My experience with Silent Nite SL

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My experience with Silent Nite SL

Postby pamsyflower1 » Thu Sep 27, 2012 5:14 pm

Hi...I'm a newbie...a 60 year old mildly obese female with moderate obstructive sleep apnea and was treated and cured of TMJ syndrome over 15 years ago. I have been wearing the Silent Nite SL dental device for about 6 weeks now. Before this, my husband would shake me awake 1 to 2 times per night because I would stop breathing and scare the wits out of him. This sweet, kind and caring man described my snoring as sounding somewhat like a mac truck under load, headed uphill. Additionally, I would wake 4 to 5 times per night with an aching dry throat and mouth, get a glass of water each time, use the restroom, then head back to bed. I didn't want to see an MD for this because I knew CPAP would be next and I just wasn't going to go there...not my idea of attractive nighttime attire. We were both getting very worn out with the situation.
My dentist does not specialize in sleep disorders or in TMJ syndrome, but I went to him anyway and told him only that my snoring was distressing my husband. I lucked out. He prescribed the Silent Nite SL device and it was ready for fitting in just a few weeks. The whole process involved just a few trips to the dentist and the total cost was under $500. At first, there was too much pressure on my lower teeth, so the appliance had to be amended to correct this. The dentist cut away the offending material in a few minutes while I waited and then the device was very comfortable. It is helping to keep my mouth closed at night. It pulls my tongue gently forward, resting it against my lower teeth and pulls my lower jaw slightly forward. The presence of the device triggers salivation, so the dry mouth/throat issues are completely cured, yet I do not drool into my pillow. I am sleeping through the night...no more trips for water or to the restroom. My husband reports that my breathing no longer stops in the night (that he can tell) and that the snoring problem is 50% improved, and that he is sleeping through the night now too. I do not sleep on my back...only on my side. My Silent Nite SL is adjusted to the 2nd peg, where it was first preadjusted. The only problem I had was when I got a little over-zealous after the first two weeks of wearing it and decided to ratchet things up a notch to see if this would cure my snoring altogether. It was a bad idea. I developed a very sore jaw and all my former TMJ symptoms returned. I immediately returned the device to its former setting, but it took a full week for the TMJ syndrome to resolve. I won't do that again. In time, I plan to take advantage of the Kaiser Permanente sleep clinic, with my device in, and see exactly where my OSA stands, just to make sure that nothing has been overlooked in this process. OSA can be deadly and I hear that it is best not to play around with it.
That's it for now...just thought I would share my experience on the chance it could help someone. :-D
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Re: My experience with Silent Nite SL

Postby a.b.luisi,d.m.d. » Sun Sep 30, 2012 3:52 pm

pamsyflower1 wrote:Hi...I'm a newbie...a 60 year old mildly obese female with moderate obstructive sleep apnea and was treated and cured of TMJ syndrome over 15 years ago. I have been wearing the Silent Nite SL dental device for about 6 weeks now. Before this, my husband would shake me awake 1 to 2 times per night because I would stop breathing and scare the wits out of him. This sweet, kind and caring man described my snoring as sounding somewhat like a mac truck under load, headed uphill. Additionally, I would wake 4 to 5 times per night with an aching dry throat and mouth, get a glass of water each time, use the restroom, then head back to bed. I didn't want to see an MD for this because I knew CPAP would be next and I just wasn't going to go there...not my idea of attractive nighttime attire. We were both getting very worn out with the situation.
My dentist does not specialize in sleep disorders or in TMJ syndrome, but I went to him anyway and told him only that my snoring was distressing my husband. I lucked out. He prescribed the Silent Nite SL device and it was ready for fitting in just a few weeks. The whole process involved just a few trips to the dentist and the total cost was under $500. At first, there was too much pressure on my lower teeth, so the appliance had to be amended to correct this. The dentist cut away the offending material in a few minutes while I waited and then the device was very comfortable. It is helping to keep my mouth closed at night. It pulls my tongue gently forward, resting it against my lower teeth and pulls my lower jaw slightly forward. The presence of the device triggers salivation, so the dry mouth/throat issues are completely cured, yet I do not drool into my pillow. I am sleeping through the night...no more trips for water or to the restroom. My husband reports that my breathing no longer stops in the night (that he can tell) and that the snoring problem is 50% improved, and that he is sleeping through the night now too. I do not sleep on my back...only on my side. My Silent Nite SL is adjusted to the 2nd peg, where it was first preadjusted. The only problem I had was when I got a little over-zealous after the first two weeks of wearing it and decided to ratchet things up a notch to see if this would cure my snoring altogether. It was a bad idea. I developed a very sore jaw and all my former TMJ symptoms returned. I immediately returned the device to its former setting, but it took a full week for the TMJ syndrome to resolve. I won't do that again. In time, I plan to take advantage of the Kaiser Permanente sleep clinic, with my device in, and see exactly where my OSA stands, just to make sure that nothing has been overlooked in this process. OSA can be deadly and I hear that it is best not to play around with it.
That's it for now...just thought I would share my experience on the chance it could help someone. :-D

I am a dentist working in dental sleep medicine. You are wise to get a sleep test to make sure that the Silent Nite is adequately controlling your OSA. It might be because it is not always necessary to totally control the snoring to get rid of the apneas/hypopneas. However, also understand that the Silent Nite is a relatively light duty appliance(but in all fairness, it is also priced accordingly). It is very possible that it could fall short in controlling your OSA, whereas a heavy duty appliance like the TAP3 Elite could get the job done.(Also much more expensive, of course). So, if the Silent Nite comes up short, the game is not necessarily over. Good luck to you!
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Re: My experience with Silent Nite SL

Postby pamsyflower1 » Mon Oct 01, 2012 1:07 pm

Thank you dear dentist...I really appreciate your input. My sleep study is scheduled for this Thursday night and I will probably do it without the Silent Nite SL in so that we all can get a good baseline to work from. Perhaps I can talk Kaiser into doing 2 studies to see how much good the Silent Nite device is doing with the apnea. I also have my eye on the TAP3 Elite, now that I understand that the Silent Nite SL is probably not going to last very long, and am looking for a local dentist specializing in sleep medicine to see me through future treatments . Kaiser Permanente may or may not cover the TAP3 Elite, which apparently costs between $1200 to $1500, but I do know that they advocate the use of CPAP as their first recomendation for treatment of sleep apnea. I understand that both the Silent Nite and the TAP3 Elite work well combined with CPAP. I am so benefitted now by the lack of dry mouth/throat and being able to sleep through the night that I think I will always sleep with some type of dental device in from here on out. Thank goodness I'm not a bruxer. Maybe I'll get good long life out of all these devices. Thanks again for your words of encouragement.
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Re: My experience with Silent Nite SL

Postby pamsyflower1 » Fri Oct 05, 2012 3:35 pm

Well...I attended the sleep clinic last night. I was asked to do the test with my Silent Nite SL in and the results were evaluated this morning because I got a call from the clinic around 11:30am. My apnea must be quite severe because the clinic wants me fitted for a CPAP ASAP and I have an appointment for this coming Monday. I had hoped that my apnea would be mild with the use of the Silent Nite, but had been told that if this were the case, that the clinic wouldn't even call me and I would have to follow up on my own through my PCP. If my apnea were moderate with the use of the Silent Nite, the clinic said that they might call in a week. Nope. I returned the equipment at 7:00am and there was a call for me from the clinic at 11:30am. This is bad. I will, of course, follow through. CPAP, here we come!
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Re: My experience with Silent Nite SL

Postby blueh2o » Fri Oct 05, 2012 4:03 pm

Good luck Pamsy. I'm going the opposite direction. Been on CPAP for about 16 months. I've been fitted for a TAP III and am awaiting it's arrival anxiously.
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Re: My experience with Silent Nite SL

Postby pamsyflower1 » Sun Oct 07, 2012 2:01 am

I found your story about your experience with apnea and am so sorry that you have had such a struggle and that the CPAP seemed to fail for you. It looks like you've postponed your surgery pending a trial with a TAPIII-good for you! The Silent Nite is very similar, just not as durable and, of course, a lot less expensive. I wish I could tell you that my appliance solved my issues with apnea, but I do know that it surely has helped. My husband says that as long as I wear it at night, I do not have any more of those "near death experiences". The snoring is 50% improved. The TAPIII appliance gives you the ability to advance the lower jaw in minute increments. Please give yourself a full month of adjusting to your appliance in the mode your dentist has set it at before you try to advance it. And when you do advance it, then do so as minutely as possible and give yourself at least a full 2 weeks at that adjustment before you adjust it further. Keep doing this until you find the famed "sweet spot" that everybody is talking about. Expect a little jaw soreness, but any tooth pressure should be addressed by your dentist right away. Use the bite strip - or chew a little gum first thing in the morning before you have your breakfast. This is not suposed to hurt you...it is suposed to help. I am unfortunately unable to advance my device because the adjustments are too grand on the Silent Nite to accomodate my TM joints, previously, though anciently, compromised by a 6-year round with tempuromandibular disorder. You don't want to get that. Just go slow...don't get too excited...don't be overzealous and give yourself lots of time. I'm excited for you. Bon chance, mon ami!
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Re: My experience with Silent Nite SL

Postby blueh2o » Tue Oct 09, 2012 5:12 pm

Thank you for the advice. I'll keep your tips on mind as I adjust.
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Re: My experience with Silent Nite SL

Postby a.b.luisi,d.m.d. » Sat Oct 13, 2012 6:35 pm

pamsyflower1 wrote:I found your story about your experience with apnea and am so sorry that you have had such a struggle and that the CPAP seemed to fail for you. It looks like you've postponed your surgery pending a trial with a TAPIII-good for you! The Silent Nite is very similar, just not as durable and, of course, a lot less expensive. I wish I could tell you that my appliance solved my issues with apnea, but I do know that it surely has helped. My husband says that as long as I wear it at night, I do not have any more of those "near death experiences". The snoring is 50% improved. The TAPIII appliance gives you the ability to advance the lower jaw in minute increments. Please give yourself a full month of adjusting to your appliance in the mode your dentist has set it at before you try to advance it. And when you do advance it, then do so as minutely as possible and give yourself at least a full 2 weeks at that adjustment before you adjust it further. Keep doing this until you find the famed "sweet spot" that everybody is talking about. Expect a little jaw soreness, but any tooth pressure should be addressed by your dentist right away. Use the bite strip - or chew a little gum first thing in the morning before you have your breakfast. This is not suposed to hurt you...it is suposed to help. I am unfortunately unable to advance my device because the adjustments are too grand on the Silent Nite to accomodate my TM joints, previously, though anciently, compromised by a 6-year round with tempuromandibular disorder. You don't want to get that. Just go slow...don't get too excited...don't be overzealous and give yourself lots of time. I'm excited for you. Bon chance, mon ami!

Good for you! You have obviously been studying up and you are getting quite knowledgeable about oral appliance therapy. Just one little addendum. The TAP 3 is rated to treat severe sleep apnea. I have had some good success with it in that area. I am not trying to discourage you from trying CPAP. By all means give it a try, if you are so inclined. Just remember, the OA is still out there if things don't work out. There are some special considerations when treating severe OSA with an oral appliance. Please get back to me before you reconsider that route. Good luck to you!
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Re: My experience with Silent Nite SL

Postby pamsyflower1 » Fri Oct 19, 2012 3:01 pm

Thank you Dr. Luisi. I have been officialy diagnosed with moderate sleep apnea - with my Silent Nite device in - the number I was given by a Santa Rosa advice nurse was 23.9. My own doctor was dismissive...perhaps rightly so, since the Kaiser PCPs do not specialize in sleep medicine. It unknown where I stand without the OA. Kaiser Permanentes' standard treatment for this is with CPAP, and titration is usually handled as a one-size-fits-all operation - factory-style, so to speak. OAs are a covered benefit only when CPAP totally fails and they do try really hard to make the CPAP work for you. Their Martinez clinic, for whatever reason, was handling my case on an urgent basis and I was actually scheduled to begin titration on October 8th...but canceled my appointment when I discovered, through information offered elsewhere in this forum, that I may receive more consideration through Kaisers' Santa Rosa location. My PCP was kind enough to write me a referral and I called Santa Rosa the next day, to find out that an urgent appointment was not really necessary. Martinez had scared the bewiddlies out of me. What a relief! I'm actually set up to begin titration today and my appointment in Santa Rosa will be at 3:30pm. I will tell them everything and will bring my Silent Nite with me so that they can see it and understand that my CPAP therapy must allow for the use of my OA. I love my Silent Nite! If it lasts for a year I will be happy. I've located a good sleep specialist dentist in Palo Alto. He is chief consultant to the Stanford Sleep disorder clinic and is also a specialist in treating TMJ disorders. I will seek out a TAPIII from him if he does not retire anytime soon. As for the CPAP, I think I may need to adjust to a full face mask as I am a mouth breather at night...been so since a very young child. I'm also very challenged with breathing at altitudes as low as 6000 ft - feels like I'm suffocating - so they are going to have to be very careful in adjusting for my titration or CPAP will likely be knocked off my map right from the start. I understand that it is very hard to exhale against pressure. I may be more-than-usually sleep deprived for this next week, so, if you don't see a post from me for a while, you'll know what is happening. Also, it's a long drive to Santa Rosa for the two of us. I am going to try very hard to love my CPAP. Anyway...thank you so much for your thoughtful words of encouragement. I have really appreciated them.
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Re: My experience with Silent Nite SL

Postby pamsyflower1 » Tue Oct 23, 2012 7:12 pm

Update...My specialists at titration strongly encouraged me to do the titration without my Silent Nite device in and I have complied - even though I was so attached to it. I was dreading the thought of having to get up 5 times a night again because of the choking dryness. I needn't have worried. I haven't even missed my appliance even once during this process. My snoring is completely cured with the CPAP! I'm on a Philips Respironics System One Auto with A-Flex with a ResMed Quattro full-face mask. Kaiser in Santa Rosa did a wonderful job of fitting me for this mask. Upward pressure on my lower lip from the cushion seals my mouth shut at night - I like that - no more "catching flies" (sorry to say that there is a little drool at the corners). I'm on maximum exhalation relief. Last night was wonderful...I slept like a baby, hearing the "ocean waves" of the CPAP rush in and out, and woke this morning feeling soooo refreshed...the first time in many years. I didn't know what I had been missing! And my husband is not missing the snoring...it is completely, 100% gone, from the very first night of CPAP. I will beg Kaiser to let me keep their machine until mine arrives, (ten days from this Friday). Perhaps they will allow me to return theirs to Martinez, which is quite a bit closer to us. The first couple of nights were not without issues...I came very close to heaving the whole setup right out the window a few times, but I'm starting to realize that you just have to take the issues, one at a time, and work through them. I love CPAP - how amazing is that? The Silent Nite will gather dust now, which is too bad, but we feel it was worth every penny because it brought us one step closer to finding the help that we needed. I will not seek the TAP III anytime in the near future. I'm just so thankful. This forum is helping me to realize that issues will continue to arise...the CPAP machinery and mask need care and maintenance, not unlike having a new little baby in the house, but I'm so relieved to know that I can do this. Everything is going to be ok. Thank you for reading my posts.
Last edited by pamsyflower1 on Thu Nov 01, 2012 2:01 am, edited 1 time in total.
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Re: My experience with Silent Nite SL

Postby VeraKeisey » Thu Oct 25, 2012 10:49 pm

I have my own methods, but i'll try yours.
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Re: My experience with Silent Nite SL

Postby pamsyflower1 » Thu Nov 01, 2012 2:00 am

Another follow-up. Titration ended on Friday. PR System One Auto CPAP reduced my episodes to 1.9 per hour on average. Wow. My own machine arrived yesterday (Tuesday) and I had my first night with my own CPAP. I was much too quick to assume that my OA would now gather dust. While I was waiting for my equipment to arrive, I used my Silent Nite SL. I did not waken as refreshed, but I did feel safer wearing it than wearing nothing. My Silent Nite will be my back up system for when the power goes out, etc. When it wears out, I will seek out the sleep dentist/TMJ expert to get a TAPIII elite. My apnea dx was upgraded to "Severe" and is estimated to be just under 50. I am just very thankful that they got my machine to me in a hurry!
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Re: My experience with Silent Nite SL

Postby Trublue6 » Tue Jan 01, 2013 7:55 pm

I have read all of your stories and I am optimistic about the Silent Night. I have had moderate to severe OSA since 1999. Actually I have had it way before that but, was actually diagnosed with a sleep study. I have been on CPAP continuosly now for about 6 years. I was put on it from day one but I always hated wearing it. I would fall a sleep and immediately take it off. Now, I use my CPAP religiously but to be vey clear, its a thrill kill. My wife has never complained about the mask but I know the air flow and just the idea of wearing a mask is a turn-off.

I was just recently fitted for Silent Night and hopeing it works. My insurance practically picked up the whole thing. I have many other medical problems to include incomplete quadriplegia C5-C7 and I have to have surgery on my thoracic spine this summer. Needless to say, I need this to work as I would love to have one less thing to worry about. I will keep you all posted with my experience with this device. Thanks

T-
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Re: My experience with Silent Nite SL

Postby pamsyflower1 » Wed Jan 02, 2013 4:24 pm

Hi Trublue6...I agree with you that the CPAP tends to be a thrill-kill. I've actually found that CPAP is not as much of a thrill-kill as snoring is - or at least, this is what my husband says. Both of us have now been diagnosed with severe OSA. We plan our thrills before masking up.

The trouble with ALL the dental appliances is that for persons with moderate to severe OSA, they DO NOT reduce OSAs into the therapeutic range of AHI 5 or less on average, per hour. Therefore, ALL of us with moderate to severe OSA are left with residual untreated OSA when we use ANY of the oral appliances by themselves. Untreated OSA has very devastating long-term effects on our health and can take several good years off our lives. NOTHING will treat you as effectively as CPAP for your moderate to severe apnea.

A dentist specializing in sleep disorders would NEVER prescribe you a Silent Nite SL for your moderate to severe OSA. Not only will it NOT reduce your apneas to an acceptable level, but the device is also not durable and will only last you for about a year, maybe less. The adjustable arms break apart easily and you wind up spending a small fortune to replace them. I am very saddened by the loss of my $500 investment in this device, but am chalking it up to the price of education and am just moving on. I need a back up device for when the power goes out here because something to treat OSA is better than nothing. My dentist, who specializes in myofacial disorders - (TMJ syndrome was activated when I advanced my Silent Nite SL for the first time) is custom-making a twin block appliance for me, cushioned in the rear to support my TMJs. ALL of the current oral appliances made by the major manufacturers in the USA today are designed without regard for the patients' TMJs and proper jaw balance. They must be modified for patient comfort and safety.

I am sorry to be the bearer of such bad tidings for you. You must have surgery this summer. Please make sure that your surgeon/anesthetist is aware of your OSA. You will need careful monitoring during and after your proceedure. Please take care.
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Re: My experience with Silent Nite SL

Postby erinprime » Wed Jan 02, 2013 10:55 pm

pamsyflower1 wrote:The trouble with ALL the dental appliances is that for persons with moderate to severe OSA, they DO NOT reduce OSAs into the therapeutic range of AHI 5 or less on average, per hour. Therefore, ALL of us with moderate to severe OSA are left with residual untreated OSA when we use ANY of the oral appliances by themselves.


Pamsyflower1, you have many insightful posts but this is just wrong. Results vary from person to person. Oral appliances are absolutely most effective at treating mild apnea, but they can in some cases effectively treat even severe apnea to a therapeutic level of an AHI less than 5. There are clinical trials to back this up. It really depends on the individual and their anatomy. All OA users should have a follow up sleep study to determine if it is providing effective treatment.

The Silent Nite SL to my knowledge is only meant to reduce snoring, not to treat sleep apnea. Anyone hoping to get rid of CPAP completely should look into getting a more appropriate appliance.

Many of the apnea oral appliances do not provide TMJ support, but that is not true of all appliances. I use the TAP3 and it is made with TMJ comfort in mind. The center hooking mechanism puts less strain on the TMJs and it is meant to have rear support added once it is all the way advanced.

Oral appliances are not the best treatment for everyone, and all oral appliances are not created equal... With that said, they are the best treatment for some people and there are some great appliances out there. You run into problems when you generalize.
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