I simply will not use any appliance not validated by good third party research, not matter how much merit I suspect that it may have. There is too much at stake for the patients. In all fairness the the patients, if a patient wants a design that you know has a lesser efficacy, they should be told that it is not the most effective out there and it should be compared to the best and let them decide if they want to take the chance on it. a.b.luisi,d.m.d.

I am a dentist working in dental sleep medicine. Dry mouth associated with an oral appliance is most often caused by mouth breathing. If you take medications, they could also be contributing to the condition and you need to be aware of that. Airway Management now offers an intraoral mouth shield for use with the TAP appliances. This soft, comfortable shield sits just inside the mouth and literally seals it off. It stops the mouth breathing and the dry mouth. The shield was originally designed for the MyTap appliance, but can be retrofitted to the TAP3 Elite with a metal post designed for the TAP-PAP CS device. Better, dedicated mouth seals are currently being engineered by the company and will be available soon. a.b.luisi,d.m.d.

I am also a dentist working in dental sleep medicine. I have been doing it for over ten years. I must respectfully disagree with your assessment of the Tap line to some degree. Very credible third party peer reviewed efficacy tests have shown repeatedly that the Taps have the highest efficacy scores of any OSA appliance that currently exists. The fact that this is the best appliance to treat severe obstructive sleep apnea is undisputed. The Taps keep the mouth closed instead of letting it flop open, which has also been shown to increase efficacy. A great feature of the anterior central bearing design is that it is self-balancing. That is to say, that the force on the tmjs is automatically equalized. This greatly improves tmj comfort. The typical dorsal fin designs make it necessary to equalize the protrusion level in each side very carefully. The slightest mistake can cause tmj pain. The new DreamTap design shifts the advancement mechanism to the lower tray. This greatly increases room for the tongue, making it essentially equal to the other kinds of appliances. a.b.luisi,d.m.d.