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Travis Bickle
Unread post  Post subject: My OAT Journey/Saga  |  Posted: Thu Nov 12, 2015 11:48 am
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OK - so the first part of my saga is posted in this thread in the "Sleep Study" folders:

http://www.freecpapadvice.com/forum/viewtopic.php?f=15&t=1592

Since my mild sleep apnea story has now evolved into an inital attempt at OAT, I figured this forum may be the best place to continue the story.

Here's the cliff notes on what's in the other thread:

- Had home sleep study which showed mild apnea (AHI 9.7)
- There was some indication of positional supine snoring - i.e. snoring more when laying on my back.
- Talked to sleep doc and he said Oral Appliance may work for me.
- Also am trying "Slumberbump" pillow you wear on your back that keeps you sleeping on your side.
- Talked to insurance and started getting run around but finally met with an "in network" oral surgeon. He scheduled me to get jaw x-rays in 1st week in December to confirm that OAT will work for me, and then he will fit me after that and I will get appliance in 4-5 weeks.


Here's the latest update:

So - I am now ALSO working with my regular dentist on an oral apppliance while I wait for the December x-rays with the oral surgeon. I will cancel the x-rays if my regular dentist makes progress before then.

Basically, my regular dentist is a young guy just a few years into starting his own practice, and he is trying to add OAT services with two inital patients - me and another guy.

Good thing is that he will definitely be attentive to my needs and has also offered to have his office staff handle all the insurance communications to help me ensure that it'll be covered before I commit. Apparently, they are contracting with some third party that specializes in getting OAT covered by insurance companies. (This is very much different from the other dentists and the oral surgeon I talked to, who would not commit to handling the insurance aspects and say that I need to pay up front and then seek reimbursement. This is very frustrating in that my insurance (Aetna) states clearly that OAT is covered for AHI between 5 and 15 along with report of daytime sleepiness/insomnia. (some light reading: http://www.aetna.com/cpb/medical/data/1_99/0004.html)


Also - as it regards the old Slumberbump I believe that is working well for me. My wife is still being driven out of the room by my snoring routinely - so I obviously still snore on my side - but I do seem to sleep a little better and feel more refreshed and less cranky/miserable in the middle of the day. I've been using it for about 3 weeks now. About once every 3-4 nights, I will awake to find myself on my back with the pillow having rotated around to my side, but usually it works well.



Question for Lefty: Do you think there's a chance that using the bump I am training myself to be a side sleeper exclusively?


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TheLankyLefty
Unread post  Post subject: Re: My OAT Journey/Saga  |  Posted: Thu Nov 12, 2015 1:46 pm
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Travis Bickle wrote:
Question for Lefty: Do you think there's a chance that using the bump I am training myself to be a side sleeper exclusively?
I don't know the answer to that. It's a good question. My thought is that you're going to wind up in the position that is most comfortable to you. The "bump" may be retraining, but there's really only one way to know for sure....that's not using the bump and seeing if you end up on your back.

I can relate to the insurance side of things on a separate note with my home sleep testing business. I offered to do the billing etc for a few patients and still regret it. The time it takes FAR exceeds the time it takes to actually perform the service. I would personally rather focus my time on providing a great service for the patient. The insurance is something between the patient and the company, I have no desire to ever be that middle man again. I have no problem providing documentation that's needed, but calling for authorizations, getting it, then being put in a holding pattern for checking medical necessity after point of service and have that scrutinized when there is an MD order stating the need for a test......but that's apparently not always enough. :x Insurance is of the devil.

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Travis Bickle
Unread post  Post subject: Re: My OAT Journey/Saga - OCTOBER 2016 UPDATE - RESULTS ARE   |  Posted: Thu Oct 20, 2016 12:44 pm
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Hi all -

Been a while since I was on, but I just got my new sleep study results in and figured I should give an update in case anyone is cruising this forum and facing decisions like I did.

To summarize the story so far:

I was diagnosed last year with mild sleep apnea with an AHI/RDI of 9.7 (link to post that showed study above).

Since it was mild, I lobbied for, and eventually successfully was prescribed, an oral appliance. the one I received was the TAP device. It took some arguing with the healthcare provider to get them to pay for it, but they eventually did pay as long as it was an in-network oral surgeon who did it. My regular dentist could not get his foot in the door with Aetna.

Image

It was pretty easy to get used to, with the worst side effect being drooling like crazy at first. In the morning, when you take your first bite of breakfast your bite will feel off, but it finds it's way back to normal by the time you are at your fourth or fifth bite. I do not have any mouth or jaw discomfort after ~8 months of use.

The results were good - my wife reports that I don't snore barely at all anymore, and she is able to sleep through what noise i do make.

A couple of months ago I met with my primary care doc and he had me do another sleep study to compare results. Below are scans of the report that I'm hoping Lanky will give me his thoughts on.

The study says I still have mild OSA, but that the average AHI/RDI across the three nights was 4.0 with a range of 2.9 - 5.7. So - the device has improved my situation pretty dramatically, and yet the diagnosis is still mild OSA with a recommendation for CPAP. :roll:

I talked to my doc and told him that I will see if the dentist who fitted me for the appliance can make adjustments, but I do not believe he can because I already have it in the max advancement position.

I'm also thnking about putting back on the back pillow that I used to wear before I got the oral appliance because in my first study the OSA appeared positional. Unfortunately, this latest study from Novasom does not show my position. Also (need Lefty's help interpreting here) it looks to me like the increase in snoring levels are at the same times as the hypopnea and OSA events and come in clusters, so I'm thinking again that these might be times I rolled onto my back.

Outside of sleeping hours, I still get occasional sleepiness, but not nearly as many headaches as I used to get.

Any thoughts are appreciated.

Image Image Image Image Image


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jb.sing
Unread post  Post subject: Re: My OAT Journey/Saga  |  Posted: Thu Oct 20, 2016 1:40 pm

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I think the research on oral appliances indicates exactly what you are experiencing, a reduction in episodes, to about 50% . Thats what I believe i read, but could be wrong. As far as sleeping positions, it is possible to adjust and learn a new position. But I think it would be better to find ways to make side sleeping more comfortable, rather than making back sleeping uncomfortable. A sleep tech suggested to me perhaps using a soft body pillow to hug.


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TheLankyLefty
Unread post  Post subject: Re: My OAT Journey/Saga  |  Posted: Fri Oct 21, 2016 10:46 pm
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jb.sing wrote:
I think the research on oral appliances indicates exactly what you are experiencing, a reduction in episodes, to about 50% .

Success for oral appliances is a decrease in the AHI by 50%. Doesn't even take into account RERAs.
It is statistically successful in mild sleep apnea (5-15 AHI) 74% of the time. This decreases greatly in moderate to severe apnea. 20% from memory.

I was just thinking about this the other day. I was working on an OAT study where we did a baseline with and OAT and then CPAP. With the OAT was back to back OSA. OAT came out and CPAP one. The difference was so dramatic as sleep with CPAP was great. The patient's perception was that sleep was very poor with CPAP. Clinically the opposite was true.

Really, this patient shouldn't have even had an OAT made since they were in the severe range.

Sorry for the aside Travis. It kind of relates in that I don't see RERAs reflected in your report (as those are Type 3 tests).

Travis Bickle wrote:
Unfortunately, this latest study from Novasom does not show my position. Also (need Lefty's help interpreting here) it looks to me like the increase in snoring levels are at the same times as the hypopnea and OSA events and come in clusters, so I'm thinking again that these might be times I rolled onto my back.

Could be position or it could be REM sleep. When OSA is intermittent like that it is always one of the two. From your report I would guess it's REM just because of the timing.

Be careful advancing your jaw forward too much. TMJ problems are serious.

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