SusanR

Hi @InventiveBlueLocust8446,

Oral appliances are increasingly recognized to play a role in managing sleep apnea. There will soon be a new "practice parameter" published by the American Academy of Sleep Medicine that I will share with you when out. This guide reviewed all of the available evidence. The guide noted there is still a need for more research but based on the existing data made a number of recommendations.

Here are some key points about oral appliances: Oral appliances are generally not as effective as CPAP in lowering the AHI compared to CPAP when each device is used for the same duration. However, some people tolerate oral appliances better than CPAP and wear them longer, so that the overall improvement in sleep apnea (AHI) averaged over the entire night and across nights can be similar to to CPAP when worn for a shorter time. Some studies show that oral appliances can reduce blood pressure and improve sleep apnea symptoms, sleep quality and quality of life, too. However, oral appliances are not without side effects--some people may have problems with their jaw or teeth with this treatment. Oral appliances can only be fit in people with a minimal number of teeth and who dont have problems opening their mouth.

The best oral appliances are those that are customized by a dentist and "titrated" to provide the right amount of jaw opening needed for the individual patient. Generally, oral appliances are recommended when patients do not tolerate CPAP. They are also often used to treat snoring that is not accompanied by sleep apnea. If you are interested in an oral appliance, talk to your sleep doctor and review what is best for you.

More research on oral appliances is needed so better decisions can be made on when to use them and who is likely to get the most benefits.

thanks for this question and let me know if you need more information.

Hi 2Sleepy,

Thanks so much for your feedback and glad you found the Harvard site helpful.

We are beginning to gather more information on support and educational materials for our MyApnea.Org site and hope to post regular updates. Meanwhile, we have a section on PAP under the Learn tab. We have just finished a second section on OSA and CSA-how it is diagnosed, treated, etc and are waiting approvals from our patient advisors before we post.

Dealing with the day to day issues of how to best adjust to CPAP can be a challenge. Choosing the right mask from the start is important, as your post indicates. Many of our members have great tips embedded in the posts too and we will see if we can begin gathering real patient and expert input into a FAQ or other tip sheet. Thank you for this suggestion!

Hello @ImpartialCrimsonBat4632,

It sounds like you may have "complex sleep apnea"--this refers to a condition where there are many of the symptoms of obstructive sleep apnea, but both obstructive apneas as well as central apneas occur--in fact, the central apneas may increase, at least initially, after starting CPAP therapy. (Note- obstructive apneas refer to breathing pauses that occur in association with blockage of air in the throat despite breathing efforts; central apneas are breathing pauses that occur with an open airway but when the neurologic drive to breathing is abnormal. This may occur when the brain center that controls breathing is "over sensitive" and responds to small changes in oxygen or carbon dioxide levels with large changes in breathing pattern which can result in apneas.) Many times, the central apneas get better over time while CPAP is used. However, other patients need treatment that treats both the obstructive apneas--keeps the throat open- as well as treats the central apneas. One approach for providing such treatment is through adaptive servoventilation (ASV)--this is a device that changes the amount of pressure on a breath by breath basis so that the machine provides just enough--and not too much- support to keep breathing regular and prevents central apneas. As described earlier, sometimes oxygen or efforts to maintain stable levels of carbon dioxide are used to stabilize breathing.

Note that ASV is not the same thing as Bi Level. You may want to talk to your doctor and ask whether you have complex sleep apnea and whether ASV is a good choice for you. Also please note that as described in a recent safety warning, ASV is not to be used to treat central sleep apnea occurring with heart failure.

Wicked,

It sounds like you are doing lots of good things to improve your health and quality of life and feeling better! Sometimes even modest weight loss can help sleep apnea to the point CPAP might not be needed. Keep up the exercise, etc. and keep in touch with your doctor to both--a) do what ever can be done to get the most comfortable mask and machine for you; and b) to consider undergoing a re-evaluation after weight loss.

Member 303535,

Sorry- I missed your last post. You can check out the Mood PPRN at https://moodnetwork.org/. H

I am so hear to hear your story and hope others do too! As soon as the full study is published, I will let you and MyApnea know about it.

In COPD, even those with nighttime drops in oxygen benefited from oxygen.

Thanks for these posts and interest in this topic!!!

At the American Thoracic Society (ATS) last week, new research was presented from groups around the world.Here are some of the highlights from the ATS meeting related to heart disease:

a. An animal model of sleep apnea showed that short periods of hypoxia-similar to the drops in oxygen people experience with apnea-- can trigger heart arrhymias.

b.A study of older men showed that an increase in periodic limb movements during sleep-especially those leg "kicks" that cause the brain to arouse or waken- increases the risk of developing a serious heart arrhthymia called atrial fibrillation (which can increase risk of stroke).

c. A new study from Europe showed that patients with sleep apnea treated with CPAP who were able to wear CPAP at least 4 hours per night had a reduced risk of having a heart attack when followed for more than 7 years compared to untreated patients or those wearing CPAP for shorter periods. This is very promising information on the ability to lower risk of having a heart attack!

d. Harvard researchers reported that patients with diabetes plus sleep apnea have worse measures of vascular health than patients with either diabetes or sleep apnea--a double whammy.

e. A research group from Spain reported on the results of blood tests that measure the activation of genes that influence heart disease. They showed that these "heart" genes can be activated at higher levels in patients with sleep apnea compared to others. What this suggests is that sleep apnea stimulates the body to produce altered inflammatory proteins and fats that then cause heart disease. They also showed that the activation of these genes returned to "normal" in a subgroup of patients who seemed to get a cardiovascular benefit from using CPAP (as measured by lowering of blood pressure). This is very early work but gets at the idea of "personalizing" treatment--using blood markers to identify which patients respond to treatment.

Let me know what you think about these research news updates.

Dear 2Sleepy-

Are there specific topics you are most interested in? I would be glad to highlight reviews in those areas. We will soon have more information on the Learn site and want it to have the best info for you. Check the Research forum posts for updates on research and topics too. Two of our members (experts in these areas) will be posting on didgerdoos and on the new Inspire device.

My colleagues at Harvard have created a site with alot of information here:http://healthysleep.med.harvard.edu/portal/. I hope you find it useful-let us know.

Thanks Dan-- its a nice article from Cleveland Clinic! Also, patients on CPAP should remember to tell their surgeons and anesthesiologists about their sleep apnea and ask to bring their CPAP units to the hospital for use after surgery (or make arrangements to have a similar machine available).