Oral appliances for sleep apnea?

[sr71blackbird]

Dr Steve,
My father has been having heart problems for a few years and had a heart attack 4 years ago. He was diagnosed with sleep apnea and it is likely part of the cause. He was evaluated and went through a sleep study and he had a great deal of difficulty because he is neurotic and I think he walked out of it. He was told by his Dr to use the cpap machine, but he cant wear the mask because it bothers him, so he has not been wearing it. Recently his condition got worse and he had a pacemaker/defibrillator installed yesterday. They determined that the other side of his heart and lung is thickening up and the doctor scolded him for not using the cpap machine. A guy where I work was also diagnosed with sleep apnea and I bet I have it too, but he went though with the study and was also told to use that machine, but he had a lot of trouble as well. Someone recommended him to a special dentist and the dentist fitted him with an oral appliance and he has had a lot of success with it.
Are these appliances known to be effective? I think this might be a solution to him, and it sounds like it would work for me too, since I could not imagine wearing a mask blowing down my throat to bed.
What are your thoughts?

[Dr Steve]

Dr Steve,
My father has been having heart problems for a few years and had a heart attack 4 years ago. He was diagnosed with sleep apnea and it is likely part of the cause. He was evaluated and went through a sleep study and he had a great deal of difficulty because he is neurotic and I think he walked out of it. He was told by his Dr to use the cpap machine, but he cant wear the mask because it bothers him, so he has not been wearing it. Recently his condition got worse and he had a pacemaker/defibrillator installed yesterday. They determined that the other side of his heart and lung is thickening up and the doctor scolded him for not using the cpap machine. A guy where I work was also diagnosed with sleep apnea and I bet I have it too, but he went though with the study and was also told to use that machine, but he had a lot of trouble as well. Someone recommended him to a special dentist and the dentist fitted him with an oral appliance and he has had a lot of success with it.
Are these appliances known to be effective? I think this might be a solution to him, and it sounds like it would work for me too, since I could not imagine wearing a mask blowing down my throat to bed.
What are your thoughts?

Blackbird:

Sorry to hear about your dad, man. There's a lot there, but I'll address your main question about the mandibular advancement splints (MAS). You're right, CPAP isn't the only thing to treat sleep apnea with, and a lot of people can't stand the mask. There's also surgery (the good ol' Uvulopalatopharyngeoplasty, or UPPP), and there are oral appliances, like the aforementioned MAS. There was an extensive review of the literature done in 2007 on these devices. Let me take the abstract and go through it (we'll try this and see how it goes) line by line and i'll translate:

Sleep Breath. 2007 Mar;11(1):1-22. Links
Review of oral appliances for treatment of sleep-disordered breathing.Hoffstein V.
Department of Medicine, University of Toronto, St. Michael's Hospital, 30 Bond Street, Toronto, ON, Canada M5B 1W8. victor.hoffstein@utoronto.ca

This is simply the CITATION...showing where the article comes from.

Between 1982 and 2006, there were 89 distinct publications dealing with oral appliance therapy involving a total of 3,027 patients, which reported results of sleep studies performed with and without the appliance.

i.e., there have been a lot of studies on this. people are intersted in alternatives to CPAP.


These studies, which constitute a very heterogeneous group in terms of methodology and patient population, are reviewed and the results summarized.

a lot of different study designs means it'll be harder to compare the results...apples to oranges, doncha know.



This review focused on the following outcomes: sleep apnea (i.e. reduction in the apnea/hypopnea index or respiratory disturbance index), ability of oral appliances to reduce snoring, effect of oral appliances on daytime function, comparison of oral appliances with other treatments (continuous positive airway pressure and surgery), side effects, dental changes (overbite and overjet), and long-term compliance.

"we looked to see if they work as advertised" :-)



We found that the success rate, defined as the ability of the oral appliances to reduce apnea/hypopnea index to less than 10, is 54%.

Well hell! The success rate of CPAP is 75%. So the odds of someone getting a response with the device is about 50:50.

The response rate, defined as at least 50% reduction in the initial apnea/hypopnea index (although it still remained above 10), is 21%.

They're making a distinction between "success" and "response"...when you use the more stringent definition of response 21% of people fell into this category

Snoring was reduced by 45%.

This in itself is good news.


In the studies comparing oral appliances to continuous positive airway pressure (CPAP) or to uvulopalatopharyngoplasty (UPPP), an appliance reduced initial AHI by 42%, CPAP reduced it by 75%, and UPPP by 30%.

so it's not as good as CPAP, but BETTER than surgery! (statistically speaking)


The majority of patients prefer using oral appliance than CPAP.

no, really? imagine that. :-)


Use of oral appliances improves daytime function somewhat; the Epworth sleepiness score (ESS) dropped from 11.2 to 7.8 in 854 patients.
that's a good result...people using the appliance were more alert during the day than people who didn't.


A summary of the follow-up compliance data shows that at 30 months, 56-68% of patients continue to use oral appliance.

I'm pretty sure that's better than CPAP, but they didn't say.



Side effects are relatively minor but frequent. The most common ones are excessive salivation and teeth discomfort.

that makes sense. unfortunately, nothing's perfect.


We conclude that oral appliances, although not as effective as CPAP in reducing sleep apnea, snoring, and improving daytime function, have a definite role in the treatment of snoring and sleep apnea.

Sounds good to me! Definitely worth talking to your doctor(s) about. What they'll do is repeat a sleep study with the appliance in place...if it's working they can tell immediately.


hope this helps!



steve

[drjoek]

Just to add my two cents. There are lots of people who will benefit from sleep apnea appliances who will not or can not tolerate the mask appliances so if there are alternatives that have been tested do pursue them. Don't get sucked in by some over the counter sleep aid. There are dentists who have been trained to treat and can offer some nice appliances. Good Luck One more thing don't dismiss the CPAP machine. They are the most effective appliances since they are actively providing oxygen. Most of the other are just designed to open your airway more so that you can breath.

[sr71blackbird]

Thank you so much, doctors!

By the way, what would happen if someone was asleep using the cpap machine, and the power went out? Can they still breathe?

[Dr Steve]

Thank you so much, doctors!

By the way, what would happen if someone was asleep using the cpap machine, and the power went out? Can they still breathe?

you can still breathe through the mask, it just wouldn't apply any positive pressure while the power was out. :-)

And following up what Dr Joe said, the Mandibular Advancement Splint is not something you can buy at the pharmacy. It's specially fitted; your ENT or DDS can discuss it with you if you're interested. These devices are for those who cannot tolerate CPAP (and there are a lot of those folks).

Good luck!

[drjoek]

you can still breathe through the mask, it just wouldn't apply any positive pressure while the power was out. :-)

And following up what Dr Joe said, the Mandibular Advancement Splint is not something you can buy at the pharmacy. It's specially fitted; your ENT or DDS can discuss it with you if you're interested. These devices are for those who cannot tolerate CPAP (and there are a lot of those folks).

Good luck!

I still think it should be called the Wierd Medicine and Dentstry Show !

[sr71blackbird]

Wow, thanks both of you!
Is there any evidence that the weight gain associated with sleep apnea could be due to the symptoms? Meaning that you are tired and lack energy, so you tend to lounge around a lot and tend to not burn calories, causing weight gain?

[Dr Steve]

Wow, thanks both of you!
Is there any evidence that the weight gain associated with sleep apnea could be due to the symptoms? Meaning that you are tired and lack energy, so you tend to lounge around a lot and tend to not burn calories, causing weight gain?

There is definitely a "vicious cycle" to this; if you gain weight and start occluding your airway at night, you won't sleep well, which makes you sleepy during the day, which makes you do less physical activity, which means you burn fewer calories, which means you gain more weight, which makes your apnea worse...

Also, the "Diving Reflex" that all mammals have seems to kick in when you're basically holding your breath and dropping your oxygen levels for 8 hours a day. The diving reflex tends to cause weight gain on its own due to some archaic mechanism that helped water dwelling mammals insulate themselves from their environment. The input from this is purely theoretical, but might explain why people with severe sleep apnea have so much trouble losing weight, even if they do make lifestyle changes.



I still think it should be called the Wierd Medicine and Dentstry Show !

Would we have to spell it like that? :smile:

[Bigtchrist]

I have sleep apnia. Problem is i cant go to a place to do the tests so i have no idea if a cpap or a oral app would work for me... People tell me i quit breathing for a couple minutes then my leg starts flailing....

[Hottub]

I still think it should be called the Wierd Medicine and Dentstry Show !

SSWA!

[mendyweiss]

SSWA!
Only If The Freakin Dentist Knows How To Spell Dentistry

[Dr Steve]

Only If The Freakin Dentist Knows How To Spell Dentistry

Ha, I wasn't going to say anything...

:-)

[Leticia]

What is the difference between insomnia and sleep apnea?

I remember reading about it before but don't remember and/or couldn't understand the differences.


Does sleep apnea have more to do with what you do while you're asleep?

[Thebazile78]

What is the difference between insomnia and sleep apnea?

I remember reading about it before but don't remember and/or couldn't understand the differences.


Does sleep apnea have more to do with what you do while you're asleep?

Insomnia = difficulty falling or staying asleep.

Sleep apnea = stopping breathing while asleep, causing you to wake up multiple times during the night.

A lot of people find that behavior modification (cutting out caffeine, only using the bed for sleeping/having sex, setting a bedtime and sticking to it even on weekends, getting up at the same time every day even on weekends, not exercising too close to bedtime because it raises your body temp, keeping your bedroom dark and cool, etc.) will solve their insomnia. It takes a lot of patience and you need to be consistent.

Some people would rather get a sleep aid, like name-brand OTC Unisom (etc.), or go to their regular GP for a 'scrip for Lunesta or Ambien (which have some pretty funky side effects in some people ... like sleep eating or even sleep-driving ... SCARY if you ask me) ... or try alternate therapies like tea (I like Celestial Seasonings Sleepy Time and Chamomile teas myself; if I am stressed out, I like to drink Tension Tamer during the day and have a cup of Sleepy Time at night) or melatonin pills or whatever.

As for sleep apnea, that should be diagnosed by a doctor (general practitioner or otolaryngologist ... a.k.a. - ear-nose-throat/ENT) or sleep specialist. Dr. Steve described the CPAP mask that helps someone with sleep apnea keep breathing during the night without waking up, but there are other options discussed in this thread too, like appliances (usually a fancy word for a retainer) or losing weight if the apnea is being caused by being overweight.

[CruelCircus]

Don't ask me how I happened to come across this thread, since I apparently missed it when it originally hit.

Anyway, I wanted to quickly throw in my own first hand experience with the "oral appliance." It's a bit more involved than a simple retainer; it's a custom molded mouthpiece in two parts- one for the upper teeth and one for the lower. The two pieces are then fitted together by small titanium bars that place your jaw in such a way that your airway is opened up.

It has worked very well for me. It took some getting used to, but it definitely has had a positive impact on sleeping and esp. snoring. The thing is, though, the doctor who did the sleep study said my case of apnea was mild enough so that the CPAP wasn't warranted. The implication being that if you need CPAP, the mouthpiece might not be enough to do the job for you. The other negative is that the thing is rather expensive, so if it's not covered by your ins. or the dentist is out of network, you may have to go in pocket for a decent amount.

[jennifer8055]

Hi,
If you're looking for sleep apnea supplies you should check out www.sleepapneasupplies.info . It seems they are offering CPAP supplies at little or no cost at all to people diagnosed with sleep apnea..

[sr71blackbird]

Hi,
If you're looking for sleep apnea supplies you should check out www.sleepapneasupplies.info . It seems they are offering CPAP supplies at little or no cost at all to people diagnosed with sleep apnea..

Spam???

[Dr Steve]

Spam???


most likely

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Finally! ...someone's making sense around here!





..:bye:

[mudflap170]

I've been suffering from sleep apnea for some 10 years now. (probably because I have a 24 1/2 inch neck) I use the c-pap machine religiously. To this day I still have problems with the mask, so I switched to a device called "nasal pillows." They are actually inserted right into your nostrils and work a lot better then the mask.

[extracheese]

I never had sleep apnea until my mid 30s when i gained an ungodly amount of weight. Over time i was exhausted all the time, falling asleep in meetings, on subways, in front of TV etc.
My Internist diagnosed sleep apnea as a possible cause, and said the weight MAY very well be responsible but i cannot lose the weight until i get my APNEA under control ( i would be too exhausted to undertake a diet/exercise plan).
I went to a clinic in Manhattan for a sleep study - results were SEVERE APNEA - meaning i stop breathing every few minutes all night long.
I was given a CPAP machine with nasal pillows (Oral appliances would not work on SEVERE apnea) and too say i was miserable and depressed is an understatement.

But its amazing how you get used to things..For a month i was feeling sorry for myself and dreaded going to sleep. But soon after i got used to it, and now i couldnt imagine a night without it.

1 year later, i lost 50 pounds and my pressure went from 9-12, to 4 - 8. My internist believes that with another 50 pounds I shouldn't need the machine at all.

Try the machine. Suffer for a few months and youll be amazed.
Also - the nasal pillows arent for everyone. If you are a mouth breather, youll need a
full face mask. But take one step at a time and get the sleep study done.

Also i found the message boards invaluable - CPAPTALK is one of my favs.

Good luck