SleepDent

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

You do have some valid concerns. I would have to agree that compulsory testing, no matter how well intentioned, is a slippery slope. The safety concerns which are the basis for it make sense on the face of it. Nobody wants to be mowed down by a driver asleep at the wheel. However, after reading the story of the original poster here, how can I say that he has been treated justly. I can not. As you said, if you make licensing contingent on a raft of these things, you have a police state. People like the poster should not have to suffer in silence. We need a national (or international) dialogue on the subject. Let's face it. Life has its dangers and no one can be protected from them all. Who knows, maybe the doctrine should be "you break it, you own it". That is, if the government wants to jeopardize this poor guy's career by making apnea an issue, THEY need to pick up the tab for all of his testing and treatment. And if they ultimately want to pull him off the road, they owe him and his family substantial compensation for that. Just a thought. Dr. Luisi

Wow! You really unloaded on us this time. I am one of the pioneers in dental sleep medicine. If you could have seen what a struggle it was to begin to find a way to treat people for OSA with little knowledge and no research and if you could have seen the hundreds of patients that I have given back their lives and their health, I hope that you would feel more kindly towards us. Doctors are human beings just like everyone else. I know some that truly care about their patients and go the extra mile. I know some that are pretty selfish and basically in it mostly just for the money. Just like people in every other profession. I know that people HATE to be diagnosed with OSA. Everyone just wants to be able to sleep in peace without masks and hoses and air pressure or appliances in their mouths, etc.. But you have to accept the hand that you are dealt and make the best of it. This is what this forum is all about. Dr. Luisi

I have to agree, your life does pretty much sound like a nightmare right now. Dr. Luisi

Believe me, I am more sympathetic to your plight than you know. I have felt the heavy hand of government regulation, too. Where will it end? Who knows? It really doesn't seem fair that you are held hostage in this way. But remember, this forum is made up of concerned people who want to help you. The most important thing to us is your health. Check it out for yourself, for your family. They need you to be healthy as the breadwinner. Good luck to you. We will be here if you need us.

Incidentally, I have seen plenty of patients take sleep tests and find out that they don't have it. The tests are pretty objective. Electric leads are put on your body to monitor things. There is no human input. As they say, leads don't lie. Don't get me wrong, mistakes are made. Sometimes the leads are put on wrong or fall off and other things happen. There are false positives and negatives, but, over-all, I have a pretty high level of confidence in the results.

I am a dentist working in dental sleep medicine. On one level I can sympathize with how you feel. When someone messes with a person's livelihood, it is, indeed, a serious matter. I have been working with sleep apnea patients for about 13 years and I have seen the condition get people fired from great jobs, lose their marriages, alienate their children, and die in their sleep. Please take it seriously. The condition affects 20 million or more people in this country and keeps growing as people get more obese. With greater awareness, doctors(and dentists) are screening people more carefully for the condition and you need to expect that. Many people do not suspect that they have the condition because they don't feel symptomatic. We now have a pretty good idea of the profile of potential victims, and from what you say, you are in there. Where I definitely DO fault the doctor is when she made the statement that you have sleep apnea based on the profile. That was unnecessarily upsetting to you. Nobody can be sure that a person has sleep apnea without appropriate testing and there is a significant chance that you DON'T have it. Screening is no big deal. They now have home sleep tests that are easy, fast, and cheap. So just get it done quickly and have peace of mind. Even if you do have it, not everybody gets CPAP. There are oral sleep apnea appliances, surgical options, and an Inspire pacemaker, too. Good luck to you. It will work out. Arthur B. Luisi, Jr.,D.M.D.