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TheLankyLefty
Unread post  Post subject: Split Oral Appliance Study  |  Posted: Fri Dec 16, 2011 11:45 am
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Just scored a sleep study where the patient had a baseline RDI of 22.6. AHI was negligible. She was in the supine position for the entire recording and did not worsen from NREM to REM. (basically all REM specific and positional components were accounted for)

Her RDI decreased to 9.8 with the use of her Oral Appliance.

The appliance was a Mandibular Advancement style. Just found this interesting. I'd really like for one of these studies to come through with a patient in the moderate severity range.

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kyhrsluvr
Unread post  Post subject: Re: Split Oral Appliance Study  |  Posted: Fri Dec 16, 2011 5:19 pm
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Interesting Jason. Curious, was this her very first time trying out the oral appliance? How did she tolerate it? Was it comfortable for her? Can you tell me how old she was and if her RDI was due to a narrowed airway or did she have other risk factors?

Still, 9.8 is nothing like the <1 AHI I'm currently getting on cpap....sigh....


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TheLankyLefty
Unread post  Post subject: Re: Split Oral Appliance Study  |  Posted: Fri Dec 16, 2011 5:46 pm
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No, she reported using it for the past three months. She received it from her dentist and used it for some period of time. Then her sleep doc wanted to see if it made a difference in her sleep consolidation.

It was unfortunate. The order was for baseline, then oral appliance, then CPAP. She refused the CPAP segment. The obstruction was deemed to from a recessed jaw causing the tongue to obstruct the airway. It seems to be at least part of the problem since there was significant improvement in the numbers.

She was mid 40's, and I don't recall other risk factors.

Your AHI is tough to beat. How have you been feeling with it lately?

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kyhrsluvr
Unread post  Post subject: Re: Split Oral Appliance Study  |  Posted: Fri Dec 16, 2011 6:11 pm
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I had been feeling increasingly better....more energy, less tired and even greatly diminished hip joint pain which my dr said could be aggravated by the less than restful sleep I had been getting. This week though, starting on sunday, a bit more tired again and more joint pain. I've been trying to jog again a little bit so maybe the cause of the pain. Maybe I do have some arthritis due to previous car accident and having a bad fall from a horse. Doesn't explain the slightly more tired feeling. Not bad today. I'm going to check my sd card this weekend to see if I may have some increasing leaks but everything looks good on my nightly details. I do have a previously scheduled appt next week with my sleep doc. we'll see how things go until then :)


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dbandas
Unread post  Post subject: Re: Split Oral Appliance Study  |  Posted: Sat Feb 09, 2013 6:31 am

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I have a Thornton device. The dentist recommended by my sleep doctor wouldn't fit me at first. He said to try the CPAP for a while and just get used to the idea. Maybe he was tricking me into having a CPAP and using the oral appliance as a backup. At any rate, I found it useful. I can still snore on my back, but I don't sleep that way often. The sleep doctor gave me a finger monitor to wear for a few nights to just check oxygen levels and they were stellar. I find that I feel about 10% better with CPAP, but this device is excellent for travel when I'm only away for a short time and don't want to carry the machine. I have moderate sleep apnea. I'm trying to use a Resmed Quattro as backup to my Swift fx (which is the best, ever) for when my nose is stuffy. This is an alternative as well.


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TheLankyLefty
Unread post  Post subject: Re: Split Oral Appliance Study  |  Posted: Sat Feb 09, 2013 11:23 am
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Yeah....the TAP.

There is a dentist in my area that runs tons of split and TAP titration studies. It does work pretty well if tongue and jaw sliding back is the problem and you're in the mild range. It also takes very little time to adjust. Pretty cool device.

For many who still need CPAP, they can use it with the TAP and will require less CPAP pressure. Have you ever used them concurrently?

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dbandas
Unread post  Post subject: Re: Split Oral Appliance Study  |  Posted: Sat Feb 09, 2013 2:07 pm

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No, nor have I work sack-cloth and crossed the dessert on my knees. :lol:

I don't believe I'd like to rely upon it exclusively, but as a stuffy nose/few days of travel backup, it works just fine. I have a friend who was relying upon one, but then discovered in a sleep study it wasn't doing the job.


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TheLankyLefty
Unread post  Post subject: Re: Split Oral Appliance Study  |  Posted: Sun Feb 10, 2013 3:25 am
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dbandas wrote:
No, nor have I work sack-cloth and crossed the dessert on my knees.
Now there is a line I had to look up! :) True, they only work for a few people.

Just out of curiosity, what is the cost of one. + or - $300?

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dbandas
Unread post  Post subject: Re: Split Oral Appliance Study  |  Posted: Tue Feb 12, 2013 6:56 am

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This may get posted twice. The cost was about $800.


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TheLankyLefty
Unread post  Post subject: Re: Split Oral Appliance Study  |  Posted: Tue Feb 12, 2013 9:38 am
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WOW! :shock:

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kyhrsluvr
Unread post  Post subject: Re: Split Oral Appliance Study  |  Posted: Tue Feb 12, 2013 7:52 pm
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Any idea if insurance covers it if a dr approves it?


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TheLankyLefty
Unread post  Post subject: Re: Split Oral Appliance Study  |  Posted: Tue Feb 12, 2013 8:18 pm
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I almost don't want to comment because I don't know, but I think a dentist has to be the one to order one. Then since the dentist is pretty much always out of network for medical insurance, the dentist can charge whatever they want.

I'd love to be educated on this subject though.

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dbandas
Unread post  Post subject: Re: Split Oral Appliance Study  |  Posted: Mon Dec 30, 2013 7:27 pm

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UPDATE: After the new veneers occasionally popping off because of the Tap Pap nasal pillow device and my old Thornton device not fitting the new smile, I had a consultation with Dr. Martin Denbar here in Austin.

If it were a personality contest and not a medical appointment, I'm afraid it might have been a failure. OMG. But, he is an apnea dental specialist with a lot of work to his credit and definitely is dedicated and really knows his stuff. He uses a Thornton-looking device and tries to remedy the apnea, then adds CPAP if necessary at a much lower pressure. You can google his name in Austin, or go to austinapnea.com to read about it. I believe it's the combo you mention above.

I'm pretty happy with my Swift fx, but I really need a dental appliance for short travel and for stuffy nose nights. This guy works with the sleep doctor and it will get billed through my insurance somehow.

I had a partial study done with the Thornton before all of this and I believe my events were down to 6 per hour. A very limited study as the machine malfunctioned.

I'll keep you posted. I plan on going in ASAP after the first and getting the ball rolling on it.


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TheLankyLefty
Unread post  Post subject: Re: Split Oral Appliance Study  |  Posted: Mon Dec 30, 2013 11:25 pm
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dbandas wrote:
If it were a personality contest and not a medical appointment, I'm afraid it might have been a failure. OMG.
:lol:

I didn't know that you were from Austin. I've heard that is an awesome place to live. Working on convincing my wife....but that's another story. :?

dbandas wrote:
I had a partial study done with the Thornton before all of this and I believe my events were down to 6 per hour. A very limited study as the machine malfunctioned.
Are you planning on have another study done? That's a pretty cool set up you've got there.

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dbandas
Unread post  Post subject: Re: Split Oral Appliance Study  |  Posted: Tue Dec 31, 2013 6:30 am

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Yes. My Thornton is shelved since so much changed after a lot of dental work. So, after the 1st, I'm going to see this guy and get a new one made from the ground up. He works closely with the sleep doctor, so after the dental appliance is made, there will be a test to see how it's working. He tries to completely correct the apnea with the dental device, only adding cpap if necessary. I'm not really in it to completely replace my cpap, though. Just need an alternative for stuffy nose nights. That's actually the dentist in the photo. It's what he uses.


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dbandas
Unread post  Post subject: Re: Split Oral Appliance Study  |  Posted: Sat Jan 18, 2014 5:27 am

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Update: I may possibly have all of my teeth secure again (omg, I feel old wiritin that) and have an appointment for my first impression to build the mouth guard. They have submitted to my insurance company, Humana, for approval already and have received approval. I think non-compliance with regular CPAP therapy is one of the criteria.

This is not really my case. I'm fine with my CPAP therapy, but I just need an alternative for travel and stuffy nose nights. I did very well with the Swift fx and have now graduated to the Aloha, which is about 1% better, IMHO.

It's interesting since I had a little surgery the other day on my eyes and was sleeping a little lightly on pain meds, that I could hear myself snore a tiny bit with the Aloha. Not on the inhale, but some kind of noise on the exhale, so I've gotten the boxer's bite guard thing out again to give it a try.

My life before and after oxygen during my sleep is so different, I'll go to any lengths. I feel fortunate to have something that works.


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