SleepDent

Your comment illustrates an important point. Much of the difficulty that people have with their CPAP masks stems from the fact the the straps have to be so tight to seal that they cause irritation on other parts of the mask. Airway Management makes a product called the Tap Pap Nasal Pillow Mask. It attaches to the upper teeth and there are no straps. The solid foundation results in no leakage from the pillows and the pillows seal well while still only pressing very lightly against the nose. Much more comfortable and no irritation. Arthur B. Luisi, Jr., D.M.D.

I am a dentist working in dental sleep medicine. I fully understand your problems. The basic problem with conventional CPAP masks, especially at the higher pressures, is that they are depending on the facial skin to form a seal and skin is moveable and deformable. Hence the leaks. I have been working on a new approach that I call the "Comfort Plus" system. The full face mask consists of a nasal pillow mask that attaches directly to the upper teeth for stability. There are no straps. The mouth leakage is prevented by a patented intraoral mouth shield that seals the mouth from the inside. There is no leakage. The system is now ready for delivery to the general public. I can text pictures of the system to people's cell phones. Contact me at www.naplescenterdentalsleepmedicine.com. Arthur B. Luisi, Jr.,D.M.D.

I am a dentist working in dental sleep medicine. Yes, CPAP is effective in treating mild obstructive sleep apnea. The problem is that the compliance rate for users with mild obstructive sleep apnea is down compared to users with moderate to severe obstructive sleep apnea. Typically, the mild patients are less symptomatic that moderate to severe ones and are thus less motivated to put up with the problems of using CPAP long term. Oral sleep apnea appliances are quite effective for patients with mild OSA and would be a good option for them because it is more patient friendly. Arthur B. Luisi, Jr., D.M.D.. The Naples Center For Dental Sleep Medicine.

I am a dentist working in dental sleep medicine. At this very moment, I am in the process of developing TAPPAP nasal pillows with an intraoral mouth shield for Airway Management. This seals the mouth from the inside and prevents mouth leakage. I actually have about five products that could help you with your problem. My contact information can be found at www.naplescenterdentalsleepmedicine.com. Solving this problem is a piece of cake with our new line of products. Arthur B. Luisi, Jr,, D.M.D.

See my post under your thread "Tap Warning". I wouldn't be overly concerned. Dr. Luisi

I understand your annoyance at this early date, but, take heart, the fixes aren't that bad. First, check that your face plate is on tight. There are two screws holding it on and usually they give you an L-shaped allen wrench that can tighten it. If you don't have one, your dentist probably does. Tighten the two screws. If it still doesn't hold adjustment, the device probably needs to go back to the lab for a repair. They may replace the screw, put some plastic shim behind it, or swap out the mechanism. At any rate, the device can be salvaged. Don't be discouraged. It is a fine appliance, probably the best there is. The glitch can be overcome. Dr. Luisi.

Yes, indeed, you really need to keep an adjustment log. I tell my patients to keep a piece of paper for that purpose. Record your original baseline setting on day one and date it. Then every time you adjust it, record it and date it. And when you are fully adjusted, record that, too. Understand, that the adjustment worm gear can wear over time and begin to lose adjustment. It usually needs to be replaced every 1.5 to 2 years. If you have no record, you will not know when it starts to drift until you begin to feel symptomatic again. Stay alert and stay organized. Dr. Luisi, The Naples Center For Dental Sleep Medicine.

I do find your story relatively fascinating, so I went to the SML web site and studied it in depth. Here is my feed-back: You have to give SML credit for innovation in designing the ASA, breakage problems or not. However, I do think that there is an inherent problem with the design that could lead to the breakage problems. The invisalign trays, although relatively thin, do have some minimal bulk. SML has the problem of adding the ASA superstructure over the trays without making the whole thing so bulky that patients could not tolerate it. By definition, then, they have to make the ASA thinner gauge than if it didn't have to fit over the existing trays.---- and this could be partially contributory to the breakage problems. So the ASA could be a satisfactory solution for people in Invisaligns, even with the breakage, but I doubt whether it would be a viable solution for you after you are out of the trays. So why the improved performance over your Somnodent? The design is quite conventional and largely similar to the Somnodent. I can't see the reason for the difference in the design which doesn't mean there isn't one. Two things I observed might account for it: 1. Your dental arches are now wider with treatment, which should help the OSA. 2. The SML specs show the ASA is capable of 8mm of protrusion VS. 5mm with the Somnodent. It may be that your better result is due to the fact that you are attaining a higher level of protrusion than before, which can be critical for severe cases. The answer may be to be sure that your next appliance can attain 8mm or more total protrusion. Hope this helps. Dr. Luisi

Well, if you got 3.5 years with the other appliances, that would be considered reasonable, average longevity. In all fairness, I have no familiarity with this particular device, but judging from the pictures above, it would seem to be an issue with the particular plastic material they are using. If you happen to be a big, strong man, you would certainly be capable of exerting significant forces on an OA, but they should all be strong enough to take that much force. The design of the Luco Hybrid does have some space between the palatal struts and the palate. It does not rest directly on the palate. Also, the design is open in the upper anterior, so that your tongue can rest against your incisive papilla, where it belongs, without interference from the device. The metal framework is clad in acrylic, so that very little of the metal is actually exposed in the mouth. Getting back to your problem. If I were the company that made the appliance, I would be quite concerned about the situation. I would assume that you are following whatever cleaning instructions you were given to the letter. If a patient is using other methods or cleaning materials on a device than factory spec, you can materially shorten the life of the material. Dr. Luisi

I am a dentist working in dental sleep medicine. Are you aware of whether or not you do sleep bruxing? That is, do you tend to clench or grind your teeth at night? Many people do and are not aware of it. There would be clinical signs of it in your mouth that your dentist could check. Oftentimes these people are the ones that can break oral sleep apnea appliances multiple times. I would direct you to the Luco Hybrid sleep apnea appliance. It is made of super-strong metal construction, has a design very similar to what you are using, and specifically inhibits sleep bruxing. See: www.lucohybridosa.com.. Arthur B. Luisi, Jr., D.M.D., The Naples Center For Dental Sleep Medicine.