SleepDent

I would take issue with one statement in this post.It is not necessarily true that if you are snoring disturbingly loud, but you are not experiencing drops in your oxygen saturation levels, then there is no problem. We now know that snoring, in and of itself, can cause sleep disturbance. There are arousals, called snore arousals, that are factored into your overall arousal index. In fact, you can have a sleep disturbance, called UARS, where there are no apneas, no hypopneas, and no snoring. If a person has some residual snoring with an MAD, that can be considered O.K. if you are not symptomatic. But since you are still symptomatic, it is not O.K.. Dr. Luisi

I am a dentist working in dental sleep medicine. Unfortunately, the EMA device, although a legitimate appliance to treat OSA, does not enjoy a reputation for being one of the most effective choices. I have seen some efficacy tests for the EMA and they were mediocre at best. There are better choices out there. As Sierra said, the only definitive way to see whether or not the EMA is performing satisfactorily is to wear it during a sleep test. I am assuming that it has been adjusted for maximum effectiveness, to the best of your ability in concert with your dentist. A home sleep test with appliance in place is the cheapest way to do it. It is generally no more than a few hundred dollars and medical insurance will often pay for it. It would be useful to know what brand of oral appliance you were using previously. I might be able to tell you if it has a better efficacy reputation. The high degree of snoring may or may not have significance. Never-the-less, I would not depend on your bed partner or snorelab to make a determination. The bottom line is that you are still symptomatic and that needs to be looked into. Arthur B. Luisi, Jr., The Naples Center For Dental Sleep Medicine.

Yes folks, it is WORKING. One of our initial concerns was whether or not the soft, pliable intraoral mouth shield could stand up to the highest CPAP air pressures(in the 17-20 cm water) range without blowing out. As we have the opportunity to do more cases at the highest air pressures, we are finding that the seal is continuing to hold reliably. We also knew that skin-borne nasal pillows will often start to leak at the higher pressures, too. Again, we are finding that, when the pillows are stabilized by the teeth, they CAN take the highest pressures without leaking. It is hard even for me to believe, but it looks like this could be a historic break-through in CPAP interfaces. Stay tuned. Dr. Luisi

This is exactly why this whole Shingles thing is such a tough deal. The course of the disease is so unpredictable and so variable. You just have to pray the it avoids or, at least, doesn't do permanent damage to critical organs like your eyes and your ears. As you say, the antivirals themselves are not particularly benign and some of the side effects can definitely make you feel even more uncomfortable. You have my sympathy in the extreme. It won't be easy for a while, but, hopefully, you will get through it O.K.. Dr. Luisi

Absolutely correct. If you do not get antiviral medication right away with Shingles, you run a much greater danger of getting post-herpetic neuralgia, and, believe me, NO ONE, wants to get saddled with that. Dr. Luisi

Shingles can have potentially serious side-effects, please seek medical attention ASAP, if you have not done so already. Time is of the essence. Dr. Luisi

I am a dentist working in dental sleep medicine. Let me go at this from a different point of view. Oftentimes people with low diagnosed AHI's who are very symptomatic really have UARS. If you have access to your original sleep study, look to see if you have a large number of RERAS(respiratory effort related arousals) or a large number of spontaneous arousals(arousals of such short duration that they can not be classified). Either of these would be an indication of UARS. Many times people with UARS or with mild sleep apnea do not do particularly well on CPAP. This is because the entire CPAP experience can be too intense for people with such a low AHI. Oral sleep apnea appliances often prove to be a better solution for people in these two categories because they work well and are a much gentler experience. Arthur B. Luisi, Jr.,D.M.D.. The Naples Center For Dental Sleep Medicine.

I understand SloBrow's anxiety about the HST vs. the lab test. There is no doubt in my mind that more diagnostic mistakes are being made now vs. when everybody got the lab tests. Actually, the sleep physicians are between a rock and a hard place. I am working in the sleep field and I can tell you that INITIALLY the physicians fiercely tried to resist the trend away from lab based sleep tests. And it was not all about money either. But they got worn down and pummelled from all sides. The patients put pressure on them to do the HSTs for convenience sake and to save money. The insurance companies started to disallow payment for the lab based tests to save money. So the physicians sort of just gave up and went with the flow. And, on average, things are getting by well enough with more HSTs. But, as SlowBro says, are there a proportion of patients being hurt by it, some seriously? Without a doubt. So, buyer beware, patients must be proactive about protecting their own health and seeing that they are getting the best care. Dr. Luisi

Yes, most HSTs are sophisticated enough to pick up central apnea events. Dr. Luisi

Very, very well said. I would largely agree that a first class HST is sufficient to facilitate treatment for obstructive sleep apnea. And that is just what it was designed to do. I think that the point SlowBro is trying to make is that most patients don't make the appointment with the doctor for sleep apnea, they make the appointment because they are not sleeping well. And there are about 90 other reasons in addition to OSA that they may not be sleeping well. So, if the issue is clearly suspected OSA, an HST is a reasonable diagnostic response. But if there are any of the other 90 reasons suspected in addition to or instead of OSA, the full lab test is the reasonable diagnostic response. I really think that we are all in substantial agreement here, but we are arguing over semantics. Dr. Luisi