Red light goes on top, if memory serves, but my sleep assistant always goes over the directions with patients, so I could be wrong. The PAT sensor stands for peripheral arterial tone, and it measures, through their own algorythm, the respirations (in lieu of the nasal cannula) to figure your AHI and RDI. It also contains an actigraph that tells when you are awake, in REM sleep or in NREM sleep.

BTW, if you have no pain and can get your jaw back in position in 5 minutes, if the numbers come back at more than 5 AHI, get that baby moved forward some more!


_________________
Kent Smith DDS

libarsh wrote:

melhajj

First of all, thre is no "cure" as yet for sleep apnea.
Dr. Barsh

I would think a MMA is "usually" a cure.

Just as glasses are not a "cure" for poor sight and a wheelchair is not a "cure" for the lame, MMAs are but a crutch. When you wear it, it opens the airway. When you stop, the airway closes again. A "cure" is something completely different.


_________________
Kent Smith DDS

I am following this lead with interest as i am the Vice President of Itamar, the company that manufactures the Watch-PAT. Dr. Smith, thanks for your input. Crossing the wires should not have any affect on your results, but i have just put the WP on my rigt hand and did not need to cross the wires. I am more worried about your first test when the red light went on (pls ask your dentist to give me a call and we will try to find out why). Otherwise, i am pleased that you found the test easy (even with a hairy chest).

If you need any help, pls dont hesistate in contacting me.

Regards

Gary J. Sagiv

The MMA I was referring to is a surgery to extents the lower and upper jaw out (usually around 10mm).  I've read a bunch of research papers on it, and they report its success rate is 95%.  So its not like glasses or crutches.  It has a long recovery though.

Currently I'm using a CPAP.  I'm about to get a SomnoDent oral appliance.   My CPAP only seems to get my AHI down to around 10 at best.  And increasing the pressure doesn't seem to change it much if at all.   My plan is to use the OA with the CPAP.  I'm hopefully the OA will open things up a bit so the CPAP on conquer it.  It would be great it OA conquered by itself too, but I'm don't want to get overly optimistic about that.

I've read that OA's are more effective on individuals who are less over weight.  I'm a tad overweight, but not significantly. (5'10", 190 lbs).  So I hope the OA will be very effective.

I gather that sleep apnea in the less overweight among us is due to structure, not fat.  And the CPAP is less effective there.  But the OA is altering the structure (temporarily).

John

I'm sorry, John, and yes, MMA (the surgery, when done for OSA is now termed telegnathic surgery, pioneered by Dr. Kent Moore) is about 95% successful. You do need 10 to 15 mms to get the same result in tongue movement that you would get with an OA. With the OA, you get an increase in baseline activity within the genioglossus (tongue muscle), so the tongue moves forward on it's own in addition to being physically brought forward with the OA. With surgery, this activity is not there, so you need more advancement with surgery to compensate.

I agree also that you sound like a better candidate for an OA since your BMI is only 27.3 Your father probably has an airway issue as well, as this would be a genetic component. With combination therapy (OA plus CPAP), you should do well. You might also consider a SomnoDent with an attachment for the CPAP Pro, but only if you are OK with nasal pillows.

Keep us posted on your progress, John!


_________________
Kent Smith DDS

Its funny that you should mention my father.  I'm quite sure he has sleep apnea, but there's no telling him that.

I'm also sure its leading to other issues, but he can't see the connection.  Its actually more sad, then funny.

I get molded for the OA on Friday.  I expect to have the device 3 weeks later.  I'll let you know how it goes.

John

gjs1964 wrote:

I am following this lead with interest as i am the Vice President of Itamar, the company that manufactures the Watch-PAT. Dr. Smith, thanks for your input. Crossing the wires should not have any affect on your results, but i have just put the WP on my rigt hand and did not need to cross the wires. I am more worried about your first test when the red light went on (pls ask your dentist to give me a call and we will try to find out why). Otherwise, i am pleased that you found the test easy (even with a hairy chest).

If you need any help, pls dont hesistate in contacting me.

Regards

Gary J. Sagiv

Gary-
When I put the Watch PAT on top of my wrist I had to cross the wires to put the PAT on the index finger and the o2 sensor on the ring finger.  The first night the red light went on when I tried to activate the unit I called Itamar telephone support and was told that there was nothing they could do over the phone that my only choice was to return the unit and obtain another one.
I will find out tomorrow the results of my study as I have been out of the country since I took the test and will meet with my doctor tomorrow.

I got my results and was somewhat surprised.  I always felt while using the Somnodent device that that my apnea had improved somewhat.  I know that a total cure without surgical intervention is not possible.  I am pleased with the results but feel I can improve on them as I still experience no pain in the jaw or teeth.  I am continuing the adjustments and will have another sleep study done.  Here are the comparison numbers:
BEFORE                                                                                  AFTER
pRDI--49.4                    pRDI--33.2
pAHI--47.9                        pAHI—28.9
ODI—27.9                        ODI—21.7

O2 Mean%--91                    O2Mean%--91    
O2Minimum—75                    O2Minimum—76
O2Max%--98                    O2Max%--98
MeanNadirs—87                    Mean Nadirs—87

Oxygen Desaturation %
O2 Events: 4 – 9= 128                  4– 9= 73
     10 – 20= 28                10– 20= 23
                   >20 =0                    >20 = 0
Total Events=156                    Total Events=96

PULSE RATE
Mean= 77                        Mean= 61
Minimum = 50                    Minimum= 43
Max = 107                        Max = 95

STUDY TIME = 7HR 36 min                              6HR 43 min
Sleep time  = 5HR 35 min                              4 HR 25 min

%REM of Sleep time= 18.5                %Rem of Sleep time=26.9

Ooh...I missed it. I guessed your AHI would be 27 after 3.5 mms of advancement (see my post from June 10). I'll work on my predictions. As I said before, time to advance!


_________________
Kent Smith DDS

Am I correct in assuming that the second test was done with an oral appliance? If it was, your appliance was far from titrated properly. Your Watch-PAT results do not show a good result but, your REM sleep did improve. Your desats are not good as you are in the 70's.

Pls contact me offline at sgary@itamar-medical.com so that i can give you some advice.

Good luck.


_________________
Gary J. Sagiv
Vice President
Itamar Medical Inc
sgary@itamar-medical.com

gjs1964 wrote:

Am I correct in assuming that the second test was done with an oral appliance? If it was, your appliance was far from titrated properly. Your Watch-PAT results do not show a good result but, your REM sleep did improve. Your desats are not good as you are in the 70's.

Pls contact me offline at sgary@itamar-medical.com so that i can give you some advice.

Good luck.

Gary,
Yes, the study was done with a Somnodent MAS that has been adjusted out from the "starting point" a total of 3.5 mm.  My snoring is reduced and I feel better than I have for the last 20 years since I was first diagnosed with OSA.  I believe that I can move forward at least 1 more mm in adjustment.  My dentist was apprehensive the last time about moving more than .5 mm forward.  I also am in a major push to lose weight as I know this will affect the airway collapse.  (twenty-two pounds so far).  I am still looking for that " sweet spot" in the adjustments that will provide me the most benefit from my device. Look for my email I sent this morning.  Any and all advice from those with day to day expertise in titrating dental devices is greatly appreciated.

To the experts that monitor this forum:
I went and had another forward adjustment.  I am now at 4.5 mm.  I have talked with an executive of Somnomed and was told that the Somnodent might become unstable at more than 5.5 mm of adjustment.  I am to meet again with my dentist to have a silicone device made that will open my nostrils during sleep and have another adjustment.  I guess they work like sinus cones to open the nostrils.  Is it normal to have some sinus drainage all the time?  I have noticed this especially after meals.  Never thought much about it as I guess I got used to the drainage happening.  Is it possible that I am unable to improve on my 28.9 AHI even with further adjustment?  I still experience no jaw pain and my jaw returns with no more than 20 minutes of excercise on bite tabs.  It does take a little longer now but still returns.  I have noticed that my jaw muscles are sore after driving home from work ( 90 min drive 119 miles).  My dentist says this from clenching my teeth from stress.  I have purchased and now wear an Aqualizer when I drive.  WOW this has worked wonders on my jaw muscles and neck tension.  I really believe that I am going to get maximum positive results when I reach the end of my adjustment phase.

papahemi

There are many reasons why your AHI will/cannot decrease and you cannot blame the oral appliance. I suggest that you get your endothelial function tested as this is a very important cardiovascular marker for other problems. There was a great study by Prof. Giora Pillar and Glen Clark that shows that in many cases if the AHI does not improve, the EF does and that is good. Ask your dentist to contact me and i will send her a copy of the study. I am pleased that you are using the Somnomed as, in my opinion, its the best on the market.


_________________
Gary J. Sagiv
Vice President
Itamar Medical Inc
sgary@itamar-medical.com

I got my SomnoMed appliance today.  I'll report back soon with how well it works.

I plan to use it with my cpap, and my cpap reports events, so I'll be able to see how well it works!

John