SleepDent

Unfortunately, you have it right. In many countries, including my own, the USA, they blew the initial opportunity for containment. Now the toothpaste IS out of the tube. Huge numbers of people are going to get sick and die and we just have to take our licks until they get enough testing done, plus vaccines, and discovering medical treatments. This is going to take serious amounts of time and, meanwhile, the economy will tank and go into recession or depression. Just shows you the price you pay with these things unless you are super sharp. Dr. Luisi

Remember that the exhaust air coming out of the vent ports on the masks is STILL PRESSURIZED. There would clearly still be potential to expel virus particles out of these vent ports for a significant distance. Dr. Luisi

I am a dentist working in dental sleep medicine. Unfortunately, I have some really bad news for the people on this forum. In a post dated 3/22/20 the American Academy of Sleep Medicine states that the use of CPAP by patients with COVID-19 infections does, indeed, pose a significant risk to other family members in the household because it disseminates the virus into the air regardless of what face mask you use. Please check out the FAQs on their web site about this. There is also some risk of spread during the routine cleaning process. Oral sleep apnea appliances are specifically cited as being a safer alternative, as are some other things. Now, I am not suggesting that you dump your CPAPs, but you MUST be absolutely sure that you are totally isolated from other household members and it may make some sense to move some very vulnerable family members(or yourself) to a different location. Arthur B. Luisi, Jr., D.M.D.. The Naples Center For Dental sleep Medicine.

I agree that putting locks on the older posts is a really BAD idea. By definition, the most recent posts are not going to be the best or the most provocative posts that ever were. It makes the whole experience much less interesting. Dr. Luisi

I am a dentist working in dental sleep medicine. It is so frustrating to hear these endless stories about mask leakage and chin straps when the answer to the problem is sitting right in my office. I have a leak-free nasal pillow mask with an attached soft intraoral mouth shield that seals off the mouth from the inside. It is comfortable and it works. O.K., you say, if it is so good why can't I buy it right now at CPAP.com. Well it is due to a combination of politics and regulatory red tape. Even though every part of my device is made up of F.D.A. approved parts, they are configured in a novel way and the F.D.A. would consider that to be a new usage, thus subject to further review. You CAN get the device directly from me and it is production ready for volume production under an investigational device protocol, but few patients know to do that. So people will continue to suffer unnecessarily as I slog along trying to figure out how to get the necessary approvals. VERY FRUSTRATING. Dr. Luisi

Let me review the present state of affairs. To date, when a person has chosen to use nasal pillow masks, and has developed a problem with mouth leakage, the conventional response is to go with a chin strap to keep the mouth closed. A very popular chin strap is made by ResMed. This leaves your head covered with TWO sets of straps. One set holds the nasal pillow mask in place and the other set is for the chin strap. Obviously, the comfort is less than ideal, and there can still be a fair amount of leakage from both the nasal pillows and the chin strap. Granted, in some applications, they don't leak, but oftentimes they still do. My device with tooth-supported nasal pillows and the intraoral mouth shield effectively replaces BOTH the nasal pillow mask AND the chin strap. Functionally, it does the same thing. The difference is that there are no straps and NO leakage, which is a big improvement in comfort. From a safety point of view, both arrangements are fine. The exhaust ports in the nasal pillow masks effectively gets rid of the exhaled CO2 unless the ports are blocked or the CPAP machine stops functioning. The addition of the chin strap or the mouth shield does not compromise safety because the exhaust ports avoid CO2 build-up even with the mouth sealed. I hope that this adds some clarity to the discussion. Dr. Luisi

Let me add one thing. Patients need to understand that they get the skimpy "out of network" reimbursements for oral appliances because most medical insurance companies WILL NOT ALLOW dentists to join the plans in network. I, for one, would be willing to join medical insurance networks for these devices. They just won't let me in. So don't blame the dentists. Blame the medical insurance companies. The only exception to this rule is that a FEW oral surgeons are allowed to go in network. Dr. Luisi

I am a dentist working in dental sleep medicine. I have had very mixed success in securing medical insurance coverage for oral sleep apnea appliances. I would agree with your sleep doctor that, as a practical matter, the insurance companies tend not to deal in good faith when covering these appliances. Firstly, you usually have to pre-certify the procedure and if you don't do it, you are a dead duck. Secondly, your documentation has to be comprehensive and you have to dot all the I's and cross all the T's. Thirdly, since most dentists are out of network for medical coverage, there tends to be a very high deductible and a lower out-of-network payment percentage. The bottom line is that you often do end up getting skunked on the coverage. Nevertheless, a few lucky patients with truly first rate medical coverage do end up getting significant coverage. I would put the percentage at about 20% in my practice. So it isn't hopeless for everybody. You have to take it case by case. I really like the Tap appliance and have used it for the majority of my patients. However. if you are breaking them that frequently, you may have an unusually severe bruxing problem. I have had success with another appliance called the Luco Hybrid for my bruxers. It is made out of metal and suppresses bruxing. See: www.lucohybridosa.com. I hope that this helps you. A.B. Luisi, Jr.D.M.D.. The Naplers Center For Dental Sleep Medicine.

Well, your OSA severity can increase with age and, most particularly, with increases in weight. If you have put on a lot of weight in the past few years, that could be a concern. That does tend to make MADs less effective. Dr. Luisi

At this point, I am no longer concerned with how well the no-leak masks will perform because they have done well. The real question is how to integrate them into the present delivery system. The biggest problem is the typical CPAP DME company. The technicians are used to strapping on a large and varied inventory of masks, but have no experience with, and possibly, no particular interest in working with tooth-supported interfaces. There is even a question of whether or not they could legally do so. This leaves us with the possibility that licensed dentists would have to be included in the loop and, of course, the DMEs would be very reluctant to do that. This is a real problem. Any suggestions? Dr. Luisi