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Dental Sleep Appliances
I have made close to 200 dental appliances for sleep apnea. I am a dentist who has taken a big interest in this field. I have attented hours of lectures on the topic. I have had 100% success not one patient doesn't like the appliance. Everyone and studies show improvements. It is a option that anyone who can't wear CPAP should look into.
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Replies to This Discussion
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Permalink Reply by Dr. Richard Charmoy DMD on
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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.
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Permalink Reply by Mary Z on
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Dr. Charmoy, a google search on this subject turned up literally hundreds of devices, mostly anti snoring devices. Are you sre you can't make a recommendation (I know this is not your job) of several to choose from. I am literally lost in the pages of information. You mention their are "severaal devices. Or perhaps you could give me some more specific google terms than (OTC boil and bite anti apnea devices).
Thanks so much.
Mary Z.
Dr. Richard Charmoy DMD said:Mary,
There are several over the counter boil type devices, some use a velcro type of material to position your lower jaw in a forward position. What is good about this type or any that allows you to adjust the position is that if you have any discomfort in you TMJ ( jaw joint) you can reposition the lower portion so your jaw isn't advanced so far forward. Be careful of any device which you can not adjust. google for these. Good luck
Mary Z said:
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Permalink Reply by Randy Bray on
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Daniel said:I know that there are something like 80 different dental appliances for sleep apnea out there. How does a dentist decide which to use? I've always had the feeling that they find one they like and that is the only one they offer.
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I was seen by a local dentist who specializes in Sleep Dentistry. He showed and discussed about 6 or 8 different Oral appliances and let me choose which I thought would work best, and it worked out. I had a UPPP and a Tongue ablasion and it didn't totally cure the apnea, the oral device (Mandibular Advancer) works very well. I sleep more soundly and wake up fully rested when using it. It also allows me to sleep well when camping or being on an aircraft where power for a CPAP is not available.
Randy Bray said:Daniel said:I know that there are something like 80 different dental appliances for sleep apnea out there. How does a dentist decide which to use? I've always had the feeling that they find one they like and that is the only one they offer.
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How do we define success?
I was initially diagnosed with sever OSA in March 2008 and went through the process of learning about and adjusting to using a CPAP machine. Between January 2009 and June 2009, I lost 30 pounds (Weight Watchers) and have since maintained my goal weight.
In the summer and fall of 2009, after the weight loss, I decided to explore the option of oral appliances. I worked with my dentist and was fitted for a TAP appliance and did a repeat sleep study. Unfortunately, the results using the appliance were not good. The numbers were not much different from my initial sleep study back in 2008. I was totally surprised and disappointed when the results were explained to me because I must have had a false sense of effectiveness. I wasn’t “really” waking up feeling rested; but I was enjoying the freedom of sleeping without the machine.
During my follow-up visit I was told, in layman’s terms, that although the average number of times/hr that I actually stopped breathing was slightly fewer, my breathing was very shallow while using the appliance.
So, it’s back to the CPAP for me.
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The question I would ask was the oral appliance advanced enough? What critera did the dentist use to verify how much advancement. Probable could have advance you more and your results would have been better. Need to make sure who you see is well qualified and has all that is necessary to verfiy his results. He may have all of this, I don't know but I have had some challenging cases but have worked through and finally achieve great results. It doesn't always happen over night.
simanc said:How do we define success?
I was initially diagnosed with sever OSA in March 2008 and went through the process of learning about and adjusting to using a CPAP machine. Between January 2009 and June 2009, I lost 30 pounds (Weight Watchers) and have since maintained my goal weight.
In the summer and fall of 2009, after the weight loss, I decided to explore the option of oral appliances. I worked with my dentist and was fitted for a TAP appliance and did a repeat sleep study. Unfortunately, the results using the appliance were not good. The numbers were not much different from my initial sleep study back in 2008. I was totally surprised and disappointed when the results were explained to me because I must have had a false sense of effectiveness. I wasn’t “really” waking up feeling rested; but I was enjoying the freedom of sleeping without the machine.
During my follow-up visit I was told, in layman’s terms, that although the average number of times/hr that I actually stopped breathing was slightly fewer, my breathing was very shallow while using the appliance.
So, it’s back to the CPAP for me.
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Permalink Reply by Raymond J. Young, Jr. on
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Your husband needs to see a Neurologist/Sleep specialist. They are aware of all meds cleared and off label to treat RLS/PLMS. Good luck.
audrey said:currently my husband is using a tongue retainer which pulls his tongue forward. It seems to be helpful,but he also has a form of restless leg syndrome so he's taking a sleeping pill or a half of one every other night. I feel like there must be better alternatives for him.
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Permalink Reply by Banyon on
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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.
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Permalink Reply by Mack D Jones, MD, SAAN on
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You stated: "Secondly I like a lab or ambulatory test to quantify my numbers and compare to original sleep study, RDI/ AHI etc."
May I ask, what are the numbers that you are obtaining in your post sleep studies?
Dr. Richard Charmoy DMD said:I am all in favor of mandibular advancement appliance provided the dentist is aware of what he is doing. We are constantly getting flyers about making these appliances to help our patients.. I have studied this extensively with some of the top sleep dentist in the country. If the proper appliance is made and considerations for TMJ situation you should have
no problems. All of the appliances I make I take this into consideration therefore avoiding TMJ problems. If they do occur most resolve themselves within a week or two. I am in Central Jersey it takes me 45 minutes from NYC, my practice is in Somerville. I use both lab testing at our local Sleep for life Center apart of Somerset Medical Center and also ambulatory sleep studies. Obviously if a patient has cardiac or other medical conditions I would prefer a sleep lab test.Since sleep apene is a life threatening condition there are not many dental situation to prevent the fabrication of these appliances. I have made them on patients who have no teeth and patients who have periodontal conditions. I define success two ways one by patients epsworth and berlin tests, family and the patients reporting back to me. Secondly I like a lab or ambulatory test to quantify my numbers and compare to original sleep study, RDI/ AHI etc.Insurance is a trety situation they look at a dentist making a medical device, however I have a computer program that will generate a 30 page report including pictures and sleep studies, and all oral cavity related situations that can be a cause of sleep apnea. Over 15 years of making these appliances with really the majority within the last 5 years not one patient on follow up tell me they are not using the appliance. I get quotes of you have changed my life and my families. My spouse now sleeps with me, I am rested, I am now excersizing everyday and am rested. If you wish to contact me further my e-mail is rcharmoy@drcharmoydmd.com.
I am here to help you and your patients in anyway.
Dr. Charmoy
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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.
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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
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