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Oral Appliance Effectiveness

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Oral Appliance Effectiveness

Postby vch » Wed Feb 04, 2009 2:20 am

I have been seeing Dr. Keropian and have been fitted with two versions of his oral appliance. The current version is a lower jaw-fitted with tongue depressor device and does not stop my snoring. I used it for one nite and felt exhausted the next day and went back to the old device and back on my CPAP. It has been over 18 months of trial and error and with each adjustment, it seem to work ok for a short period, then I would lapse back. It seemed the device would work for a while, then my body would figure it out and defeat it.

Also I am leary about how he tests, and does his scans. The echo always shows an improvement after an adjustment. His CET scans are done sitting upright and not showing the airway when in a natural sleeping supine position.

Yeah, the tongue depressor effect can stop the snoring, but the device does not address the posterior part of the tongue as well as the walls of the throat, that may have less tone as we get older.

I wonder what Dr. Lawler has to say about my experience with dental devices.
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Postby lawler » Wed Feb 04, 2009 7:18 am

Dental appliances cannot completely address every sleep-breathing issue. Regarding Keropian's appliance, show me the studies! I'm sure that it can help some people, but without a follow-up sleep study--either home study or PSG--you cannot assume anything. There is a saying that the proof of the pudding is in the tasting. In this case, the proof is in the testing. You absolutely cannot go by how you feel.

I have long thought that the echo tests are nothing by a show. There is absolutely no validity unless it can be done while you are sleeping.

If you are not getting the results that you want with an appliance used by itself, consider blending that therapy with either surgery or CPAP.
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Dental Appliance from Dr. Keropian

Postby vch » Thu Feb 05, 2009 1:40 am

Thank you Dr. Lawler. I agree that the proof is in the testing, but Dr. K goes by clinical outcome then backs it up by the oximetry test at home. I never got to feeling good enough for long enough to get it done. I have had blood panels, anemia, cancer etc checked out to rule out other issues. What bothers me is that the mouthpiece seemed to work for a while.

Dr. K seems highly confident in his cure rate, but it bothered me that he switched the design which means the old design was failing others as well. The new appliance is a lower jaw design and doesn't seem to work at all.

I saw an ENT who specializes in U3P etc and he told me to forget surgery and go back to the CPAP. I am now trying the CPAP and mouthpiece. My GP recommended the CPAP Pro which I am going to try. Thank you.
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Throat Exercises

Postby vch » Thu Feb 05, 2009 1:43 am

One other note, that if the throat muscle tone deterioates with age, why hasn't any of the clinicians mentioned throat and tongue exercises?
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Postby lawler » Thu Feb 05, 2009 7:19 am

I want to say the following gently: Why a clinician would invest in a very expensive instrument to do an echo of airway cross sectional area as a pre-treatment "evaluation" of oral appliance effectiveness on an upright and awake patient and then only use simple oximetry rather than a much more sophisticated home sleep study (there are many of these out there of which Watch PAT is one) or a PSG is beyond my understanding. If anything, the post treatment testing is the most important part. Without that, you have no idea of what you have accomplished.

I respect anyone who is doing something unique that is helpful. This appliance is certainly unique. Because it is unique, and since it is claimed to be so extremely effective, there is all the more reason to do a study showing its effectiveness. Studies take an enormous amount of time to prepare and to do. I am in the middle of initiating a study now <link to website removed>. I am stunned a the paperwork and preparation that it takes to do a simple 10 patient pilot study. But at the end of this study, I will know if my premise is worth pursuing or not. But it will be a very controlled study. I am hopeful that there is such a study being planned for this very unique appliance that is getting so much attention.
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Re: Throat Exercises

Postby ApneaKiwi » Fri Feb 06, 2009 12:00 am

vch wrote:One other note, that if the throat muscle tone deterioates with age, why hasn't any of the clinicians mentioned throat and tongue exercises?


my understanding is that exercises do not work. if they did, i think we would hear alot more about them. there was one ?prospective study about a didgeridoo (indigenous australian musical instrument) that showed some promise but there have apparently not been the necessary follow up studies.
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Postby sleepsurfer » Sat Feb 07, 2009 10:25 pm

hey vch.....my dentist is apparently setting me up with the full breath (dr. kerporian) however, after i get dialed in i will be scheduled for a complete sleep study to gauge it's effectiveness. i have heard many good things and success stories regarding this appliance.....sorry to hear that it didn't work for you. if this one doesn't work for me then i will try an advancement appliance(have you considered this?)......then my last resort will be cpap....
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