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Dental Appliances
Looking at this post I don't see much information about dental appliances which if done by a qualified well trained dentist is a very effective solution for many people. Why?
Views: 426
Replies to This Discussion
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Permalink Reply by Mack D Jones, MD, SAAN on
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The truth is that dental devices do not eliminate obstructive sleep apneas. At best, they only reduce your AHI. You are still stuck with apneas which can kill you. (If you don't believe me, read "Deadly Sleep" Is Your Sleep Killing You).
The goal is to eliminate all apneas by whatever means or methods necessary. So far, PAP has been the only way to accomplish this (short of a tracheostomy, which in my opinion, is a better choice than a dental device, assuming you are an absolute PAP failure).
BTW, if you find that the combination of PAP and a dental device get you an AHI of 0, go for it.
So, what will it be? Apneas or No Apneas? I'll take the latter, thank you.
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Permalink Reply by Shelia Shafer on
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A dental device I use, if it will get me close to zero, is better than a bi-pap I won't use.
Maybe someone can explain the rating system to me. My pulmonologist rated me as "Severe Obstructive Sleep Apnea" and when I finally looked at my paperwork, I'm only a 25. My heart and lungs are very healthy with no issues. I have normal blood pressure, normal cholesterol and normal blood sugars. Unless something gets drastically worse, I'm not quite understanding the "severe" part. Yes, I am obese and I have interrupted sleep. I don't doubt that I have sleep apnea, I just wonder about the "severity" of it. I'm 55 and I've had sleep apnea for at least 10 years.
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Permalink Reply by Vickie Reynolds on
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I did mention that I use a CPAP when they mentioned the dental device and again, when I went in for the molds to be made, they didn't seem to even correlate the two...might talk with them more when I go in to get the final fitting...
j n k said:Some of the oral appliances for treating OSA are very similar to the oral devices used for bruxism (teeth-grinding), except that they move the bottom jaw forward a fixed amount to expand the back of the throat to lessen sleep-breathing problems. Other oral appliances for OSA are very different, much more complicated, and very adjustable.
It would have been nice if your device for bruxism could have been the type that can be made to take your sleep apnea into account. That way it would move your jaw forward a bit while preventing the teeth-grinding at the same time. In fact, I would be pretty mad at a dentist who made me an anti-bruxism device without considering my sleep-breathing problem, if he knew about it, myself.
-jeff
Vickie Reynolds said:I have a question...are we talking a dental device that is used to stop grinding my teeth at night? I hesitated to even get this device due to the fact that I am a CPAP user....I will be picking up my dental device on 7/6/2010 - can I used this and CPAP or is this device totally different than the one we are talking about. This device took about an hour for all the measuring/fitting/molds to be done - sorry, but I'm confused...
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Having first tried the appliance approach, only to discover a less than 20% reduction in episodic apnea occurances, the CPAP therapy has proven itself to be highly effective in addressing my needs. With the CPAP machine, I have experienced an almost 100% improvement.
Weird as it may sound, I actually look forward to "hooking-up" each night. After years of suffering, the sure knowledge that I am about to experience seven hours of truly restful sleep, is pure bliss.
Finally, (and this may sound a bit over the top), even with its discomforts, CPAP has been one of the true blessings in my life.
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Hallo from an industry insider and someone who has specialised in making oral appliances for sleep disordered breathing for over 15 years. My name is obviously not John Doe but in order not to be perceived as advertising for a particular company and to protect my identity I have used this as a pseudonym. I would like to HELP and INFORM where I can.
Let's begin!
May I suggest we work on some terminology? Dental Appliances is one name but this is incredibly broad ranging and could include dentures and childrens orthodontic appliances. In the industry there are several acronyms but one that is CURRENTLY favoured is MRD - meaning "mandibular repositioning device". (mandible being the lower jaw).
Some designs of MRD's may be used for patients that present with both jaw pain that may be from temporo-mandibular joint dysfunction (TMD) and sleep disordered breathing when a specialist expert dental professional has assessed the patient and a thorough baseline is established before commencing treatment. I have to say that (in my personal opinion) TMD treatment consists of certain factions or schools of thought and there is a great deal of VooDoo and somewhat sketchy clinical data substantiating the claims made for each factions views. I think we are best to confine ourselves to treatment of sleep disordered breathing which is what this forum is about.
With regard to efficacy of MRDs the facts are (in my opinion) that CPAP remains the best treatment for significant OSA. HOWEVER.... you will note that I have used an ambiguous word "significant" and this is quite deliberate. Significant is an undefined quantity. That's because each individual is unique and may respond better or less well to an MRD. I believe its fair to say that CPAP is an arduous therapy AND SO ARE MRDs!
Why then are MRDs confined to less significant OSA? Well without compliance data (evidence that the device has been used) it could be potentially dangerous to rely on an MRD as a treatment for say an airline pilot or lorry driver. Its also doesnt end there... with a CPAP (simplistically) regardless of how 'significant' the OSA is we can pretty much just dial up the pressure until it overcomes the apnea. With an MRD we don't know yet whether someone will respond to its use before they BUY one and if so whether the improvement will really be adequate. You can think of MRDs as allowing you to breath for yourself (passive) whereas a CPAP is actively pushing air into you.
OK thats enough for now. Please keep up the good work on Sleep Guide and I hope that I have been of some help and can continue to do so.
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Permalink Reply by Mary Z on
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Thanks for this information.
Mary Z.
John Doe said:Hallo from an industry insider and someone who has specialised in making oral appliances for sleep
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I have had my TAP oral appliance for 1 year now. Although I absolutely love it, and have adjusted to wearing it nightly, it has been a bit slow going, and the kinks aren't all worked out yet. I am still having some trouble with the slipping of the skrew that adjusts the appliance. It will slip in the night which makes the appliance ineffective. However, when all is well, all is well!!! I have had many awesome nights sleep that I havdn't had in years prior to getting it. I highly reccomend having it made by someone who only does oral appliances. I really don't think a General Dentist would be a good idea.
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Permalink Reply by Mike on
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John Doe -- thank you for joining us and for bringing your insider perspective to bear on this thread. i have heard rumors of technology being developed to measure compliance/ efficacy of the MRD. My question is whether and when you think that will happen?
John Doe said:Hallo from an industry insider and someone who has specialised in making oral appliances for sleep disordered breathing for over 15 years. My name is obviously not John Doe but in order not to be perceived as advertising for a particular company and to protect my identity I have used this as a pseudonym. I would like to HELP and INFORM where I can.
Let's begin!
May I suggest we work on some terminology? Dental Appliances is one name but this is incredibly broad ranging and could include dentures and childrens orthodontic appliances. In the industry there are several acronyms but one that is CURRENTLY favoured is MRD - meaning "mandibular repositioning device". (mandible being the lower jaw).
Some designs of MRD's may be used for patients that present with both jaw pain that may be from temporo-mandibular joint dysfunction (TMD) and sleep disordered breathing when a specialist expert dental professional has assessed the patient and a thorough baseline is established before commencing treatment. I have to say that (in my personal opinion) TMD treatment consists of certain factions or schools of thought and there is a great deal of VooDoo and somewhat sketchy clinical data substantiating the claims made for each factions views. I think we are best to confine ourselves to treatment of sleep disordered breathing which is what this forum is about.
With regard to efficacy of MRDs the facts are (in my opinion) that CPAP remains the best treatment for significant OSA. HOWEVER.... you will note that I have used an ambiguous word "significant" and this is quite deliberate. Significant is an undefined quantity. That's because each individual is unique and may respond better or less well to an MRD. I believe its fair to say that CPAP is an arduous therapy AND SO ARE MRDs!
Why then are MRDs confined to less significant OSA? Well without compliance data (evidence that the device has been used) it could be potentially dangerous to rely on an MRD as a treatment for say an airline pilot or lorry driver. Its also doesnt end there... with a CPAP (simplistically) regardless of how 'significant' the OSA is we can pretty much just dial up the pressure until it overcomes the apnea. With an MRD we don't know yet whether someone will respond to its use before they BUY one and if so whether the improvement will really be adequate. You can think of MRDs as allowing you to breath for yourself (passive) whereas a CPAP is actively pushing air into you.
OK thats enough for now. Please keep up the good work on Sleep Guide and I hope that I have been of some help and can continue to do so.
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Permalink Reply by RL on
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Per John Doe: :"fair to say that CPAP is an arduous therapy AND SO ARE MRDs!"
I like that word - "arduous" ! That fits my feeliing about OSA/CSA therapy quite well.
Thanks for your input John Doe. We all need whatever help we can get. I just got a plastic dental "night guard" to help with bruxism and sometimes feel that if I have to put one more devise on my head to sleep, I might need a tranquilizer! LOL!. I am 100% compliant with my CPAP for six months, and would say it has gotten more challenging over the months, to remain compliant. My motivation to be healthy is what keeps me going, despite frequent discomfort of the "gear". I can only imagine that DMRs would be just as difficult if not more so, but still worth regular quality sleep if they work. Since DMRs have to be custom made for the patient, there is no resale value if it does not work. This makes it more difficult economically for the system and ultimately the patient. I believe all of these devices will get better over time, especially with increasing patient volume adding to experience of medical providers.
Maybe - John Doe - you could give us some composite case examples of what to expect in the process of being fitted for such a device and what, as a dentist, would help you do your job better in terms of the patient response? Thanks for your participation.
I also appreciated the other member's posts on this thread for perspective.
As my apnea diagnosis is in the severe range, I don't expect the MDR would eliminate my OSA, but since I need the night guard anyway, it might be worth a try with the MDR to get my AHI to zero, and prevent further cpap pressure increases over time. I told my dentist about my OSA/CSA, but she must be inexperienced in this area, as she did not mention the possibility of the MDR. I'm not ready to try the MDR yet, but will keep it in mind as a future supplementary option.
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Permalink Reply by Melissa Enderle on
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Was there special wording included by your doctor to get the insurance payment for UARS? So far, my insurance has denied CPAP and has not given any alternate treatment. I've been using the CPAP (purchased on my own) for over 1 year and still have fatigue and memory, sleep deprivation issues.
SaraLynn said:I use a mandibular advancement device for UARS. I actually felt worse on CPAP. Upon awakening the first morning after using the MAD, I woke up and did not want to get out of bed, not because I felt unrested, but because I was so relaxed...my limbs felt both heavy and heavenly because I had not struggled all night to breathe. I had completely forgotten what that feels like...it has been years! I use my MAD every night and my sleep deprivation symptoms have gone away. It has been over a year now, and I would never choose to go to sleep without it.
Interestingly, my husband was diagnosed with UARS one year later. He has been using the CPAP religiously for a year now and feels no better. My dental device was approved through insurance without problem while 6 months later, my husband's prior authorization request to the same insurance company for the very same device and for the very same diagnosis was denied...after 4 appeal letters, it is being covered...he is anxiously awaiting the final fitting. So, the insurance piece, at least for UARS, clearly can be tricky.
Some sources have indicated that patients with UARS are less tolerant to CPAP use due to an increased sensitivity in the nervous system...I understand that UARS is placed on a continuum with OAS, and it is treated the same as OAS; however, there are some differences that I think need to be taken into consideration.
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Thanks Mike all for the welcome. Compliance data for MRDs is the subject of intellectual property claims and then field trials. So I would imagine we are at least a year away more likely two and then the technology will not be available on all MRDs in all regions of the World.
I agree with the view that patients should seek out a specialist for their MRD. Absolutely. I would recommend in the US to look at www.snoringisntsexy.com or www.dentalsleepmed.org steer away from dentists that want to use an airway assessment tool on you while conscious and standing up! This is a tool to make pretty pictures on a screen and justify the patient paying lots of money. It has little scientific validity when what we want to know is how the airway is when the patient is asleep and supine.
Steer away from self fit MRDs as these basically do more harm than good and have wasted your money. They are not valid as trial devices for a custom MRD! The TAP One, Somnomed and a European or Canadian only device from ResMed (at present) are valid and effective devices. The difference is in how easy it is for the patient to wear and side effects. Yes there are side effects! We can go over these another time.
Hope this helps.
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When we looked closely at our insurance policy, it defined criteria for diagnosis of UARS; however, the criteria for qualifying for medical management (CPAP/dental device) referred specifically to the apnea hypopnia index, which did not apply to the UARS diagnosis for neither my husband nor myself as the AHI was only 1. Interestingly, the policy did not describe any medical management for UARS, but went on to say that surgery for UARS might be approved upon failure with medical management...so there were two holes in which UARS got sucked into...basically, it excluded coverage for medical management by definition.
Your best bet is to have a sleep dentist, who is well-versed in the process, submit the prior authorization/letter of medical necessity with thorough documentation. A rep for the dental appliance company commented that it is rare to get insurance coverage for their MAD with a diagnosis of UARS... My husband went to a different dentist who submitted minimal documentation, and it was rejected. His sleep MD wrote 2 appeals that were denied. Once the holes were pointed out, we were allowed one additional appeal that was finally approved. It took 9 months to push it through. We felt it was worth it just to get them to re-examine the policy and possibly help others in the same boat. Don't give up!
Melissa Enderle said:Was there special wording included by your doctor to get the insurance payment for UARS? So far, my insurance has denied CPAP and has not given any alternate treatment. I've been using the CPAP (purchased on my own) for over 1 year and still have fatigue and memory, sleep deprivation issues.
SaraLynn said:I use a mandibular advancement device for UARS. I actually felt worse on CPAP. Upon awakening the first morning after using the MAD, I woke up and did not want to get out of bed, not because I felt unrested, but because I was so relaxed...my limbs felt both heavy and heavenly because I had not struggled all night to breathe. I had completely forgotten what that feels like...it has been years! I use my MAD every night and my sleep deprivation symptoms have gone away. It has been over a year now, and I would never choose to go to sleep without it.
Interestingly, my husband was diagnosed with UARS one year later. He has been using the CPAP religiously for a year now and feels no better. My dental device was approved through insurance without problem while 6 months later, my husband's prior authorization request to the same insurance company for the very same device and for the very same diagnosis was denied...after 4 appeal letters, it is being covered...he is anxiously awaiting the final fitting. So, the insurance piece, at least for UARS, clearly can be tricky.
Some sources have indicated that patients with UARS are less tolerant to CPAP use due to an increased sensitivity in the nervous system...I understand that UARS is placed on a continuum with OAS, and it is treated the same as OAS; however, there are some differences that I think need to be taken into consideration.
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