Sleepy PSGT wrote:jwpegram: do you use PAP with your appliance or are you feeling better even with an AHI of 14?
I think one of the biggest advantage to oral appliance is being able to reduce PAP pressures for those who can not tolerate higher pressures.
And I will say this agian, not all apnic patients are the same, an oral appliance may work wonders for some but not at all or very little for others.
I always tell my patients to study up on all available treatments before spending the money out of pocket. If PAP is tolerated, your ins company will cover it more often then not, then give it a shot and realy try for 3 months. The #1 problem with PAP is comfort and patient compliance. I have seen many try it for a week then give up and want another treatment. It actualy took me 3 weeks to get to the point that I could use my PAP through out the entire night with out ripping it off my face in my sleep lol.
No I don't use the PAP at all. I will say I gave it almost 6 months, multiple masks, multiple machines and tried every pill on the market to sleep, the problem was either I could never go to sleep or I'd go to sleep but wake up with it off after recording only an hour or so. After a while I was feeling so bad, "sticking with it" just wasn't an option for me so we tried the OA. I could tell an immediate difference. Would I have dropped the $2500 for it had the machine worked? In my case, probably. I feel much better, but not what I'd term as "normal". Understand though, I never went into it as a cure, and I completely agree that anyone touting it as a cure is as irresponsible as someone touting CPAP as a cure. Even at 100% reduction in AHI neither is a cure and shouldn't be presented as such. I haven't tried to use the PAP and the OA but then I've had extensive exams done on my neck and everyone I've seen has since recommended the OA since I had so much trouble tolerating the CPAP. If insurance paid for the things, I'd say you should get one and try it but since they don't and you tolerate the machine then it's a much harder decision. That's a lot of money for a chance at being able to lose the machine and there's no guarantee you will even if it does help, but without trying one and having testing you can't truly know that so it's kind of a catch 22 right now.
I'll also say this, they do need some kind of regulation. I knew my dentist sold the TAP3 but I only considered it after he talked to me about his own severe OSA and could explain to me the results of my PSG to me. Not an expert but where I live, those are few and far between so I at least felt comfortable he understood the difference in treating a snoring and something more serious. He also never said it was a cure, simply and alternative to the CPAP that may help. I do believe that's the exception rather than the rule but how that problem gets fixed I don't know.