A lot of acronyms right? I know - welcome to my life. I'm sure all our our lives...
Short Story: Does anyone else use or have used the Aligner Sleep appliance from SML Global? If so, would you message me?
Long Story: I have obstructive sleep apnea (OSA), with my initial sleep lab results showing I had an AHA over 40. I tried CPAP and am one of the people who can not tolerate it. It was a defeating feeling for me to wake up with the mask on the floor. And a doctor who blamed me for psychologically & unconsciously not wanting treatment. It was quite the opposite - I craved treatment and have been an advocate for my care for over eight years, ever since I was diagnosed. Of course that doctor and clinic is in my rear view mirror. I worked with my primary physician to get assessed for a mandibular advancement device (MAD, aka oral appliance) and was a good candidate. I started with the Somnomed device, which pulled my AHIs to about 10 and a much healthier, mindful existence. I won't go into the health insurance side of this which was a bear, though is catching up.
My particular issue is a small mouth coupled with a large tongue. Add to that mix large tonsils as well, which were a 4 on the Brodsky scale. We removed them to see if it would help. While I no longer snore, it did not impact my OSA - which was a likely outcome. I think those here understand snoring isn't necessarily related to OSA, though many of us are loud snorers. We did a lab study with a MAD and without and the results mirrored the study done before the surgery - so no or negligible change. I wouldn't not do it again since i no longer snore.
A couple years ago my dentist suggested I use Invisalign to correct a tooth which was twisted about 30 degrees. I said I would if there was an oral appliance which worked with Invisalign. So I set out on the hunt and eventually found SML Global, who makes the Aligner Sleep Appliance (ASA) which works with Invisalign. It was a long road to get it though, me and my dentist found SML hard to work with. The ASA was new to the market and, while on their web site, had not been officially announced at the time. So, six months later she found a lab which would make them. My dentist has been an advocate for me through this entire process and only not naming since I haven't asked her if I could.
So, I got the ASA and did a sleep study with it in. The results showed it was incredibly effective. My AHI's went down to 3-4, which took me to the next level where I don't experience apnea while sleeping with it in. Unlike CPAP and my other MAD it was markedly effective while I was supine - which was a thrill. The design has a bridge between the upper molars which goes across the upper soft palate. This leaves about a quarter inch of space between the bridge and my soft palate. My guess is my tongue rests against it and leaves an airway open while the jaw advancement keeps my trachea clear. Double duty for the win!
One unexpected win of having the Invisalign done is that part of the process included widening my mouth by pushing the teeth outward on my jaw. I didn't know this was part of the process but self-reported that I didn't seem to have as much of a next-day impact when I fall asleep on the couch without my appliance in. My doctor agreed it was likely the case since widening the oral cavity is known to help improve obstructive sleep apnea. So I requested a referral to a specialist to see how much more we could widen my mouth. And my dentist was on board for updating my Invisalign treatment to maximize the oral cavity. Thankfully, we had already gone about as far as we could - the specialist saying that we could maybe push another mm but it wouldn't have an impact on my OSA. Since every sleep specialist I've seen knew my mouth was too small for my tongue, I don't know why this was never part of my treatment strategy. It was just pure, dumb luck that I discovered it should have been. I will follow-up with a sleep study once the Invisalign is complete so stay tuned.
The problem has been that the Aligner Sleep Appliance breaks, and breaks often. So far not one piece has lasted over a few months. It's either the upper or lower piece, but always one of them. Having gone through two oral appliances before the ASA, I let my dentist know this is unusual and that the material they are using is very brittle. My previous appliances were replaced due to wear rather than having broken. The Aligner Sleep Appliance has broken apart simply by putting it in my mouth. And also while simply adjusting it the side sheered off. The adjusters have also tarnished and become unadjustable. It's unusual and the lab hasn't been very helpful with slow turn-around times and trying to charge me for fixes which should be covered by the SML 3 year warranty.
I want to reach out to the larger community to see if anyone else is using SML Global's Aligner Sleep Appliance and whether they have the same experience. If not, I'd like to use the same lab to get my next ASA replacement. If so, maybe we can work together to see if we can get SML to adjust the material they use to last.
Thanks SleepDent for the informed response. Yes, the designs are very similar and I'll look into this model when I finish Invisalign. All that metal gives me some pause though. Heh. I can't tell from the pics if it's creating a space between the upper palate and the appliance or whether it rests on the upper palate. I'm basically looking for one with a "tongue rest" with some space. Do you know the answer?
No, I don't have bruxing symptoms, though it's a good question and see why you would ask. I have been through two other devices which both lasted about three and a half years and were replaced due to normal wear. If bruxing were the cause I would expect those MADs to have had the same issue, or at least some indicator of it.
In contrast, both upper and lower pieces of the Aligner Sleep Appliance have broken at separate times, with each lasting on the order of about 5 months. This results in a lot of time without treatment, which as you can imagine is difficult for me to get through. Based on the great results from the lab sleep study, I had hoped to keep the appliance permanently and get multiple copies of my last Invisalign trays to continue using it. Based on the breakage experience though, I won't be doing that and trying to push my Invisalign faster to get away from these breaks and avoid further treatment downtime. The SML-associated lab moves slowly, on the order of months, in replacing them so I don't feel they are good stewards of my apnea care.
I wish I had information on the plastic composite used across appliances. I've asked my dentist to inquire about the material composite the lab uses and to see if there's something else they can use when casting the molds. But we haven't received a response on that question.
I'm attaching pictures of one of the breaks, which occurred while while advancing the device. The section with the advancement just sheared off in my hand. IMO, this shouldn't happen.
