Replies to This Discussion

Permalink Reply by Sleepgs on April 10, 2010 at 4:37pm

Hey Mary,

I wouldnt do a OTC Boil and Bite,,,,,, I think you should call a Dentist in your area and see him and ask him. we have a list of Dentist that do it all over the US. just look at www.dentalsleepclinics.com

• ▶ Reply

Permalink Reply by Irma Hudson on April 11, 2010 at 5:39pm

Hello, Dr. Charmoy,

I have a question. I have a lot of crowns, and when I discussed the possibility of a sleep appliance with my dentist, he thought it was a very bad idea because the appliance would put too much stress on the crowns. What has been your experience with this?

I am using a CPAP right now. Its setting is only 6. So although I have severe OSA with 48 AHI per hour, I would like to explore whether a dental appliance might change the airflow enough that I might be able to do without the CPAP, at least occasionally, such as for travel. But I certainly don't want to jeopardize my investment in my teeth.

Do you think this is worth exploring further?

Thanks, Irma

• ▶ Reply

Permalink Reply by Dr. Richard Charmoy DMD on April 12, 2010 at 2:57pm

There is no contraindication not to fabricate an oral appliance due to crowns. I do it all the time. In fact if you have so many crowns you should have some sort of guard to protect them. A sleep appliance would serve this purpose. There is various materials which they can be fabricated out of.

Irma Hudson said:

Hello, Dr. Charmoy,

I have a question. I have a lot of crowns, and when I discussed the possibility of a sleep appliance with my dentist, he thought it was a very bad idea because the appliance would put too much stress on the crowns. What has been your experience with this?

I am using a CPAP right now. Its setting is only 6. So although I have severe OSA with 48 AHI per hour, I would like to explore whether a dental appliance might change the airflow enough that I might be able to do without the CPAP, at least occasionally, such as for travel. But I certainly don't want to jeopardize my investment in my teeth.

Do you think this is worth exploring further?

Thanks, Irma

• ▶ Reply

Permalink Reply by Dr. Richard Charmoy DMD on April 12, 2010 at 3:04pm

Here are some articles to look up SLEEPAND BREATHING--VOL. 4, NO. 2, 2000
CASE REPORT
lmprovement in Daytime Sleepiness by the Use
of an Oral Appliance in a Patient with Upper Airway
Resistance Syndrome
EDMUND ROSE, M.D., D.D.S., 1 SlBYLLE FRUCHT, 1
THOMAS SOBANSKI, 2 GABRIELE BARTHLEN, 3 and RITA SCHMIDT ~


Guerrero, M., L. Lepler, et al. (2001). "The upper airway resistance syndrome masquerading as nocturnal asthma and successfully treated with an oral appliance." Sleep Breath 5(2): 93-96.

Hope this helps
Dr. C

Dr. Richard Charmoy DMD said:

I will go through some articles and see what I can find. You can try looking on the PubMed site.

SaraLynn said:

I use the Somnodent successfully for my diagnosis of UARS. I was desperate to find help, as the CPAP seemed to be making my symptoms worse. I have seen UARS described as a hypersensitive nervous system that causes arousals due to increased efforts to breath. In that case it only makes sense that adapting to a CPAP would be extra challenging. When I woke up the first morning after using the dental device, my arms and legs felt heavy and relaxed (I couldn't remember feeling like this before) and I wanted to stay in bed, not because I was tired, but because I felt so good. My body had not been struggling to breath all night long. I stopped falling asleep whenever I sat down and could watch an entire tv show or go to a performance without missing out. I love to read, and I was no longer falling asleep on my book.

I would like to see more studies on treatment of UARS with the adjustable mandibular advancement devices.

• ▶ Reply

Permalink Reply by Dave on April 12, 2010 at 3:32pm

Dr. Charmoy,

How did you decide on using the Watermark/ARES? Does that get expensive using the device for three nights?

Dr. Richard Charmoy DMD said:

I have used the SomnoMed in mild and severe OSa. It is my belief if a patient isn't going to use CPAP at all, then whatever I am able to achieve with a oral device then it would be aiding the patient to some degree. I have been amazed at some patient who come in classified as severe OSA over weight and I amke an SomnoMed oral device and we eliminate the snore and get there AHI and RDI below 10 when initially they were above 60. Each patient responds differently and can not be classified one way or another when treating with an oral device.

When I state a 100% success it is a combination of patient and quantifying results through a multi night study with a Watermark/Ares ambulatory sleep study. I hav enot had any patient who have not been satisfied or who have stated in six years of follow up that they have stop wearing thetre appliances in fact they state they can't sleep with out them. The sllep study which is done at home is done for three nights again it is my belief that every night gives a different pattern of sleep, so getting multiple nights allows me to see what is really going on. Many of the sleep docs who refer to me in the begining use to require the patients to have a PSG after my treatment and titration of appliance, they were getting great result with conclusion of absent of OSA as long as patient use sleep appliance.

Donald R. Byrd said:

Dr. I was under the impression dental devices should be considered for patients with Mild obstructive sleep apnea. Not anyone who cant tolerate cpap therapy.

Are you recommeneding the dental device for Moderate or Severe OSA? How about patients with mixed sleep apnea such as Central / Obstructive or those diagnosed with only Central sleep apnea? Do you recommend this device to patients who use Bi-level therapy? How do you address (identify or treat) possible nocturnal oxygen desaturation asscociated sleep apnea?

Lastly, how do you measure 100% success, clinically or patient report?

Thank you.
Donnie B. RRT-RCP

• ▶ Reply

Permalink Reply by Carl on April 12, 2010 at 3:44pm

Actually, that link points to an abstract, and the actual article costs $10 should I wish to purchase it. Sorry, I'm not going to do that - if anyone else wants to - there should be enough freely available information out there. There was no mention of who paid for this "research" either, and we all know how numbers and research can be manipulated.

It also sounded more than a bit strange that women weren't affected under the same circumstances as men. So, if anyone has this article, I'd like to read it.

Carl

Banyon said:

Carl said:

I would like a pointer to that study please.

Carl

Banyon said:

This has just been reported in another discussion on this forum: A new study showed that even mild levels of obstructive sleep apnea significantly increases your chances of stroke, even in middle aged men. In the mild to moderate range, one unit increase in the apnea hypopnea index increased the stroke risk by 6%! In women, the risk for stroke was not significant until severe levels of sleep apnea are reached.

One of the first things that comes to mind is users of oral appliances, many of whom, may still experience mild (or higher) levels of OSA. They may think they are getting good treatment but they are still left with much higher risk of stroke.

There is a link in Dr. Park's post: http://www.sleepguide.com/forum/topics/mild-to-moderate-sleep-apnea-a

• ▶ Reply

Permalink Reply by Dr. Richard Charmoy DMD on April 12, 2010 at 3:47pm

Dave,
I originally was using the Watch Pat 200, which was a very good device. However in very small print it states that the probe on the finger and pulse ox on finger can give variable result on patients taking beta blockers. Also I thought that the patients putting the leads on could be a factor in some error in results. Also you can not do multiple night studies.
The Ares unit is very simple for the patient to use. It's like a head band with a nasal canula. You push a button to turn it on and off. If anything isn't in the right position it speaks to you. It reads the data from your forehead and nasal cannula and mic for snore. It is not expensive to use. Being a dentist I am only having my test read forresults not diagnosis. Multiple nights in ones own bed will give a truer result, no one night is the same sleep pattern so the ablity to have multible is great.
Dr. C
Dave said:

Dr. Charmoy,

How did you decide on using the Watermark/ARES? Does that get expensive using the device for three nights?

Dr. Richard Charmoy DMD said:

I have used the SomnoMed in mild and severe OSa. It is my belief if a patient isn't going to use CPAP at all, then whatever I am able to achieve with a oral device then it would be aiding the patient to some degree. I have been amazed at some patient who come in classified as severe OSA over weight and I amke an SomnoMed oral device and we eliminate the snore and get there AHI and RDI below 10 when initially they were above 60. Each patient responds differently and can not be classified one way or another when treating with an oral device.

When I state a 100% success it is a combination of patient and quantifying results through a multi night study with a Watermark/Ares ambulatory sleep study. I hav enot had any patient who have not been satisfied or who have stated in six years of follow up that they have stop wearing thetre appliances in fact they state they can't sleep with out them. The sllep study which is done at home is done for three nights again it is my belief that every night gives a different pattern of sleep, so getting multiple nights allows me to see what is really going on. Many of the sleep docs who refer to me in the begining use to require the patients to have a PSG after my treatment and titration of appliance, they were getting great result with conclusion of absent of OSA as long as patient use sleep appliance.

Donald R. Byrd said:

Dr. I was under the impression dental devices should be considered for patients with Mild obstructive sleep apnea. Not anyone who cant tolerate cpap therapy.

Are you recommeneding the dental device for Moderate or Severe OSA? How about patients with mixed sleep apnea such as Central / Obstructive or those diagnosed with only Central sleep apnea? Do you recommend this device to patients who use Bi-level therapy? How do you address (identify or treat) possible nocturnal oxygen desaturation asscociated sleep apnea?

Lastly, how do you measure 100% success, clinically or patient report?

Thank you.
Donnie B. RRT-RCP

• ▶ Reply

Permalink Reply by Dr. Richard Charmoy DMD on April 12, 2010 at 4:44pm

I have used the oral appliance to treat mild, moderate and severe. I am not recommending it across the board for any particular patient. If a patient presents to me whether mild, moderat or severe and is not using CPAP or doing nothing and they want to try a MAD ( mandibular advancement device), my feelings are that they will benefit to some degree. It is better then doing nothing. My statement about 100% is based on patient compliance, no patient not wearing or being satisfied with there individual results.

cite>Dr. Richard Charmoy DMD said:

Dave,
I originally was using the Watch Pat 200, which was a very good device. However in very small print it states that the probe on the finger and pulse ox on finger can give variable result on patients taking beta blockers. Also I thought that the patients putting the leads on could be a factor in some error in results. Also you can not do multiple night studies.
The Ares unit is very simple for the patient to use. It's like a head band with a nasal canula. You push a button to turn it on and off. If anything isn't in the right position it speaks to you. It reads the data from your forehead and nasal cannula and mic for snore. It is not expensive to use. Being a dentist I am only having my test read forresults not diagnosis. Multiple nights in ones own bed will give a truer result, no one night is the same sleep pattern so the ablity to have multible is great.
Dr. C
Dave said:

Dr. Charmoy,

How did you decide on using the Watermark/ARES? Does that get expensive using the device for three nights?

Dr. Richard Charmoy DMD said:

I have used the SomnoMed in mild and severe OSa. It is my belief if a patient isn't going to use CPAP at all, then whatever I am able to achieve with a oral device then it would be aiding the patient to some degree. I have been amazed at some patient who come in classified as severe OSA over weight and I amke an SomnoMed oral device and we eliminate the snore and get there AHI and RDI below 10 when initially they were above 60. Each patient responds differently and can not be classified one way or another when treating with an oral device.

When I state a 100% success it is a combination of patient and quantifying results through a multi night study with a Watermark/Ares ambulatory sleep study. I hav enot had any patient who have not been satisfied or who have stated in six years of follow up that they have stop wearing thetre appliances in fact they state they can't sleep with out them. The sllep study which is done at home is done for three nights again it is my belief that every night gives a different pattern of sleep, so getting multiple nights allows me to see what is really going on. Many of the sleep docs who refer to me in the begining use to require the patients to have a PSG after my treatment and titration of appliance, they were getting great result with conclusion of absent of OSA as long as patient use sleep appliance.

Donald R. Byrd said:

Dr. I was under the impression dental devices should be considered for patients with Mild obstructive sleep apnea. Not anyone who cant tolerate cpap therapy.

Are you recommeneding the dental device for Moderate or Severe OSA? How about patients with mixed sleep apnea such as Central / Obstructive or those diagnosed with only Central sleep apnea? Do you recommend this device to patients who use Bi-level therapy? How do you address (identify or treat) possible nocturnal oxygen desaturation asscociated sleep apnea?

Lastly, how do you measure 100% success, clinically or patient report?

Thank you.
Donnie B. RRT-RCP

• ▶ Reply

▶ Reply to Discussion

• ‹ Previous
• 1
• …
• 4
• 5
• 6
• Next ›
• Page