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Has anyone had any Success with a dental appliance?
I'm just not having much success with the masks, I'm on my 9th one now, there are some nights I can tolerate it, somenights it's just not gonna happen, I thought maybe I can alternate with a dental appliance, just want to see if I get any positive feedback, and the neg. too, before I ask my dentist to make one, I heard they are expensive, and I don't think insurance covers that. thanks Lisa
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Replies to This Discussion
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Permalink Reply by Mike on
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i personally know of someone who was committed to getting compliant with cpap, but who could just not do it. he's now using a dental device, and just got a sleep study with the dental device on to figure out how well it's working. turns out it lowered his AHI substantially, although not as much as CPAP. i think he's going to alternate as you suggest you might do.
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Permalink Reply by Dave on
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I'm still figuring this out myself.....I just did a sleep study with the dental device and positional therapy with a zzoma pillow. My test hasn't been scored yet (I'm supposed to get it tomorrow)....however, I have some idea of the result from a preliminary report (see below). I also didn't do a good job of having my dentist communicate with the sleep doctor before the study....My sleep dentist would have changed the protocol to allow for more tweaking (my somnomed is adjustable and it had more adjustment possible than the sleep lab and I realized). Anyway, I should have more info soon! So far, I think dental devices are beneficial if you are using nothing....I've not heard of it working 'better' than CPAP.....I suppose if you are really mild tongue OSA, it might treat you (I'm not a doctor, so don't go by that)......I'm skeptical for those with more moderate/severe and/or other airway issues (probably like myself).....the device does reduce my RDI/AHI greatly from using nothing, but at this point we are not convinced it is the best treatment for me....In any case, you should make sure you have a great sleep doctor and a great ENT who has lots of patients with both CPAP/dental appliances......stay tuned!
The patient slept with both his positional pillow (to avoid supine sleep) and his mandibular advancement device for the entire night.
Sleep: All sleep stages were seen. There was fragmentation of sleep due to respiratory events. Intrusion of alpha waves was noted during the study. There were some periodic leg movements, however, most of these were associated with respiratory events.
Respiration: Respiratory events characterized by flow limitation and respiratory related arousals with rare hypopneas and desaturization. As a result of the positional pillow, only lateral sleep was observed.
Lowest O2 saturation: 90%
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Permalink Reply by Kelly Moore on
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Dental Appliance Therapy is a good alternative! I actually work for a Dentist that dedicates most of his time making appliances! We have three offices and work with many Sleep Physicians and Primary Care's in the area. Im not sure where you live, but I think that the most important thing to do is to go to the American Academy of Dental Sleep Medicine's website and search for a Dentist that is closest to you. These Dentist know what they are doing and have been trained not only on sleep medicine but have experience with helping you get it covered by insurance! Our office files insurance for all our patients... and remember its is Medical Insurance not Dental Insurance Coverage. Our patients sometimes get full reimbursement, of course it depends on what medical insurance plan you have. I would be happy to answer any more questions.. you can also visit our website for more information regarding the different types of appliances! Good Luck www.dentalsleepsolutions.com
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Permalink Reply by Gary Franklin on
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I think you don't need to have your Dentist make you one. There are plenty out on the market to buy that will work. At least, you can begin with those to see if you can adjust to it. I to could not use the CPAP mask machine. I've been using the mouth inserts without any issues for almost a year and i couldn't be more happier. I'm getting the rest (deep sleep) that I need. I also think my blood pressure has returned to more normal levels. Sleep Apnea can cause elevated blood pressure readings. There are two kinds of mouth inserts. The first is a molded brand that you place into hot water and place into your mouth to mold the mouth piece to your mouth (this make theinsert much more comfortable). The other brand is just a mouth insert place into you mouth and is not molded. This one is a little more uncomfortable and takes getting use to. I've tried both and perfer the non-molded type. Although more uncomfortable, it pushes my lower jaw forward more which allows deeper breathing. It has eliminated my snoring and my Sleep Apnea. It took it a while to get use to it (gag reflex) but now that i am comfortable with it, I am getting the deep sleep I'm looking for. It's changed my life for the better.
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Both my husband and I have a diagnosis of UARS. Initially, we each tried CPAP with acceptable compliance, limited tolerance, and no improvement in status. I switched to a mandibular advancement device (Somnodent) and noted significant improvement from day one. My husband is in the process of getting one as well. For both of us, the tongue is the known primary issue (I have a history of tongue thrusting, and my husband actually snores with his mouth closed).
It is my understanding that there may be a correlation for CPAP tolerance related to AHI...the lower the AHI, the less one may tolerate CPAP. I have read that using both CPAP and the MAD together at the same time has been successful for some who have significant OSA.
As to the insurance coverage, it really depends. My husband was told yesterday by his sleep doc that failed treatment with CPAP may be more favorable for MAD coverage versus coverage for initial treatment with the MAD. I saw a sleep dentist who was not a provider for our insurance and paid an extra $1000 out-of-pocket ($2100 total for the device); however, my husband has now found a dentist who will provide the same device (he bills $600 less than my dentist), AND our insurance will cover it. So there can be a huge difference. I now feel very ripped off, but I must admit that the MAD has made a HUGE improvement in my sleep and in my life. I like the Somnodent because it is slimmer fitting (I have read a lot of complaints about the cheaper, over-the-counter models being bulky and resulting in a lot of drooling due to difficulty closing the mouth). I also find the ability to fine tune the adjustments myself significantly helpful (e.g., during allergy season I have been able to advance it further). I also think it is important to have a knowledgeable dentist assessing your bite and your jaw before implementation and while using the device.
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Permalink Reply by Rock Conner RRT on
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I have had dozens of patients return their rented PAP systems because they were successfully fitted and treated with dental appliances. The field is developing. A buddy of mine just passed the Dental Sleep Medicine board exam. I don't know much about their fitting or performance, but there something positive going on there.
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I had an expensive appliance ($1,200) made by a dentist at University of Michigan. My Blue Cross did cover this 100%, but I just hated wearing it. It is very tight on my teeth and uncomfortable. I also bought a generic applicance from the internet and used it for almost a year. I had some problems with my front teeth shifting, and then when I finally had another sleep study with that appliance - and it was not helping my apneas. Now I use my Cpap every night...
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What brands of over the counter devices do you recommend or worked for you and where can I get one?
Gary Franklin said:I think you don't need to have your Dentist make you one. There are plenty out on the market to buy that will work. At least, you can begin with those to see if you can adjust to it. I to could not use the CPAP mask machine. I've been using the mouth inserts without any issues for almost a year and i couldn't be more happier. I'm getting the rest (deep sleep) that I need. I also think my blood pressure has returned to more normal levels. Sleep Apnea can cause elevated blood pressure readings. There are two kinds of mouth inserts. The first is a molded brand that you place into hot water and place into your mouth to mold the mouth piece to your mouth (this make theinsert much more comfortable). The other brand is just a mouth insert place into you mouth and is not molded. This one is a little more uncomfortable and takes getting use to. I've tried both and perfer the non-molded type. Although more uncomfortable, it pushes my lower jaw forward more which allows deeper breathing. It has eliminated my snoring and my Sleep Apnea. It took it a while to get use to it (gag reflex) but now that i am comfortable with it, I am getting the deep sleep I'm looking for. It's changed my life for the better.
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Permalink Reply by Kinderhook on
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I got my cpap machine in March. I have yet to sleep a full night with it. I've tried different masks, too (though not 9) and no matter what I do, I can't sleep with it on. I get drowsy by reading (something I've done since childhood) and then I shut off the light, put on the mask and blammo! I'm wide awake again. If there was a way to put my glasses on & the mask on at the same time, I'd read w/ the mask on to see if that would work. But in addition to apnea, I'm a chronic insomniac and this cpap machine seems to be exacerbating that. I've tried the pillows and full face masks and regular masks. Still nothing. A couple of weeks ago I gave up. But I know I shouldn't give up so when I saw this topic, I thought I'd chime in! Any hints? Thanks.
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Permalink Reply by Dr. Farhad Hakimi on
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CPAP is considered the “gold standard” in sleep apnea treatment. Unfortunately, it is not easily tolerated and can be embarrassing when sleeping with a bed partner. Many people are becoming more aware of and opting for dental appliance therapy, which keeps the airway open, ensuring sufficient oxygen to enter the body and lowering their risk of stroke, heart disease, and sleep-related car accidents. Oral Appliance Therapy is a great alternative to CPAP. According to a research published by the American Academy of Sleep Medicine in July of 1995, which reported that oral appliances are indicated as a first line of treatment for patients with primary snoring and mild to moderate obstructive sleep apnea and as a second line of treatment if CPAP is intolerable for patients with severe obstructive sleep apnea. I have invented and patented a dental appliance which I have used over the past 10 years and have successfully treated 95% of my patients who suffer from snoring and mild to severe obstructive sleep apnea. My device which is called VIAdmd is a one piece device that is fitted to your upper teeth and worn at night when asleep. It is comfortable, well secured and very easy to fall asleep with. Most insurance companies do provide benefits for oral appliance therapy providing there is a confirmed diagnosis of Obstructive Sleep Apnea. My office staff will submit claims and all necessary documents to your insurance company to ensure reimbursement. You can obtain more information at www.VIAdmd.com.
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Yes. A properly fitted adjustable dental appliance with monitoring of it's response can be very effective. There are ways to obtain coverage through your medical insurance. In my case CPAP was actually suppressing my REM sleep. I was getting worse with CPAP. With an oral appliance; no snoring, same efficacy on follow-up and I feel great. Look for an expert. Not all Dentists know that much about appliances and how to adjust them. Your evaluation shouls include an assessment of your jaw and facial anatomy to select the right appliance.
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I HAVE FOUND OUT THAT IF YOU CANNOT TOLERATE THE CPAP. ,YOU THEN CAN TRY THE DENTAL APPLIANCE. AND INSURANCE DOES PAY. YOU HAVE TO GO TO A DENTIST THAT SPECIALIZES IN SLEEP DISORDER DENTAL APPLIANCES TO HAVE IT COVERED. THERE ARE NOT ALOT OF THEM OUT THERE FROM WHAT I UNDERSTAND. i LIVE IN THE PITTS PA AREA AND WE HAVE 1. I HAVE NOT GOTTEN MINE YET SO I CAN'T GIVE YOU ANY INFO ON HOW THEY WORK. BUT MY SLEEP DR. SAYS FOR SOME PEOPLE , THEY WORK GREAT. GOOD LUCK
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