Would MAD be the key for me?

Hi everyone, basically I am suffering from severe apnea and I was diagnosed last year (39.6 AHI). I've been on a resmed s10 apap for almost a year now and I've never felt well, even using the machine and it says it's treating (usually AHI below 3 or 2) and no leaks either. Every day I wake up the same way, dark circles under my eyes, yawning all the time and brain fog. All the doctors I went to could say is: just use the machine! I recently saw a sleep specialist dentist. She ordered some x-rays and found that I would be a good candidate for MAD, even with severe apnea. She told me that my retracted jaw is probably the cause, as the tests show. I am 22 years old and thin, I have no other options and I need some restful sleep to get on with my life. What is your opinion on this?

The conventional thinking is that MAD is for mild to moderate sleep apnea. There used to be a dentist that specialized in MAD devices that checked in here now and then. Have not seen a post for a while though. One recent participant here, @ScantyZ, has used a MAD with some success while still using an APAP. You could post in his thread to ask for his thoughts.

Actually, the conventional thinking is wrong. MAD devices are effective for mild, moderate, and severe obstructive sleep apnea. When the FDA approved MADs initially, the approved them for mild to moderate obstructive sleep apnea. For medico-legal reasons, the MAD producers still stick to that statement. In a 2019 position paper, the AADSM supported the claim that MADs are effective for mild, moderate, and severe. It has been my clinical experience that MADs can handle most cases of severe obstructive sleep apnea. I will elaborate if asked to. A.B. Luisi, D.M.D.. The Naples Center For Dental Sleep Medicine.

I am a dentist specializing in dental sleep medicine. As to the patient's problem, one would have to ask for how many hours per night is he actually using the CPAP and are there mechanical problems, such as mask leaks, that tend to interrupt his sleep? CPAP treatments produce a real dilemma for some very sensitive patients. On one hand, it is mechanically very effective at reducing breathing problems (lowering AHI), but on the other hand, the experience is just TOO INTENSE for some people to get restful sleep. Some people just cannot cope with the feel of the mask and straps, the sensation of compressed air going into their airway, the sound of the machine, and the presence of the air hose. Just can't. For these unusually sensitive people, an oral sleep apnea appliance is an excellent option. The whole experience is just GENTLER. You just have two thin trays over your teeth and you are breathing normal room air with zero noise (hopefully). Good luck to you. Chances are you will do just fine. Let us know the outcome. A.B. Luisi, D.M.D., The Naples Center For Dental Sleep Medicine.