Have read some of the other threads and since I didn't see this specific routine, thought I'd run it by you folks.
Basically I'm a cheap so-and-so, and dislike having to pay the going price for the recommended DentaSoak.
I understand the abrasive issues with toothpast as well as the effects of alcohol based solutions , etc.
I have been brushing my herbst with a soft toothbrush dipped in a non-alcoholic mouth wash. Seems to work well, but I wonder; a: is it really getting the job done, and b: even though I rinse it thoroughly in clean water after brushing, will it tend to deteriorate the material over time?
Any input on this, or you own preferred systems greatly appreciated.
p.s.
Mini-Rant time: I struggled for over 6 months trying to adapt to first a CPAP and then a BiPAP device. Worst 6 months of my life sleep and comfort wise. I finally gave up on it and decided to try an oral herbst. The results have been great. I'm getting a good night sleep again.

Why do we get put through the high tech, high expense, highly invasive PAP machines FIRST, and only get introduced to the low cost, low tech, (at least for me) far more comfortable ora devices AFTER the machines have failed???????

I really don't know. The SLEEP APNEA HELP! section of the forum most of the time seems to be the CPAP IS THE ONLY WAY! section. I struggled horribly for 2 years with my CPAP machine. I did not set out to hate it and I was so excited to get it in the beginning. I was never once able to tolerate an entire night with it on. I tried different masks. I tried different machines. I tried wearing it during the day. I tried sucking it up and being miserable while wearing the thing all night and not being able to sleep a wink. I tried loading myself up on benedryl. Nothing ever made it any better. I had never had a problem going to sleep, but the more I tried and failed at CPAP, the more anxiety I had about it when I went to bed.

I now know that I wasted all of that time. The first night I got my oral appliance I fell asleep withing 5 min of wearing it and I slept the entire night. It was a miracle and it was not a fluke. I have not ever had a problem sleeping with it. I feel like a pusher on the main forum because I am always trying to advocate for appliances, but I want to shout from the rooftops that they are not too good to be true. You don't have to miserably tolerate your treatment! I really don't understand why it isn't the first stop for apnea patients that are good candidates (obviously with their effectiveness checked by a follow up study). CPAP is only the gold standard of treatment if you can actually sleep with it and I am scared to think about how many people give up on CPAP without knowing about this alternative.

And another thing... why is my insurance company willing to shell out thousands of dollars for my machine, humidifier and all that goes with it, replace my mask, hose, and filter every 3 months at who knows what cost, pay for $800/month worth of Provigil... but they were not willing to cover the cost of my oral appliance at a whopping one time cost of like $700. They have no problem throwing money down the drain but had no interest in paying for the one thing that worked. It is insane. I am hoping insurance coverage for appliances will get better now that major CPAP manufacturers are playing around with their own versions of dental appliances.

Rant over.

Anyways... as for cleaning. I use Dawn. It cleans it really well (this I know) and my dentist claims that it will not deteriorate the appliance (this I hope is true).

Erin,
I sure appreciate your response. Your experience has been almost word for word the same as mine. I only suffered with the CPAP/BiPAP for 6 months, and I never tried the Benadryl. Otherwise I could have written you letter myself. Strange world, isn't it.
Thanks for your suggestion on using Dawn. I've kept a supply for years as the best thing for cleaning my glasses and I've seen it mentionned for use in cleaning up birds and other wildlife caught up in oil spills.
Sounds good to me. I'll give it a try.
Thanks again,
and Happy New Year!

RCrosby257 wrote:Erin,
I sure appreciate your response. Your experience has been almost word for word the same as mine. I only suffered with the CPAP/BiPAP for 6 months, and I never tried the Benadryl. Otherwise I could have written you letter myself. Strange world, isn't it.
Thanks for your suggestion on using Dawn. I've kept a supply for years as the best thing for cleaning my glasses and I've seen it mentionned for use in cleaning up birds and other wildlife caught up in oil spills.
Sounds good to me. I'll give it a try.
Thanks again,
and Happy New Year!

I am a dentist working in dental sleep medicine. I absolutely agree with you that, for mild to moderate OSA sufferers, many if not most, should be using oral appliances first. Patients prefer OA's over CPAP in a ratio of 10-20 to 1 and the compliance rate is better. The real tragedy is that many patients who have rejected CPAP just drift away from treatment and spend the rest of their lives untreated. I think that there have been two problems. The first is that medical insurance has been paying more readily for CPAP than OA's and the second is that sleep specialists remained unconvinced of the efficacy of OA's or do not have any competent sleep dentists in their area to refer to. Since Medicare now pays for OA's, I think that the insurance problem will gradually go away. I am not so sure about the other, but the future for OA's should improve. People like you will make it so.

I absolutely agree with you that, for mild to moderate OSA sufferers, many if not most, should be using oral appliances first.

Completely at variance with published studies....otherwise OAs would be first line treatment option....which they are not.

Patients prefer OA's over CPAP in a ratio of 10-20 to 1 and the compliance rate is better.

Where on earth did you get that figure from ??

but the future for OA's should improve.

In time, I agree.....but unfortunately clinical guidelines will have to be developed and greater advocacy efforts.

Daniel.

Daniel wrote:

I absolutely agree with you that, for mild to moderate OSA sufferers, many if not most, should be using oral appliances first.

Completely at variance with published studies....otherwise OAs would be first line treatment option....which they are not.

Patients prefer OA's over CPAP in a ratio of 10-20 to 1 and the compliance rate is better.

Where on earth did you get that figure from ??

but the future for OA's should improve.

In time, I agree.....but unfortunately clinical guidelines will have to be developed and greater advocacy efforts.

Daniel.

I guess we need another go round on this one. Let me take some time to line up the information.

Daniel wrote:

I absolutely agree with you that, for mild to moderate OSA sufferers, many if not most, should be using oral appliances first.

Completely at variance with published studies....otherwise OAs would be first line treatment option....which they are not.

Patients prefer OA's over CPAP in a ratio of 10-20 to 1 and the compliance rate is better.

Where on earth did you get that figure from ??

but the future for OA's should improve.

In time, I agree.....but unfortunately clinical guidelines will have to be developed and greater advocacy efforts.

Daniel.

First, let us go back to the Practice Parameters for the Treatment of Snoring and Obstructive Sleep Apnea with Oral Appliances: An Update for 2005. See:www.AASM.org We have discussed these before: Para. 3.3.4 "Patients with severe OSA should have an initial trial of nasal CPAP because greater effectiveness has been shown with this intervention than with the use of oral appliances" We both agree that CPAP is unequivocally the first line treatment for severe sleep apnea. Para. 3.3.3 "Although not as efficacious as CPAP, oral appliances are indicated for use in patients with mild to moderate OSA who prefer OAs to CPAP, or who do not respond to CPAP, are not appropriate candidates for CPAP, or who fail treatment attempts with CPAP or treatment with behavioral measures such as weight loss or sleep position change." Again, I think that we are into the matter of semantics for mild to moderate. Note that the AASM has stated no requirement for an initial trial of CPAP for mild to moderates. They basically make the choice of OAs vs. CPAP a matter of personal choice for mild to moderates. If one places the most emphasis on the greater efficacy of CPAP, one Is justified in calling CPAP the first line treatment for mild to moderate OSA. However, one could also read Para 3.3.3 as basically making CPAP and OAs co-equal choices for treating mild to moderate OSA. I think that one can make a case for calling both CPAP and OAs first line choices for mild to moderate OSA. Within the profession of dental sleep medicine, most dentists will cite both CPAP and OAs as first line choices for treating OSA. If you ask sleep physicians and ENTs, most will state that CPAP is the first line choice for mild to moderate OSA, but a minority of them will now state the CPAP and OAs are co-equal, so the semantics are evolving.

Patients prefer OA's over CPAP in a ratio of 10-20 to 1 and the compliance rate is better.

Where on earth did you get that figure from ?
Daniel.[/quote]
I will cite one study. I have others: From Sleep Review, Medical World Communications, "Oral Appliance Therapy for SDB" Jeffrey P. Pancer,DDS July/August 2003(Note: Jeffrey Pancer is a Diplomate of the AADSM and past president of the American Academy of Dental Sleep Medicine, device tested was TAP3.) "Patients in our study prefer oral appliances to CPAP 20:1; 99 patients preferred oral appliances given the choice,with four patients who had good results with an oral appliance still preferring CPAP and using oral appliances only for travelling."

a.b.luisi,d.m.d. wrote:

Patients prefer OA's over CPAP in a ratio of 10-20 to 1 and the compliance rate is better.

Where on earth did you get that figure from ?
Daniel.

I will cite one study. I have others: From Sleep Review, Medical World Communications, "Oral Appliance Therapy for SDB" Jeffrey P. Pancer,DDS July/August 2003(Note: Jeffrey Pancer is a Diplomate of the AADSM and past president of the American Academy of Dental Sleep Medicine, device tested was TAP3.) "Patients in our study prefer oral appliances to CPAP 20:1; 99 patients preferred oral appliances given the choice,with four patients who had good results with an oral appliance still preferring CPAP and using oral appliances only for travelling."[/quote]

The study that you quote is dated 2003....a little dated. In fact I have been unable to find a link to it on pubmed or similar databases. It is always helpful to quote relative URLs so that members can see the full text/paramaters of the study or abstract.

More updated studies are as follows:

http://www.ncbi.nlm.nih.gov/pubmed/21636666

Efficacy of an adjustable oral appliance and comparison with continuous positive airway pressure for the treatment of obstructive sleep apnea syndrome.
Holley AB, Lettieri CJ, Shah AA. (2011)
Source
Department of Pulmonary/Sleep and Critical Care Medicine, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD 20889, USA. aholley9@gmail.com
Abstract

BACKGROUND:
We sought to establish the efficacy of an adjustable oral appliance (aOA) in the largest patient population studied to date, to our knowledge, and to provide a comparison with continuous positive airway pressure (CPAP).
METHODS:
We conducted a retrospective analysis of patients using an aOA. Results of overnight polysomnography with aOA titration were evaluated and compared with CPAP. Predictors of a successful aOA titration were determined using a multivariate logistic regression model.
RESULTS:
A total of 497 patients were given an aOA during the specified time period. The aOA reduced the mean apnea-hypopnea index (AHI) to 8.4 ± 11.4, and 70.3%, 47.6%, and 41.4% of patients with mild, moderate, and severe disease achieved an AHI < 5, respectively. Patients using an aOA decreased their mean Epworth Sleepiness Score by 2.71 (95% CI, 2.3-3.2; P < .001) at follow-up. CPAP improved the AHI by -3.43 (95% CI, 1.88-4.99; P < .001) when compared with an aOA, but when adjusted for severity of disease, this difference only reached significance for patients with severe disease (-5.88 [95% CI, -8.95 to -2.82; P < .001]). However, 70.1% of all patients achieved an AHI < 5 using CPAP compared with 51.6% for the aOA (P < .001). On multivariate analysis, baseline AHI was a significant predictor of achieving an AHI < 5 on aOA titration, and age showed a trend toward significance.
CONCLUSIONS:
In comparison with past reports, more patients in our study achieved an AHI < 5 using an aOA. The aOA is comparable to CPAP for patients with mild disease, whereas CPAP is superior for patients with moderate to severe disease. A lower AHI was the only predictor of a successful aOA titration.


http://www.ncbi.nlm.nih.gov/pubmed/21239397
Eur J Orthod. 2011 Jun;33(3):318-24. Epub 2011 Jan 13.
A systematic review of the efficacy of oral appliance design in the management of obstructive sleep apnoea.
Ahrens A, McGrath C, Hägg U.


Source

Discipline of Dental Public Health, Faculty of Dentistry, The University of Hong Kong, SAR China.

Abstract

Oral appliances (OAs) are increasingly advocated as a treatment option for obstructive sleep apnoea (OSA). However, it is unclear how their different design features influence treatment efficacy. The aim of this research was to systematically review the evidence on the efficacy of different OAs on polysomnographic indices of OSA. A MeSH and text word search were developed for Medline, Embase, Cinahl, and the Cochrane library. The initial search identified 1475 references, of which 116 related to studies comparing OAs with control appliances. Among those, 14 were randomized controlled trials (RCTs), which formed the basis of this review. The type of OA investigated in these trials was mandibular advancement devices (MADs), which were compared with either inactive appliances (six studies) or other types of MADs with different design features. Compared with inactive appliances, all MADs improved polysomnographic indices, suggesting that mandibular advancement is a crucial design feature of OA therapy for OSA. The evidence shows that there is no one MAD design that most effectively improves polysomnographic indices, but that efficacy depends on a number of factors including severity of OSA, materials and method of fabrication, type of MAD (monobloc/twin block), and the degree of protrusion (sagittal and vertical). These findings highlight the absence of a universal definition of treatment success. Future trials of MAD designs need to be assessed according to agreed success criteria in order to guide clinical practice as to which design of OAs may be the most effective in the treatment of OSA.
http://www.ncbi.nlm.nih.gov/pubmed/19852636

Angle Orthod. 2010 Jan;80(1):30-6.
Five years of sleep apnea treatment with a mandibular advancement device. Side effects and technical complications.
Martínez-Gomis J, Willaert E, Nogues L, Pascual M, Somoza M, Monasterio C.
Source
Department of Prosthodontics, Faculty of Dentistry, University of Barcelona, Campus de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain. jmartinezgomis@ub.edu
Abstract

OBJECTIVE:
To determine the variation in prevalence of temporomandibular disorders (TMD), other side effects, and technical complications during 5 years of sleep apnea treatment with a mandibular advancement device.
MATERIALS AND METHODS:
Forty patients diagnosed with obstructive sleep apnea received an adjustable appliance at 70% of the maximum protrusion. The protrusion was then progressively increased. TMD (diagnosed according to the Research Diagnostic Criteria for TMD), overjet, overbite, occlusal contacts, subjective side effects, and technical complications were recorded before and a mean of 14, 21, and 58 months after treatment and analyzed by the Wilcoxon test (P < .05).
RESULTS:

Fifteen patients still used the oral appliance at the 5-year follow-up, and no significant variation in TMD prevalence was observed. Subjective side effects were common, and a significant reduction was found in overjet, overbite, and in the number of occlusal contacts. Furthermore, the patients made a mean of 2.5 unscheduled dental visits per year and a mean of 0.8 appliance repairs/relines per year by a dental technician. The most frequent unscheduled visits were needed during the first year and were a result of acrylic breakage on the lateral telescopic attachment, poor retention, and other adjustments to improve comfort.

CONCLUSIONS:
Five-year oral appliance treatment does not affect TMD prevalence but is associated with permanent occlusal changes in most sleep apnea patients during the first 2 years. Patients seek several unscheduled visits, mainly because of technical complications.

These studies are all within the past two years. Some of the conclusions are at variance with some of your comments.

I have already mentioned on a number of occassions that Oral Appliances do have a place in treating OSA, primarily in the mild/moderate area....but stating that patients prefer Oral Appliances to CPAP at a rate of 20:1....really !!!
Within the paramaters of the study quoted..maybe...but what were the paramaters ? BUT your figures quoted indicate that from all OSA sufferers there is a 20:1 ratio in favour of Oral Appliances.........if this is the case, why is dental treatment for OSA still in its infancy, with very few (relative to respiratory/ENT sleep specialists) practitioners.

Daniel.

To Daniel: I have to respect your approach to the oral appliance question. You have a healthy skepticism and you do your homework. I think that forum members have an obligation to seek the truth in this matter. It is vital. I could bring in some other articles to countervail some of your points, but instead I am just going to speak to you from the heart to try to give you some sense of how I really see things. Remember, I do this thing every day with real people and real results. You can call what I say anecdotal, but if we were acquaintances, I think you would find me to be a pretty honest person. The big problem is that different dental sleep medicine dentists appear to have wildly varying rates of success. In my area, the sleep physicians tell me that I am the ONLY one who can make the darn things work with any consistency. I am not proud of this. And I am not superman. I know top dental sleep specialists who absolutely can do much better than the figures you quote. I know others who couldn't come close to achieving the numbers you quote. I know that mine work well. I have check PSG's on the patients to prove it. So it has to be possible. I think that the problem is that you can't go to grad school and get a good two year course in this at this point. You have to piece your knowledge together from many fragmented sources. A few dentists HAVE been able to find a way to do this well. Admittedly, not that many. But I do insist that it is possible, even at this early stage of knowledge. I do have to agree with this wider point, however, that there are not nearly enough competent sleep dentists to make it nationally viable at this time. Can I tell lay people on the forum that, yes, you can get effective OA treatment anywhere in the country with ease. No, I can not. In fact, the odds are probably pretty much against it. Never-the-less, I am not going to say that it can't be done when it can. That would not be honest. Also understand that when I say that an OA is successful, what I mean that it can ultimately be made successful. A portion of mine do initially fail, but ultimately succeed after an ENT surgeon on my team does some minor procedures on the patient's nasal passages. From the patient's point of view this is a success, although it would be scored as a failure at a clinical trial. I am here to make the patient better, not pass the test.

Another thing that I would like to address is the continuing concern about oral appliances causing tooth movement. Yes it does. Maybe in almost every case. BUT IT IS MINOR. A matter of a few millimeters here and there. The patients almost never notice it and I can just about pick it up if I look very hard under magnification.In not one patient in which I have placed an OA since 2007 has it become a significant problem. It comes down to a matter of priority. Given the serious health issues caused by OSA, this tooth movement is of far less import. And let's put it into perspective. I have a list of the side effects of CPAP. The list runs to two pages. Some of the problems are pretty bad. When people talk about OA's, they mention tooth movement and TMJ's because they have to say something, but it is really pretty small stuff. Also, the tooth movement also comes down to correct patient selection. Patients must have strong teeth and solid bone support. If you have periodontal disease, you will get serious tooth movement, but you should not be getting an OA.

To Dr. Luisi.

5 years ago I might have been described as slightly negative on Oral Appliances.
4 years ago I was looking positively at Oral Appliances as a CPAP back up device to use while camping or long haul travel.
3 years ago I began to see that there may well be a future in Oral Appliances in treating OSA......BUT was unconvinced with some of the practitioners.

Since then I have opened my mind and opinions to the whole concept.
I am in fairly regular contact with a practitioner (here in Ireland), with whom I am very impressed......because of his attitude, his patient care and his willingness to accept defeat (in the odd case) and his willingness to work with Respiuratory Sleep Physicians. The way the market is at present, he will never make a fortune fitting Oral Appliances, he does well with snoring (cures) and oralfacial pain management.

As a recognised patient advocate I feel a big duty to the weakest link in the chain (the least informed and frightened patient), so I am more sceptical than most on anything that is new (CPAP since about 1985, Oral Apliances since about mid 1990's) and I need convincing. I receive about 15/20 phone calls per week and about 20 emails.....all to do with Sleep Apnoea and treatment options...problems with treatment etc. While the CPAP companies produce loads of reports, upgraded devices and the like.........the Oral Device manufacturers seem to sit on the fence and don't seem interested in promoting their devices. They will have to improve in this area and take a leaf from ResMed and Philips....while on this subject, ResMed have recently (within the last 24 months) taken over an Oral Appliance manufacturer.....they are going to get into this market....realistically there has to be something positive in this.

Only yesterday I received a full pack from Somnowell (in fact the full manufacturers guidelines to practitioners).....I attended a presentation of their custom built device a few months back (cobalt construction). I was very impressed with the compact design and rugged/tough construction.......We need more of this type of thing.
In October last I commented positively on the new ResMed device (Oral Appliance) on national TV.

My big problem with all of this is that the manufacturers are not promoting their devices with realistic clinical studies. It is being left up to individual practitioners, and there is a perception that the eveil $$$ rules.
The homeopathic cure brigade put more resources into promoting a 'cure' for OSA than the Oral Appliance manufacturers.
A prime example.....European Respiratory Society, Annual Conference 2010 in Barcelona and 2011 in Amsterdam....only one Oral Appliance manufacturer present....ResMed......all the major CPAP manufacturers wrere there.

I have absolutely no doubt that your heart is in the right place, you believe in the product that you fit/construct and you follow up with your patients.......If I didn't, you would have been blown out of this forum (there have been a few before you who tried to use the forum as a sales pitch). Your opinions are valued, but we also demand high standards from you because of your professional status.

We are effectively coming off 'the same hymn sheet'......BUT it has to be convincing and backed up.

I enjoy your posts, and gain knowledge from them......BUT I am a Sleep Apnoea sufferer first, a patient advocate closely second and will always look to give as much protection to the patient as possible.

Keep posting.

Daniel.

Daniel wrote:To Dr. Luisi.

5 years ago I might have been described as slightly negative on Oral Appliances.
4 years ago I was looking positively at Oral Appliances as a CPAP back up device to use while camping or long haul travel.
3 years ago I began to see that there may well be a future in Oral Appliances in treating OSA......BUT was unconvinced with some of the practitioners.

Since then I have opened my mind and opinions to the whole concept.
I am in fairly regular contact with a practitioner (here in Ireland), with whom I am very impressed......because of his attitude, his patient care and his willingness to accept defeat (in the odd case) and his willingness to work with Respiuratory Sleep Physicians. The way the market is at present, he will never make a fortune fitting Oral Appliances, he does well with snoring (cures) and oralfacial pain management.

As a recognised patient advocate I feel a big duty to the weakest link in the chain (the least informed and frightened patient), so I am more sceptical than most on anything that is new (CPAP since about 1985, Oral Apliances since about mid 1990's) and I need convincing. I receive about 15/20 phone calls per week and about 20 emails.....all to do with Sleep Apnoea and treatment options...problems with treatment etc. While the CPAP companies produce loads of reports, upgraded devices and the like.........the Oral Device manufacturers seem to sit on the fence and don't seem interested in promoting their devices. They will have to improve in this area and take a leaf from ResMed and Philips....while on this subject, ResMed have recently (within the last 24 months) taken over an Oral Appliance manufacturer.....they are going to get into this market....realistically there has to be something positive in this.

Only yesterday I received a full pack from Somnowell (in fact the full manufacturers guidelines to practitioners).....I attended a presentation of their custom built device a few months back (cobalt construction). I was very impressed with the compact design and rugged/tough construction.......We need more of this type of thing.
In October last I commented positively on the new ResMed device (Oral Appliance) on national TV.

My big problem with all of this is that the manufacturers are not promoting their devices with realistic clinical studies. It is being left up to individual practitioners, and there is a perception that the eveil $$$ rules.
The homeopathic cure brigade put more resources into promoting a 'cure' for OSA than the Oral Appliance manufacturers.
A prime example.....European Respiratory Society, Annual Conference 2010 in Barcelona and 2011 in Amsterdam....only one Oral Appliance manufacturer present....ResMed......all the major CPAP manufacturers wrere there.

I have absolutely no doubt that your heart is in the right place, you believe in the product that you fit/construct and you follow up with your patients.......If I didn't, you would have been blown out of this forum (there have been a few before you who tried to use the forum as a sales pitch). Your opinions are valued, but we also demand high standards from you because of your professional status.

We are effectively coming off 'the same hymn sheet'......BUT it has to be convincing and backed up.

I enjoy your posts, and gain knowledge from them......BUT I am a Sleep Apnoea sufferer first, a patient advocate closely second and will always look to give as much protection to the patient as possible.

Keep posting.

Daniel.

I really think that, fundamentally, we are on the same page. When I first saw this forum, I was completely over-whelmed by the level of compassion shown to strangers and the incredibly good information that was being delivered to people in need. I am a human being first and a doctor second. I really believe in what is being done here and that is why I have devoted so much time to it, is spite of being very busy. I actually enjoy the fact that my statements are challenged and not accepted uncritically. I have been made to think about some of my assumptions and to change them from time to time. This is good. You have a duty to protect the patients and I respect you for doing it well.

Daniel:

I was not sure whether I wanted to get into any type of disagreement with you, but exchanging ideas/opinions is part of this. You can, as the expression goes, argue "Until you are blue in the face," about why you feel the CPAP is better than oral appliances, but to myself & most who post on oral applicances, your arguments will fall on deaf ears. Go ahead & cite your facts, figures & studies, but myself & the OA users will almost certainly place more credibility on Dr. Luisi's views than yours. You cannot deny a couple of facts, though: the OA compliance rate is much higher than the CPAP compliance rate and with oral appliances, air is not being forced into your lungs like it is with CPAP.

Now on a lighter note: if you followed LSU football, I would invite you to post on [Moderated. Please refer to posting guidelines] That is where I post far more than this forum--perhaps my priorities are not properly set. But there is far more name calling & vigorous arguing there.

You cannot deny a couple of facts, though: the OA compliance rate is much higher than the CPAP compliance rate and with oral appliances, air is not being forced into your lungs like it is with CPAP.

Can you post evidence to back this statement up ? Not heresay, BUT peer reviewed studies ? They should also show efficacy levels and compliance for 5 years and longer.
I have looked, I have spoken to three dental sleep medicine practitioners (only last week end)......but I can't find any such studies.
Maybe they are there.....but I can't find them.

Now on a lighter note: if you followed LSU football, I would invite you to post on [Moderated. Please refer to posting guidelines] That is where I post far more than this forum--perhaps my priorities are not properly set. But there is far more name calling & vigorous arguing there.

What does one achieve by name calling ?
I used to participate (infrequently) in a forum for my local soccer club. Gave it up as it got way too abusive.

Daniel.