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Oral Systemic Balance (dental device)
Hello, I was asked to post this as a new discussion topic. I wanted to provide some information on the Oral Systemic Balance (OSB). I am not a dentist, I am a professor. I have had migraines for 36 years, have had every treatment from acupuncture to Zanadine (muscle relaxant). The migraines usually came twice a week, and lasted 1-3 days. You can see how this would define my life. I got the OSB (oral systemic balance) dental device from Dr. Lawler, and have not had a migraine in 3 months. I'm one of the people Dr. Lawler has videotaped. All I can say is, I hope the dental and medical communities embrace this research so others can benefit as I have. Dr. Lawler is studying with Dr. Farrand Robson of Tacoma Washington.
Views: 4038
Replies to This Discussion
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Permalink Reply by RockRpsgt on
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Don't forget:
CPAP clinics
A.W.A.K.E. groups
PAPNAPS
Humidifiers
Sleep conventions
.......and me Rock Hinkle Rpsgt
Nothing is as it was 25 years ago.
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We also did not have oral devices 25 years ago, or digital recording of brain and respiratory signals. Just saying sleep is evolving.
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To the docs in this discussion: First of all I understand your frustration with UARS and RERAS. This is something that I have fought over at least once a week in every lab that I have worked in.
These questions are not meant to belittle your product. I really want to know more about it. I understand that the way a person feels is a much better parameter than any number I can come up with in a lab. I also know that there are millions of people out there who feel great that have untreated OSA. I was one of them. How do you measure your success without having a sleep study done before and after? Dr. Dement talks in many of his publications on how even a small increase in sleep efficiency can make a bad sleeper feel like they have more energy. He also discusses how this energy can be short lived if the source of the bad sleep is not rooted out and finally eliminated.
As I understand it success on the oral devices,as well as many other OSA treatment options, is a 50% reduction in AHI. in the case of UARS it would be a reduction in RDI. if a person has an RDI of 40 and your product reduces it to 20 that is great. Won't the RDI of 20 eventually catch up to the person? Is it possible that they could relapse in a few years? What about the stress on the heart that an RDI or AHI of 20 would produce? Most apnea fighting surgeries only have a shelf life of about 6 years according to studies. None can combat or prevent an increase in apnea due to weight gain or aging like PAP therapy(short of a trach). What does your product do to prevent a relapse? How would you know?
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Permalink Reply by David E. Lawler DDS D.ABDSM on
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Rock this is a great discussion and I appreciate your question.
In our practice we utilize unattended home monitoring to see if a PSG is warranted on many new patients who present for treatment. A very significant amount of the time, based on home testing, there is no possibility of getting a diagnosis for obstructive sleep apnea. The ones that we struggle with are those on the borderline. Getting a diagnosis for OSA certainly helps with insurance reimbursement. Studies show that home sleep monitoring can be more consistent in identifying mild obstructive sleep apnea because patients are sleeping in a familiar environment and there is less variability in their sleep patterns. It is really frustrating for all of us to attempt to get a diagnosis when the home sleep study shows a significant issue in a patient with symptoms and, yet, the patient didn't desaturate enough in the sleep lab. So the variability is not in the scoring but in the sleeping and breathing.
Certainly we are going for symptom relief, but we are also trying to normalize breathing as much as possible. So we are aiming to get the AHI under 5. (A 50% reduction in AHI is a criteria that is used in palatal surgery but not oral appliances.) Again, in my practice, home sleep monitoring is utilized to assess our level of success. Ideally a follow-up PSG is done but few patients will go back to the sleep lab once they feel better. I am very pleased that Carl, went back to the sleep lab to evaluate his Oral Systemic Balance mandibular repositioning appliance. His PSG and his home sleep study with the Watch PAT home monitor were in lock step agreement. I would defy CPAP to manage him as well as his oral appliance and he certainly felt better than when he was on CPAP. And we were lucky. Had we not been lucky, we could have combined his oral appliance with CPAP and allow for more comfortable CPAP use. Carl was perfectly compliant with CPAP. It just wasn't working well for him.
As to relapse over time, there is very little about the body that is static. We all deal with that. I have dental patients who have been on CPAP for years with no follow up, even with significant weight gain. Are they stable? In this regard, we do the best we can in helping patients stay healthy. And I can tell you that getting patients who feel good to come back for additional testing is a tough sell.
Rock Hinkle said:To the docs in this discussion: First of all I understand your frustration with UARS and RERAS. This is something that I have fought over at least once a week in every lab that I have worked in.
These questions are not meant to belittle your product. I really want to know more about it. I understand that the way a person feels is a much better parameter than any number I can come up with in a lab. I also know that there are millions of people out there who feel great that have untreated OSA. I was one of them. How do you measure your success without having a sleep study done before and after? Dr. Dement talks in many of his publications on how even a small increase in sleep efficiency can make a bad sleeper feel like they have more energy. He also discusses how this energy can be short lived if the source of the bad sleep is not rooted out and finally eliminated.
As I understand it success on the oral devices,as well as many other OSA treatment options, is a 50% reduction in AHI. in the case of UARS it would be a reduction in RDI. if a person has an RDI of 40 and your product reduces it to 20 that is great. Won't the RDI of 20 eventually catch up to the person? Is it possible that they could relapse in a few years? What about the stress on the heart that an RDI or AHI of 20 would produce? Most apnea fighting surgeries only have a shelf life of about 6 years according to studies. None can combat or prevent an increase in apnea due to weight gain or aging like PAP therapy(short of a trach). What does your product do to prevent a relapse? How would you know?
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Permalink Reply by Rooster on
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Lisa Barnhart said, (I) wear my OSB 24/7 except to eat.
Is my assumption correct that it is a daytime appliance?
How do you manage eating in restaurants and replacing the appliance? Do you carry items to brush and floss after eating?
Do you have any returning symptoms while eating - symptoms like noticeably irregular breathing or labored breathing or anxiety?
Have you ever tried exercising without the appliance? If so, did you notice a poorer performance or less endurance as compared to exercising with the appliance in place?
I am still amazed at your story and the total transformation of your life. It brings to mind many other people. One very sad case was a young son of my friends. He had a lot of emotional problems despite being a bright kid. He committed suicide in the ninth grade. I remember clearly he had a heavy neck and a small recessed chin. I can't help but believe he was suffering with a breathing disorder. This is a sad thought for me that his life could have been transformed with the proper diagnosis and treatment. On the other hand it offers hope for others in the future.
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Permalink Reply by Roberta McPhee on
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Hi Dr. Lawler, I need one of those devices for my mouth at night. I am loosing my back teeth because of my grinding even tho I have a mask that says it takes care of the grinding but it dosen't so before I have false teeth I have to find out the price and if my insurance will pay for it. Bertabee1
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Is my assumption correct that it is a daytime appliance? Yes- I wear the day time device.
How do you manage eating in restaurants and replacing the appliance?
I am a woman, therefore I always plan plan plan. If I forget to remove prior to entering a restaurant, I excuse myself to the powder room :-)
Do you carry items to brush and floss after eating? Don't know if you are married, but it is amazing how much stuff fits in a purse!
Do you have any returning symptoms while eating - symptoms like noticeably irregular breathing or labored breathing or anxiety?
Many patients do not even wear the day time device except at night after several months of continuos use, as there is residual effect / benefits. You would need to ask Dr Lawler, but I believe this is due to the improvement in the tone of the tongue muscle.
I am apparently not one of those patients. Perhaps because I had 4 permanent molars removed as a teenager in braces... a common practice in the 70's. My lower jaw is extremely small and very little space for my tongue. About 50% of the time after a meal I find myself clearing my throat, which immediately stops once I put my OSB back in. Other times I will forget to put it back in for a half day.
Have you ever tried exercising without the appliance? If so, did you notice a poorer performance or less endurance as compared to exercising with the appliance in place?
Oh good question.....I have lost 40 lbs since getting OSB.
All my adult life I was frustrated by how horrible I felt after exercise.... exhausted, not "energized" like the "experts" say.
I went from huffing and puffing to walk a quick mile to currently jogging 4 miles, up multiple hills, and only get winded jogging up the hills. I usually feel like I could go farther, but moms can only indulge in self for a short time each day.
I always have my OSB for the 4 miles. I have used the elliptical without the OSB, just drop my jaw forward some to open the airway if needed.
I am encouraged by your comments about others who come to your mind and thoughts that so much suffering could be over come with proper diagnosis and treatment. I see those people everywhere and share my story with anyone who doesn't look at me like I've seen too many info-commercials. I have two friends that took my advice to try OSB and they have their own amazing stories. One is a age 50+ woman, using CPAP.... hated it, had severe neck and shoulder pain.
After her initial OSB fitting, had no more pain and her sinuses opened up that day for the first time in years and she could breath through her nose. She told me last week that using her daytime device at night, she no longer is using her CPAP and had stopped needing her stomach acid pills.
I have about a dozen more people who would already have gone, if insurance would help with the cost.
Based on what you all know about the numerous illnesses sleep disorders are linked to, the "no insurance" argument becomes an investment decision .... if you are going to wait for insurance companies to dictate your health choices, then
you're going to pay with your health,
or pay the Dr. and drug companies to treat the symptoms per the insurance companies guidelines
or
like me, invest in your health no matter what it takes.
For those who exhibit many more physical symptoms than I do, the expense of OSB will be offset by the savings of everything we buy just to keep ourselves going.
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Roberta McPhee said:Hi Dr. Lawler, I need one of those devices for my mouth at night. I am loosing my back teeth because of my grinding even tho I have a mask that says it takes care of the grinding but it dosen't so before I have false teeth I have to find out the price and if my insurance will pay for it. Bertabee1
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Thank you for your response Dr.Lawler. While I do not have alot of faith in the current HST technology I am very glad to here that you are using the Watchpat to evaluate your patients. I strongly feel that this is the best one on the market at this time.
Can an HST evaluation accurately Dx for UARs? Do you have any screenshots of the events you are marking?
FYI if any of you think that you may have UARS seek out a pediatric sleep doctor. They will have much more experience in this particular disordeand the events that go with it.
David E. Lawler DDS D.ABDSM said:Rock this is a great discussion and I appreciate your question.
In our practice we utilize unattended home monitoring to see if a PSG is warranted on many new patients who present for treatment. A very significant amount of the time, based on home testing, there is no possibility of getting a diagnosis for obstructive sleep apnea. The ones that we struggle with are those on the borderline. Getting a diagnosis for OSA certainly helps with insurance reimbursement. Studies show that home sleep monitoring can be more consistent in identifying mild obstructive sleep apnea because patients are sleeping in a familiar environment and there is less variability in their sleep patterns. It is really frustrating for all of us to attempt to get a diagnosis when the home sleep study shows a significant issue in a patient with symptoms and, yet, the patient didn't desaturate enough in the sleep lab. So the variability is not in the scoring but in the sleeping and breathing.
Certainly we are going for symptom relief, but we are also trying to normalize breathing as much as possible. So we are aiming to get the AHI under 5. (A 50% reduction in AHI is a criteria that is used in palatal surgery but not oral appliances.) Again, in my practice, home sleep monitoring is utilized to assess our level of success. Ideally a follow-up PSG is done but few patients will go back to the sleep lab once they feel better. I am very pleased that Carl, went back to the sleep lab to evaluate his Oral Systemic Balance mandibular repositioning appliance. His PSG and his home sleep study with the Watch PAT home monitor were in lock step agreement. I would defy CPAP to manage him as well as his oral appliance and he certainly felt better than when he was on CPAP. And we were lucky. Had we not been lucky, we could have combined his oral appliance with CPAP and allow for more comfortable CPAP use. Carl was perfectly compliant with CPAP. It just wasn't working well for him.
As to relapse over time, there is very little about the body that is static. We all deal with that. I have dental patients who have been on CPAP for years with no follow up, even with significant weight gain. Are they stable? In this regard, we do the best we can in helping patients stay healthy. And I can tell you that getting patients who feel good to come back for additional testing is a tough sell.
Rock Hinkle said:To the docs in this discussion: First of all I understand your frustration with UARS and RERAS. This is something that I have fought over at least once a week in every lab that I have worked in.
These questions are not meant to belittle your product. I really want to know more about it. I understand that the way a person feels is a much better parameter than any number I can come up with in a lab. I also know that there are millions of people out there who feel great that have untreated OSA. I was one of them. How do you measure your success without having a sleep study done before and after? Dr. Dement talks in many of his publications on how even a small increase in sleep efficiency can make a bad sleeper feel like they have more energy. He also discusses how this energy can be short lived if the source of the bad sleep is not rooted out and finally eliminated.
As I understand it success on the oral devices,as well as many other OSA treatment options, is a 50% reduction in AHI. in the case of UARS it would be a reduction in RDI. if a person has an RDI of 40 and your product reduces it to 20 that is great. Won't the RDI of 20 eventually catch up to the person? Is it possible that they could relapse in a few years? What about the stress on the heart that an RDI or AHI of 20 would produce? Most apnea fighting surgeries only have a shelf life of about 6 years according to studies. None can combat or prevent an increase in apnea due to weight gain or aging like PAP therapy(short of a trach). What does your product do to prevent a relapse? How would you know?
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Rock, there are screenshots of the Watch PAT report at http://www.centerforsoundsleep.com/blog/home-sleep-monitoring/
Because of the limitations of the dental practice license, dentists cannot diagnosis sleep disorders. We can merely "guide" and defer to a physician to dictate treatment. The problem is that there is little interest in the medical community in managing these more "mild" disorders.
I have done a Watch PAT evaluation side-by-side with a PSG on one of my patients. He had a pRDI (the Watch PAT term) of 22 vs a RDI of 7 from the PSG. Interestingly it was necessary for this test case to have the scoring tech list the RERAs as hypopneas because the software that was used in the lab gave no option to record RERAs.
So I believe that the Watch PAT is more sensitive than a PSG for the most mild forms of sleep disruption. There certainly can be false positives as a result of this. All I know is that when the upper airway is managed, this number goes down.
Rock Hinkle said:Thank you for your response Dr.Lawler. While I do not have alot of faith in the current HST technology I am very glad to here that you are using the Watchpat to evaluate your patients. I strongly feel that this is the best one on the market at this time.
Can an HST evaluation accurately Dx for UARs? Do you have any screenshots of the events you are marking?
FYI if any of you think that you may have UARS seek out a pediatric sleep doctor. They will have much more experience in this particular disordeand the events that go with it.
David E. Lawler DDS D.ABDSM said:Rock this is a great discussion and I appreciate your question.
In our practice we utilize unattended home monitoring to see if a PSG is warranted on many new patients who present for treatment. A very significant amount of the time, based on home testing, there is no possibility of getting a diagnosis for obstructive sleep apnea. The ones that we struggle with are those on the borderline. Getting a diagnosis for OSA certainly helps with insurance reimbursement. Studies show that home sleep monitoring can be more consistent in identifying mild obstructive sleep apnea because patients are sleeping in a familiar environment and there is less variability in their sleep patterns. It is really frustrating for all of us to attempt to get a diagnosis when the home sleep study shows a significant issue in a patient with symptoms and, yet, the patient didn't desaturate enough in the sleep lab. So the variability is not in the scoring but in the sleeping and breathing.
Certainly we are going for symptom relief, but we are also trying to normalize breathing as much as possible. So we are aiming to get the AHI under 5. (A 50% reduction in AHI is a criteria that is used in palatal surgery but not oral appliances.) Again, in my practice, home sleep monitoring is utilized to assess our level of success. Ideally a follow-up PSG is done but few patients will go back to the sleep lab once they feel better. I am very pleased that Carl, went back to the sleep lab to evaluate his Oral Systemic Balance mandibular repositioning appliance. His PSG and his home sleep study with the Watch PAT home monitor were in lock step agreement. I would defy CPAP to manage him as well as his oral appliance and he certainly felt better than when he was on CPAP. And we were lucky. Had we not been lucky, we could have combined his oral appliance with CPAP and allow for more comfortable CPAP use. Carl was perfectly compliant with CPAP. It just wasn't working well for him.
As to relapse over time, there is very little about the body that is static. We all deal with that. I have dental patients who have been on CPAP for years with no follow up, even with significant weight gain. Are they stable? In this regard, we do the best we can in helping patients stay healthy. And I can tell you that getting patients who feel good to come back for additional testing is a tough sell.
Rock Hinkle said:To the docs in this discussion: First of all I understand your frustration with UARS and RERAS. This is something that I have fought over at least once a week in every lab that I have worked in.
These questions are not meant to belittle your product. I really want to know more about it. I understand that the way a person feels is a much better parameter than any number I can come up with in a lab. I also know that there are millions of people out there who feel great that have untreated OSA. I was one of them. How do you measure your success without having a sleep study done before and after? Dr. Dement talks in many of his publications on how even a small increase in sleep efficiency can make a bad sleeper feel like they have more energy. He also discusses how this energy can be short lived if the source of the bad sleep is not rooted out and finally eliminated.
As I understand it success on the oral devices,as well as many other OSA treatment options, is a 50% reduction in AHI. in the case of UARS it would be a reduction in RDI. if a person has an RDI of 40 and your product reduces it to 20 that is great. Won't the RDI of 20 eventually catch up to the person? Is it possible that they could relapse in a few years? What about the stress on the heart that an RDI or AHI of 20 would produce? Most apnea fighting surgeries only have a shelf life of about 6 years according to studies. None can combat or prevent an increase in apnea due to weight gain or aging like PAP therapy(short of a trach). What does your product do to prevent a relapse? How would you know?
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You are very correct. I appreciate your honesty. I have been talking about false positives with the HSTs for sometime now. The military has done several studies on the technology behind the Watchpat listing it's limitations at recording sleep problems. basically the military said that it was "just" good enough for their needs. I believe that they said the same thing about the Hummer as well.
I do not see it possible to Dx UARS via this program. It's tough to see flow limitation on these units let alone arousals. Thanks foir the answers to my questions. Good luck!
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Rock, we are not on the same page regarding our opinions of the Watch PAT. I have done well over 550 Watch PAT studies so I'm more than a little familiar with this instrument. The pRDI may be overly sensitive compared to a RDI obtained with a polysomnogram. They clearly are measuring something different. You obviously cannot measure air flow with something on your finger. However you CAN measure the EFFECT of diminished airflow by looking at sympathetic surge. How do you know that there is not something more subtile going on in the body that the PSG is overlooking?
This needs to be repeated: When the upper airway is managed the pRDI measured by the Watch PAT goes down. This is a straight line correlation. So something is getting better. I contend that the sympathetic surge measured by the Watch PAT signal has a deeper meaning than a respiratory effort related arousal derived from a PSG. Guilleminault himself said that he thought that there was some subcortical effect on the brain that was deeper than a RERA.
Those of us who are working with Oral Systemic Balance principles see amazing things that until now were completely overlooked by the medical community. There are many, many amazing stories by patients on this thread who have shared things that are not credible with conventional thought. I contend that the Watch PAT gives a window into this previously overlooked part of the body's physiology.
Rock Hinkle said:You are very correct. I appreciate your honesty. I have been talking about false positives with the HSTs for sometime now. The military has done several studies on the technology behind the Watchpat listing it's limitations at recording sleep problems. basically the military said that it was "just" good enough for their needs. I believe that they said the same thing about the Hummer as well.
I do not see it possible to Dx UARS via this program. It's tough to see flow limitation on these units let alone arousals. Thanks foir the answers to my questions. Good luck!
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