I am a dentist working in dental sleep medicine. Actually, there is very little to do. They will just take upper and lower impressions and a special bite record. The only thing that I can think of is to brush and floss carefully to make his mouth super clean and free of plaque. That way you will get the sharpest and best impressions. Arthur B. Luisi, Jr.,D.M.D.. The Naples Center For Dental Sleep Medicine.
No. That would be about normal.
You really do have a complex and vexing situation. In terms of nasal patency, you already have that covered and have already done every procedure that a person would reasonably want to have done. So the question remains, if you possibly have UARS, what is causing the increased breathing resistance, if not your nose? A possibility is that you just have an unusually small diameter trachea and other breathing tubes leading into the lungs. An ENT could determine that, but I am not sure that I would want to get into that because I think that those endoscopic procedures could be problematic. You might get a consult just to discuss the issue. I would not recommend boil and bite oral appliances to anyone, mostly because they do not work well and do tend to do some damage to your teeth and mouth. The horror stories as to OAs messing up the bite are definitely over-rated. In my practice, it has not been that much of an issue if you use a morning realigner and a good quality appliance properly fitted. In life, lots of things are trade-offs. Which would you hate more, to go through life always feeling lousy and tired, or getting a little tooth movement. Your life-- your choice. I would focus your attention on one appliance in particular, the Luco Hybrid appliance. It is not very well known, but excellent for comfort, low potential for tooth movement, and restoring EXCELLENT levels of oxygenation. It is really good for UARS. See: www.lucohybridosa.com. Dr. Luisi
I am a dentist working in dental sleep medicine. From what you relate, it is very possible that you have UARS. The problem medically is that physicians are generally not very focused on UARS. If you pass the sleep test with a low enough AHI, they tend to wash their hands of you because, theoretically, you are O.K. and insurance won't pay for treatment of UARS anyway so they just kind of throw you out. Unfortunately, people with UARS are often just as symptomatic as people with OSA, if not MORE SO. Sleep dentists tend to get a lot of people with UARS after the physicians cut them loose. People with UARS tend to have low blood pressure, be jumpy and a bit high strung, possibly have fibromyalgia or a lot of somatic pains, G.I. problems, and be VERY light sleepers. Because they are such light sleepers, CPAP may tend to disturb their sleep because it is just too intense an experience. Oral sleep apnea appliances are often ideal for UARS patients because it is a gentle, quiet, no air pressure experience and the minimal AHI is easy for the appliance to control. It might make sense to consult with an ENT doctor also, because one major contributor to UARS is nasal obstruction. I hope that this helps you. Arthur B. Luisi. Jr., D.M.D.. The Naples Center For Dental Sleep Medicine.
Some people have asked me whether or not they could do medical tourism and get a leak-proof CPAP interface that way. The answer is YES. I am in SW Florida and it is a pleasant place to visit. You need to call us and we will ask you some screening questions to see if you are a candidate. We will send you some life-size pictures to examine. If you are interested, we need a least 2-3 weeks lead time to assemble your device. It takes about 2 hours to deliver. You need to have your CPAP machine with you. We can deliver about 10 per week so order well in advance. And if we can't make it work to your satisfaction, there is no charge. See: www.naplescenterdentalsleepmedicine.com. Dr. Luisi
You asked an easy question. However, the answer is not that simple. Recent studies of patients with very SEVERE mixed apnea(a combination of both obstructive and central apneas) show that the use of an OA to treat the obstructive component tends to lessen or even eliminate the central component. Don't ask me why. I don't know. Well, I could give you a very complex explanation based on fluid dynamics. but I can barely remember it myself. The point is, when you are using a combination device incorporating an OA and CPAP, the OA mainly holds the mask in place in lieu of the straps. The machine is going to do the heavy lifting with both the obstructive and the central components anyway. Remember, this patient is fairly close to getting down to the magic number of AHI 5. Certainly, the OA could help with the obstructive component and, marginally, with the central component. Probably, just enough to get her over the goal line. Worth it, I think, for this patient since the higher numbers concern her. Dr. Luisi
I would like to talk about the AHI score for a moment. Ideally, you would like the treatment AHI to be below 5, which is considered "normal". But this is the real world. When a person is very severe(like an AHI of 98), our present equipment often struggles to cope with it. When your doctors seem not too concerned with a treatment AHI of 5-20, they are probably looking at a number of long-term studies that show that an AHI of 20 is low enough to take the really bad stuff(heart attack, stroke) off the table and low enough not to shorten a person's life span. Coming from an AHI of 98 that is a real improvement. Certainly you should not be terrorized by your situation. If you really want to get it down lower though, one thing you could consider is combination therapy using both an oral appliance and the CPAP. See: The Tap-Pap CS system. www.tapintosleep.com. Arthur B. Luisi, jr., D.M.D.
I recently got some positive feedback on my concepts from the Mayo Clinic. Very encouraging. will keep you posted. Dr. Luisi
I hate to say it, but numbers like that could very well put you in clear and present danger. If I were in the same position. I would consider it to be a medical emergency and would press my doctor for immediate action without respect to money considerations.
I am a dentist working in dental sleep medicine. Yes, there are other patients with the same concerns. First of all, the device should be firmly on the teeth and there should be some resistance to removal, but you should not have a life and death struggle to get it out. If you do, it could just be on too tight. You need to make an appointment with your sleep dentist to loosen it up somewhat. It can be done. Secondly, make sure that you do not try to remove it bilaterally(from both posterior sides at once). this is very hard to do. Instead start by removing it from one posterior side or the other and just "peel" it off. Thirdly, when you start to remove the DreamTap, open your jaws gently(don't hurt your TMJs) to put tension on the trays. They remove more easily that way. Fourthly, if all else fails, you can spray a bit of original Pam cooking spray on the inside of the trays. That will grease them up and they remove more easily that way. If you are getting too much saliva in your mouth and that is making you uncomfortable, ask your dentist if taking one OTC Benadryl before bedtime is O.K. for you. If it is, that would greatly help that problem. People can usually ween themselves off the Benadryl in about a week. These suggestions should get the job done for you. If they don't, perhaps you need have another consultation with the dentist. A few people just can't get past the feeling that the two trays are joined. If so, your dentist may need to go to another design where the two trays are not joined and you can open and close your mouth. Arthur B. Luisi, Jr., D.M.D., The Naples Center For Dental Sleep Medicine