SleepDent

Good news. I have been able to continue development of the no leak face mask from the prototype stage to a simplified production ready stage. To date, we have had to take between one half hour to an hour to assemble each one and therefore had to price it at $450 dollars installed on your CPAP machine. With the simplified assembly, we can now install one on your machine for $280. If we actually go into production, I would anticipate a price of somewhere near $150, which is competitive with a high-end conventional mask. Dr. Luisi

Well, I think that I am going to split the difference on this dispute. As a health care professional in the sleep field, I am asked to base treatment decisions based upon the data from both types of studies. There is no question that you get a more complete picture from the actual in-lab sleep study. I am always glad to see an actual in lab test because it makes my job easier. Having said that, I find that a good quality HST usually is sufficient to screen for OSA and CSA, if only barely so. I would not underestimate the value of having a sleep technician present in the room to observe you all night. The biggest issue is that they can tell if you are ACTUALLY asleep which is always speculative with an HST. As the original poster said, there are a number of other sleep disorders that become evident in a lab test, so that the diagnostic data is much richer. However, in defense of Sierra's position, a lot of patients find a lab-based test either too much to cope with or too expensive and would simply fail to address their problems if not for the more simplified HST route. In that sense, the HST is a boon. Probably, the whole question will be moot soon because the insurance companies, which are always out to save money at the patient's expense, are increasingly unwilling to pay for the lab test anyway. But make no mistake about it, if you patients want the VERY BEST for yourself diagnostically, the lab test is still IT. Arthur B. Luisi, Jr., D.M.D.. The Naples Center For Dental Sleep Medicine.

Another more comfortable approach is to get a nasal pillow mask supported by the teeth, rather than being secured by straps. With a tooth-borne device you have more stability and the pillows seal well with much lighter pressure against the nostrils. See: MyTap-Pap device at www.Tapintosleep.com. Available without a prescription on CPAP.com, ApriaDirect, and other internet sites. Dr. Arthur B. Luisi, Jr., The Naples Center For Dental Sleep Medicine.

There has been a lot of discussion on the forum about mouth taping to eliminate the air leakage through the mouth caused by CPAP. I am not going to discuss the validity of the concept other than to say that: 1. The price is certainly right. 2. It does seem to be a bit of a hit or miss approach depending on the skill of the patient and how active his lips and facial muscles are during the night. 3. Even with the lightest and least allergenic tape you could find, I wouldn't think that the comfort would be superb, although you patients could correct me if I am wrong. Certainly having tape over your lips long term couldn't be that good for the health of your skin. What I am working on what seems to be a far better approach and it is proving to be so clinically. I have a very soft, comfortable, thin, hypoallergenic, silicone-like clear seal that goes right inside the lips. The air from the CPAP machine seals it tight inside the lips and there is no leakage even it your mouth and facial muscles move around. It is gentle to your skin, lasts about 3 months before replacement and costs between $12-$35 dollars to replace. I do believe that this could be the ultimate solution. The product is made by Airway Management, Dallas, Texas, but this is the first time that it has been used in this way. Only time will tell. Arthur B. Luisi, Jr., D.M.D. . The Naples Center For Dental Sleep Medicine.

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