All my patients are referred for follow-up sleep studies with mandibular advancement appliances and I request a copy of the study and report be sent to me. If the appliance can reduce a patient to AHI <5 and also establish Oxygen saturation >94 would that not be a successful criteria when the patient was orignally mild-moderate AHI and having an Oxygen saturation <89?? Appliance therapy may help a severe apneic patient and bring them to a level of mild -moderate apnea, if they are not compliant with CPAP, is that not still helpful? Patients can also use nasal pillow therapy with oral appliance therapy as an adjunct to the nasal therapy. Is the criteria for cure a zero AHI? If that be the case do you believe all patients who have AHI 1-5 should be put on CPAP?
Rock Hinkle said:applianceI have seen the results Dr. Mack. They are not good. I have very little evidence that an oral device by itself will produce the needed effect. I have seen some very good results in studies using both a PAP and an oral device. However I did not do any of the studies on these pts prior to them using both devices. I have never had a dentist refer a pt for a sleep study. Everytime someone tells me that they have an oral device I look for the dentist name. Have yet to find one in any chart.
Mack D Jones, MD, SAAN said:I am not convinced that oral appliances do what they claim to do. I haven't seen any PSG results after the appliances are in use. Unless the AHI is reduced to zero by the appliance, in my opinion, it is not successful. I seriously doubt that any of them completely eliminate all obstructive apneas.
Loving your oral appliance and getting fabulous results doesn't mean that your AHI has been reduced to zero. I wouldn't be satisfied with any oral appliance unless a sleep study proves that it is actually eliminating all apneas.
Show me the proof that they are actually doing what they are supposed to do and I'll support them.
I am a board certified dentist in dental sleep medicine. Your concerns/coimplaints are common and not without answers. Treatment of life-threatening problems such as sleep apnea should be placed in the hands of a competent and experienced doctor; most general dentists do not have much or any real training or experience. You will get help if you contact the American Academy of Dental Sleep Medicine (see: www.AADSM.com) and find a dentist with credentials...that is a good start. Additionally, 89% of people who use oral device will have some bite changes...it is totally unavoidable but it happens over months or years not over night and it is not a problem in most instances. It sounds like you need some time and adjustments. If you are clenching your teeth at night becuase of restless legs (untreated) or if you still have apnea you will need to adjust your SomnoMed more and until the apnea is fixed, you will probably still have some tooth grinding problems. "Back" teeth discomfort might be becuase the internal ball clasps in the SomnoMed might be a bit too tight...easy adjustment. Also, make certain that you are using your blue bite tabs in the morning to loosen up your jaws; chewing gum on the way to the shower is helpful too but don't obsess over it and make yourself miserable. Sometimes, a muscle relaxant to help with sleep while accomodating is helpful too...I took some clonazepam for a couple of weeks and it helped me a lot...oh yes, I have apnea too but I am "hybridized" i.e. I use BOTH an oral device and CPAP...works great...took some time but the best of both worlds-low CPAP pressure and moderate jaw advancement...this is how it should be approached more often, in my view.
... I'll lay down a truism: too many people are CPAP-intolerant becuase they cannot breathe through their noses. We send a lot of people out for "nose jobs" and they are (often) forever grateful and some even find a way to begin to tolerate this wonderful therapy, FINALLY. ....
I went to a Sleep Dentist and my SomnoMed is supposed to be ready on April 14th. We will see.