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kyhrsluvr
Unread post  Post subject: Oral appliance success rate?  |  Posted: Sat Oct 01, 2011 4:46 pm
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I have just been diagnosed with moderate sleep apnea and still getting used to the idea. :o I don't know why I have it since I am a healthy, normal weight 47 year old female (although constantly sleepy). My dr did mention on my first visit that I had a small throat so maybe that is why. She suggested cpap but I did not want to use it and suggested that my insurance may not want to pay for an oral appliance until I have tried cpap. But, I have made an appt with a dentist who specializes in oral appliances in about 2 weeks. I saw it posted somewhere that the oral appliance works for 75% of the patients who try it. Do you think that is fairly accurate? Is there anything I need to do to make my use of it a success? Does it work as well as cpap if fitted and used correctly? Anything else I need to know? Thanks for any ideas/comments.


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TheLankyLefty
Unread post  Post subject: Re: Oral appliance success rate?  |  Posted: Sat Oct 01, 2011 11:18 pm
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kyhrsluvr wrote:
I have just been diagnosed with moderate sleep apnea and still getting used to the idea. :o I don't know why I have it since I am a healthy, normal weight 47 year old female (although constantly sleepy). My dr did mention on my first visit that I had a small throat so maybe that is why. She suggested cpap but I did not want to use it and suggested that my insurance may not want to pay for an oral appliance until I have tried cpap. But, I have made an appt with a dentist who specializes in oral appliances in about 2 weeks. I saw it posted somewhere that the oral appliance works for 75% of the patients who try it. Do you think that is fairly accurate? Is there anything I need to do to make my use of it a success? Does it work as well as cpap if fitted and used correctly? Anything else I need to know? Thanks for any ideas/comments.


I can completely understand where you are coming from. I am a health, very active, young (35) and lean. When I was diagnosed with hypertension it was a little bit of a slap in the face. You discovered something many doctors don't know, small airways are what sleep apnea is all about. Once you boil it down, that is all that matters.

I'm actually at a Sleep Medicine conference today and tomorrow and one of the lectures was oral appliances. What luck! Here are the statistics:

AHI % success (success defined as a 50% reduction in AHI)
5-20 (mild) 75%
20-40 (moderate) 61%
>40 (severe) 40%

Your doctor isn't that far off, but there are definitely some things that you should know. The definition of success is a huge factor. Since you are in the moderate range, that's tough. You are at a 61% chance of cutting your AHI in half. I personally don't like those odds. You found out that insurance companies don't either. You basically have a coin flip of a chance that you will cut your AHI to a value that will still get you a diagnosis of sleep apnea. This doesn't even speak of your RDI (these include RERAS, hypopneas, and all apneas. It's always higher than your AHI...or equal to it...but that's very rare)

CPAP is definitely the gold standard. It's non invasive, and it's success rate and effectiveness are much higher than anything else. (finding the right mask is critical) If you try this and "fail" (non-compliant) then you can usually get an OAT device. The OASYS is probably one of the better ones. There are a ton of different brands, so success relies on finding the one that best addresses the cause of your Apnea.

Realistically though, ask yourself what you can wear in your mouth that will cause your throat to get bigger. Your airway is small. The only thing that you can really do is protect it with a pneumatic splint (CPAP). Even though the airway is small, this will keep it open.

Trust me when I say that sleep apnea effects EVERYONE!!! Young, old, in shape, and out of shape. Once you weigh the pros and cons of CPAP, it suddenly doesn't look all that bad. The cons are really few. If you were in the mild range, then things would be much different.

Any questions about this?

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kyhrsluvr
Unread post  Post subject: Re: Oral appliance success rate?  |  Posted: Sun Oct 02, 2011 4:56 am
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Thanks so much for the info. I am unsure at this point on what I want to do. The thought of something strapped to my head all night blowing air into me just makes me uncomfortable, for lack of a better word. How does a person exhale. i know you can because obviously people use it all the time. I just tend to be claustrophobic and the thought of it is making my heart pound as I write this. Also, my husband is very skeptical about this whole thing and that is probably making things more difficult. It just makes me almost cry when I have to argue with him that this is all real. He says I never snore when I'm on my side and my breathing always seems regular. He never hears me snort/choke as when a person would do when aroused out of an apneac or hypopneac (sp) event. According to the report, I definitely have more hypopnea events than apnea and definitely more on my back than on my side but my overall AHI is 22.
Thanks so much for info.


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kyhrsluvr
Unread post  Post subject: Re: Oral appliance success rate?  |  Posted: Mon Oct 03, 2011 3:26 am
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Another thought came to me. If I can obtain about a 75% reduction of my AHI with an oral appliance, I can almost obtain a nearly normal number. Of course, that would be if I was in the 61% who have success with it.


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TheLankyLefty
Unread post  Post subject: Re: Oral appliance success rate?  |  Posted: Mon Oct 03, 2011 9:05 am
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If the report breaks down supine vs. non-supine REM (as it should), then you would be able to tell if your AHI is drastically different between the two. This is VERY common to have your AHI elevated on your back, and then much lower on your side. Hopefully the report hashes out REM as well. How was your sleep on your back and on your side during REM? Non-supine REM and supine REM numbers are important in evaluating this.

If it was okay on your side (sounds like there is good evidence from your husband), then you might have some good news. What did the sleep lab say about snoring on your side? What was the AHI and RDI on your side?

If these are low then you can talk to your doctor about this. Positional therapy would work. That's "fancy talk" for just sleeping on your side. You can wear a shirt with tennis balls sewed into the back to keep you on your side. That's my cheap way of doing things.

It also sounds like an oral appliance may work for you in this situation. It's very possible that even if it doesn't completely work while you are supine, then it would very likely help while you are on your side. A combination of positional therapy and oral appliance therapy. Again, take these concerns to your doctor with your sleeping position (AHIs in mind). If you have a copy of your report it's good to use it for evidence that you can be treated without CPAP. Doctors like evidence!

It sounds like if you remained on your side, then an oral appliance would put you well into the normal sleep range. Considering all positions though, you only have a 61% chance of decreasing your overall AHI by 50% (remember that this doesn't count RERAs though. They wake you up as well) Check the report for what your RDI is in the non-supine position.

With regards to CPAP usage, that is difficult when it sounds like you aren't getting support from your husband. I have some real screen shots of sleep tests showing all this stuff on my website so he can see that it is in fact very real. I don't have sleep apnea, but I test out masks all the time. I find they make breathing easier. When you exhale there is resistance, but it's something you quickly overcome once you realize you are always in control. Let me know if it comes to that and we can deal with it then.

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kyhrsluvr
Unread post  Post subject: Re: Oral appliance success rate?  |  Posted: Mon Oct 03, 2011 10:13 am
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The report says (which I got only because I work at the hospital affiliated with the sleep center and I got it from the electronic medical record) the OSA was positional - supine AHI - 49 events/hr, side AHI = 14 events/hr. REM in either position is not mentioned. REM latency was 171 mins ( I couldn't get to sleep and was given ambien after about 1 1/2 hrs). Arrousals 24.4/hr, no mention of RDI, total sleep time of 214 mins. No mention of snoring.

Should I take this info to my dr and ask for more info? Or talk with the sleep center director to view a longer? more detailed report?

In the last 24 hrs or so, I've gotten some feedback from friends (one of which is a nurse) about people they know with sleep apnea. They are on cpap and highly recommend it and feel much better. I feel a little better about trying cpap but still undecided if I should try the oral appliance first, if my insurance company authorizes it which may be the determining factor.

By the way, I had previously asked my husband to look at the screen shots although I don't know if he has yet. As of last night he hadn't. He thinks that I may have this but is basically a "normal" part of aging and very common. He also thinks since I was given the ambien, it probably messed with the results to an extent that I was on my back more and thus having more snoring or events perhaps. In any case, I am not going to listen to him and just make my own judgements about it all after I get all the facts and info I need.

Thanks for all your help. It really helps to have a knowledgeable, unbiased person to discuss all this with.


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kyhrsluvr
Unread post  Post subject: Re: Oral appliance success rate?  |  Posted: Mon Oct 03, 2011 10:27 am
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Oh, wanted to mentioned my minimum O2 sat was 87%. That doesn't sound good to me but I don't know how many times it got to that level or how long I was at it.


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TheLankyLefty
Unread post  Post subject: Re: Oral appliance success rate?  |  Posted: Mon Oct 03, 2011 11:17 am
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I like helping people, so no problem. :)

The only reason I would take it to your doctor is if you want to avoid CPAP or are questioning the diagnosis. Just for your own records it is a great idea to get the most detailed report.

Your husband is correct that sleep apnea can be a normal part of aging and it is somewhat common and by estimates, very under-diagnosed. Other things that are a normal part of aging are hypertension, hearing loss, diabetes, bone density loss, heart disease, stroke.....but we treat those right? Sleep apnea is treated as well, but instead of prescription medication, it's treated with prescription upper airway pressure. (just an argument to help your spouse understand better)

An AHI of 14.0 on your side is 1.0 away from being in the mild diagnosed range. It's so hard to say whether or not sleeping on your side would help, but that's cheap and easy to try even tonight to see if it helps. If not, CPAP is fairly comfortable once you find the right mask. Most insurances want you to try CPAP because it is the proven gold standard.

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dbandas
Unread post  Post subject: Re: Oral appliance success rate?  |  Posted: Fri Nov 01, 2013 4:21 am

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I use a TAP device when my nose is stuffed. I did a home sleep test, since that's all my insurance would pay for. The machine malfunctioned and got less than an hour's data. But, based on that, my AHI was 6 and my oxygen was normal.

I consider this good enough for the occasional night when I can't breathe well through my nose, when I travel on short trips, or when I just "can't take" the machine.

Does this seem reasonable? I don't remember my AHI number from my study, but I was at the high end of "moderate."


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TheLankyLefty
Unread post  Post subject: Re: Oral appliance success rate?  |  Posted: Sat Nov 02, 2013 10:27 pm
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dbandas wrote:
Does this seem reasonable? I don't remember my AHI number from my study, but I was at the high end of "moderate."
Statistically if you are in a moderate range with regards to your apnea, an oral appliance would STATISTICALLY not work by their own loosey goosey standards.

I can't really answer "does this seem reasonable". That's one of those questions that you'd be hard pressed to even get a doctor to answer without some data to back it up.

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kyhrsluvr
Unread post  Post subject: Re: Oral appliance success rate?  |  Posted: Tue Nov 05, 2013 6:30 pm
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I've been bad and haven't been on this forum much lately :oops:

FYI.....I've been fitted for an oral appliance and should have it within 2 weeks. The oral surgeon says that once I get used to it they will order a sleep study to see how its working. I'll let everyone know how it goes.


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Lukie
Unread post  Post subject: Re: Oral appliance success rate?  |  Posted: Sat Nov 09, 2013 3:52 pm

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I hope you do well with your oral appliance. Just make sure u keep on top of having regular sleep studies to see if your device adequately controls your apneas. I am 72 years old. In my 50s I was given a dental device because I did not sleep long enough to document apneas. I wore it for a while and it helped. Then I got TMJ pain from pulling my jaw forward . One night with the device on I woke up choking and couldn't breath through my nose and the device was holding my mouth shut with jaw forward. I panicked and ripped it off my teeth and gasped for air.
It happened again and I threw it in the drawer never to use it again. Now after 20 years with no sleep apnea treatment of any kind, I have developed tachycardia/bradycardia related to sleep apnea. I will be fitted with a mask this month. Finally in my old age I am getting the right treatment for me with this awful disease.


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kyhrsluvr
Unread post  Post subject: Re: Oral appliance success rate?  |  Posted: Sat Nov 09, 2013 5:32 pm
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Thanks Lukie for your input.....I will keep all your points in mind. I am aware of the possible problems related to an oral appliance device and I am willing to give it a try. The oral surgeon who is fitting me for the device, insists on a sleep study and makes no promises to how well it will work. He has measured the extra widening of my airway to be about 2 mm, so it's not much but at least it's an improvement. I will post in the future with results.


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kyhrsluvr
Unread post  Post subject: Re: Oral appliance success rate?  |  Posted: Thu Dec 05, 2013 6:47 pm
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Update.....I have been using the oral appliance for about a week now and was having issues with my jaw not wanting to go back into position. I've tried chewing gum, doing jaw stretching exercises and massages but I still wasn't able to chew correctly with my teeth seeming to be offset from each other....side to side, not back to front. Everthing else seemed great. I was able to sleep with it all night and my husband did not notice anything to be concerned with such as snoring, pauses in breathing, etc.
The doctor had told me if anything seemed not right, to call and not wait for my checkup in 2 weeks. So like a good patient, I called and they got me in the same day. I explained what was happening and he adjusted something on the oral appliance. He hopes that will help but if it doesn't, in his words, "it's a deal breaker". He wanted me not to use it for as long as it took to get my jaw back to normal and after just one night, it is. i will use the cpap again tonight though and then try the OAP again. I am to call on Monday to let them know how it's working.
sooooooo......to be continued..................


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TheLankyLefty
Unread post  Post subject: Re: Oral appliance success rate?  |  Posted: Thu Dec 05, 2013 6:54 pm
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I certainly hope that it works for you. Also glad that your jaw went back to normal so quickly. I've seen people have TMJ problems and it's not pretty.

Is there a brand name of the device you're using?

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kyhrsluvr
Unread post  Post subject: Re: Oral appliance success rate?  |  Posted: Thu Dec 05, 2013 7:08 pm
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TheLankyLefty wrote:
I certainly hope that it works for you. Also glad that your jaw went back to normal so quickly. I've seen people have TMJ problems and it's not pretty.

Is there a brand name of the device you're using?


I wasn't told a brand name and I just took a look at the case I have it in and the actual appliance and I don't see any name :? . I know all the particulars of my measurements and jaw molds were sent to somewhere in New York where it was made. I'll try to remember to ask the next time I see the doctor. Have you heard of any particular ones being better than others?


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TheLankyLefty
Unread post  Post subject: Re: Oral appliance success rate?  |  Posted: Thu Dec 05, 2013 7:42 pm
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No, I'm not really familiar with many of them other than the one that sucks your tongue out (feels awful) and the Oasis. Haven't tried that one though, but did speak with the inventor of it at a conference. Seems well thought out, but expensive compared to others....at the time at least.

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kyhrsluvr
Unread post  Post subject: Re: Oral appliance success rate?  |  Posted: Tue Dec 31, 2013 7:43 am
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TheLankyLefty wrote:
Is there a brand name of the device you're using?


Follow-up.....The brand of the oral appliance I am using is called a Herbst appliance.

I've been using this appliance now for a while with another adjustment made by the dr to advance it a little further. All has been working well and had another appointment with the dr who was satisfied how everything was currently and I was sleeping well and not having any more issues. He ordered a sleep study and I was able to get an in-home sleep study done before the end of the year, just last night. This study hardly went any better :( than my first even though I was in my own bed, but with the help of 10 mg of melatonin I was able to fall asleep I think for about 3 hrs. I'll be very curious of the results and will post when I know more.


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kyhrsluvr
Unread post  Post subject: Re: Oral appliance success rate?  |  Posted: Sat Jan 18, 2014 6:51 pm
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I've written a longer post about the results of my sleep study with an oral appliance device, in the subject "use of ambien in a sleep study", but I wanted to get this information on here in case anyone was following this specific topic. I've been using the oral appliance device for a couple of months now and have tolerated it well after an initial adjustment. I then had an in-home sleep study done before the end of the year. I don't have all the details yet but the dr's office called to say the sleep study went well and continue with the OAD as much as I wish. I asked what the actual AHI was and they said it was 3 :o . I hoped for a good number but I didn't expect that good :!: So I will continue with the OAD and perhaps periodically use the cpap.

I just wanted to get this posted in case anyone was considering trying an OAD. It can and does work but it's not for everyone.


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yesman400
Unread post  Post subject: Re: Oral appliance success rate?  |  Posted: Sat Jan 18, 2014 9:37 pm

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I tried an adjustable oral appliance..AHIs were around 18-20, it brought it down depending on the night to 11, sometimes to 6.0 just did not make sense ( using a home sleep test with oral appliance in/out) However, I seem to take shallow breaths in general I have played with the adjustments, did not help... I would wake up after 4 hours of sleep, feel terrific, clear headed amazing...then two hours later completely crash. Even though my AHI's came down, I don't feel it completely solved the problem.. I think there are other factors related to the oral appliance making my results unpredictable.. I wish I would have taken better data though


My dentist thinks we still need to find the right setting but he gives no explanation for my results other than my AHIs are reduced

I went out and bought a resumed auto system one M model...and I also bought the new Z travel CPAP so I am giving this a try.. I also failed with CPAP several years ago - 2007? starting over with A PAP... hence I am on this site


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