melhajj

First of all, thre is no "cure" as yet for sleep apnea. CPAP and oral appliances are meant to manage the problems associated with sleep apnea but do not offer a cure.  As I said earlier there are many oral appliances results, however, depend upon the willingness of the patient to wear them for a full night and the education and training of the dentist in managing the therapy. Unlike a dental procedure like a filling, with medical procedures there are no guarantees that any appliance will work and at this time no real way to accurately predict which appliance will work best for each individual patient.

Somnomed, TAP, Klearway - there are many good appliances available to dentists to use but which to use depends on the skill and experience of each individual dentist.

As far as dentists in New Jersey, you can check the Find a dentist lists at www.Snoringisntsexy.com and www.quietsleep.com.

Dr. Barsh

I just finished my third adjustment with a Somnomed MAS.  My doctor is moving it 1mm at a time.  What should I be looking for when I know the adjustment is correct?  Is there a maximum amount of adjustment?  I am trying to improve a 49.7 AHI and can't tolerate CPAP.  Any suggestions or advice?

It's best to talk with your doctor about this but, in general, look for a decrease in snoring, an improvement in the way you feel in the morning and throughout the day and a lessening of any symptoms you may have been having.  When you report that you are "feeling better" your doctor may want to check your blood oxygen levels and, if he/she has a sleep recorder, check your AHI and/or refer you for a follow up sleep study.

Dr. Barsh

Dr. Barsh,
WOW that was a fast response.  Thank you so much.  A at home sleep study measuring O2 levels along with AHI is provided as part of my therapy.  I should also say that I am battling spinal stenosis pain which doesn't help in getting a good nights sleep.  Again thanks



Last edited by papahemi on Tue May 27, 2008 12:05 pm; edited 1 time in total

papahemi wrote:

I just finished my third adjustment with a Somnomed MAS.  My doctor is moving it 1mm at a time.  What should I be looking for when I know the adjustment is correct?  Is there a maximum amount of adjustment?  I am trying to improve a 49.7 AHI and can't tolerate CPAP.  Any suggestions or advice?

Is he really moving you forward 1 mm at a time? That seems excessive, but if you are not having any pain, it must be OK. The maximum amount of adjustment on a SomnoMed (now called SomnoDent) depends on where you started. If in the middle (where they usually have it adjusted to when sending it from the company), the maximum would be 5 mms. If you max out and still need more advancement, the appliance will need to go back and the assembly will need to be moved forward.

As Dr. Barsh mentioned, only a study will tell you if you are advanced enough. Research has shown us that even when you think you are in good shape, you still have OSA about 35% of the time.


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Kent Smith DDS

Dr. Kent,  
My doctor said each adjustment was 1 mm.   I experience a little tightness in the jaw muscle when I first put the appliance in at night but as my jaw adjusts I am fine.  I wake in the morning no tightness at all. In fact I can move my jaw forward a good 1/4 inch.  Using my bite tabs while I shower moves my jaw back to my "normal position" within the first hour. My wife says my snoring has gone from 20 ( on a scale of 1 to 10 )  to a 3 maybe 4.  I am really encourage with my results so far as I have been living with untreated sleep apnea for 20 years.  I just don't want to over adjust my appliance and cause problems.  There is about 7 to 10 days between adjustments and I go in again this Thursday.  Thanks to both Dr. Kent and Dr. Barsh for the information.  I will keep everyone posted as to my progress.

Thank you Dr. Kent and Dr. Limbash for your answers; they are of great help to all the people around this forum; you don't know how important is that doubts that we have around certain treatments for sleep apnea are being answered; it is great that we can find some answers in this forum, since people all around the usa take a look at your wise answers and opinions; words are short to describe how much good you are doing by helping this community of sufferers of sleep apnea. God Bless You, Both. Best regards.

Went for an adjustment yesterday and a major Q&A session.  My Doctor was hesitant to advance my Somondent MAS appliance more than 1/2 mm this time.  She was concerned about causing problems with my jaw.  I slept all night and woke with a slight dull headache.  Not sure if it was caused by my appliance adjustment (which felt OK no soreness at all) or my neck ( a little stiff this morning, maybe have slept wrong).  After bite tabs jaw returned to normal with no problems  I remember waking up only once about three hours after going to bed ( before I would remember waking almost every hour, at least six to seven times a night).  I am scheduled to take home the sleep study equipment on Tuesday next week to record the results of my efforts.  I am a little nervous as to the findings but hoping for a healthy improvement in the numbers.  More to come next week.

After a week of adjusting to the latest adjustment I finally took home the sleep study equipment.  The first unit failed so I had to return the unit the next day and get another one.  I did the study on Friday night and returned the unit today. I anxiously await the results.  I am now adjusted out to 3.5 mm from the starting point.  I hope to improve on a 49.7 AHI reading.  More to come.

What type of ambulatory unit did you use? Watch-PAT, ApneaLink, Remmers, ARES, Embletta? Tell us about your experience.


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Kent Smith DDS

I was given the Watch-PAT 100 for my sleep study.  The unit is very easy to use except for the snoring/sleep position probe that won't stay taped to a hairy chest very well.  Also if its worn on the right hand you have to cross the wire leads for the PAT and the O2 sensor.  I sleep mainly on my left side so I put it on the right. Had a problem with the first unit as after I went and put it all on and depressed the "On" button I got a red light instead of the flashing green. Had to get another unit the next day. Not a major problem except that I live 30 miles from the Dentist office. I now anxiously await the results of the study. When I get the results I will post the before and after numbers.

Sounds like the "On" button had been pushed prematurely. Yes, the Watch-PAT is easy to use for patients, which is why it's my favorite. You should wear it on the non-dominant arm, but I don't think it matters too much. Did they not give you extra tape for the hairy chest? We try to do this with everyone, as that seems to be the only complaint I ever hear. BTW, don't count on the snore decibels going to zero...never does. Did you do the Watch-PAT originally so we can get an apples to apples comparison?


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Kent Smith DDS

My first sleep study was with the Watch PAT 100.  They did not include a roll of tape but I had some at home.  Probe still came loose during the night.  Does it make a difference which finger the PAT and the O2 sensor goes on?  I have a more accurate measuring device for the snoring than the Watch PAT anyway.  My wife says the number of snoring episodes have reduced by 90 percent and the decibel level went from a 20 (on a scale of 1 to 10) to a 3 maybe 4 at its loudest.  I have experienced no jaw or teeth pain.  I sleep better at night and feel great in the morning.  I have a horrible work schedule that doesn't help my sleep patterns and am battling a pain in my thoracic spinal region caused by nerve pressure. I am considered to by overweight by the charts with a BMI of 41.  I am meeting with the doctors in two weeks to consider the Lapband surgury option.  To top it all off I work in the airline industry which is going down the toilet at the moment. But I am determined to survive this apnea problem that I have had for 20 years despite my HMO and the CPAP intolerance.  Boy talk about long winded.  Dr. Kent again I thank you.

Yes, it does matter which fingers the PAT and oximeter go on. Did you follow the pictorial instructions? Yes, your wife is a good measuring device, but she does not know how much louder you are in REM. Overall, that doesn't really matter, however, as we really want to know how your O2 did during the night, and what the AHI and RDI read, compared to the first study. The amount of REM sleep you got is rather ambiguous, as you can typically catch up on REM sleep through REM rebound, so it's difficult to delineate the importance of change between 2 snapshot nights.

I am most impressed with a BMI of 41 getting your snoring down to a tolerable level. Treating OSA with appliances in that BMI range is rather iffy, so I desparately hope your results are better than expected. From a 49.7, my best guess, after 3.5 mms of adjustments, would be 27. Make me eat my prediction with something under 10! I'm rooting for you!


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Kent Smith DDS

Dr. Kent,
I did follow the picture but had to cross the leads as the picture shows a left hand setup. Without crossing then sensors they would go on different fingers.  My right is my non-dominant hand.and I sleep more on my left side.  Does the red O2 light go on top of the nail or does the sensor go on top of the nail.  What does the blue PAT sensor read?
  
Any significant reduction in the AHI and RDI numbers will be a welcome sight, along with a decrease in desaturation events of course.  I still have no teeth pain or jaw pain and my jaw returns within five minutes in the morning.  By the way your suggestion on "leaning on the lower jaw" works great to reposition the jaw.  Thanks again.