Hi everyone - I have some questions about dental devices.  I have been totally committed to my CPAP for about 2 years and it has saved my life. I am 37 and not overweight, but I was a walking corpse before the CPAP. I was also lucky enough to have a girlfriend who understood the need for me to play elephantman every night.  The problem is that she's gone now and I am struggling to imagine how to sell myself to the next Ms Right with a garden hose coming out of my face.  Anyway, I had the UPPP surgery 2 years ago - waste of time, money and heartache.  Also had the deviated septum corrected - good call.  The next thing I want to try is the dental device as that may be an easier sell to a prospective mate. I have a large overbite and when I move my jaw forward, I feel immediate relief in breathing.  My ENT is not helpful and has told me he doesn't know any dentist who does it, end of story.  Can anyone suggest a starting point for finding an experienced dental technician to assess the opportunity?  Getting... sleepy...

Mike,
I'm 37, newlywed.  My wife doesn't complain about my snoring.  She uses earplugs all nite.  Hey, can you tell me more about the UPPP?  It doesn't work at all??  Btw, if you happen to meet your ms. right, can you tell her frankly that you have OSA before taking her home?  just tell her that you have to sleep with CPAC, explaining to her why before she actually sees the darn thing.   I'm a newly diagnosed, also researching alternatives....  I've tried CPAC for about a week, finding it quite cumbersome and hard to comply.  Having said that, I must say that those few mornings after hooking up CPAC I felt much less tired.


_________________
mild6

Mike,

The only problem with dental devices is that it is specific to your anatomy, AND usually only works for folks with mild OSA.  When you do find a doc/dentist, make sure that they do an overnight sleep study with the new device in, you don't want to find out that all the device did was reduce snoring and apnea's, not eliminate them.

Tiredmike,
  I do not use a dental appliance, but do have a friend who is pleased with his.  I have done some reading and find this to be an informative website with pictures and reviews of many different brands.
www.quietsleep.com

TiredMike wrote:

Hi everyone - I have some questions about dental devices.  I have been totally committed to my CPAP for about 2 years and it has saved my life. I am 37 and not overweight, but I was a walking corpse before the CPAP. I was also lucky enough to have a girlfriend who understood the need for me to play elephantman every night.  The problem is that she's gone now and I am struggling to imagine how to sell myself to the next Ms Right with a garden hose coming out of my face.  Anyway, I had the UPPP surgery 2 years ago - waste of time, money and heartache.  Also had the deviated septum corrected - good call.  The next thing I want to try is the dental device as that may be an easier sell to a prospective mate. I have a large overbite and when I move my jaw forward, I feel immediate relief in breathing.  My ENT is not helpful and has told me he doesn't know any dentist who does it, end of story.  Can anyone suggest a starting point for finding an experienced dental technician to assess the opportunity?  Getting... sleepy...

Hi Tired Mike,

CPAP ain't that bad. Great conversational piece. 'Going to bed with a six foot hose'  

What type of apnoea do you have ? Mild, moderate or severe. Dental devices are really only suitable for mild apnoea, in some cases moderate.

The assessment on suitability is normally made in conjunction with the sleep doctor, as the dentist will not know how severe your apnoea is and you really don't want someone messing with your mouth when he might be only chancing his arm. Like all aspects of sleep medicine there are some right chancers out there. Stay in contact with the sleep lab.

An additional thought. Some sufferers who use cpap regularly are also using dental devices when going away overnight or week ends. Might be worth a shot.

Daniel


_________________
The untreated Sleep Apnoea sufferer died quietly in his sleep.......
Unlike his three passengers who died screaming !!!!!!

(Anon)

Anyone know if Medicare covers dental devices for OSA and snoring?

Thanks.

I am a dentist. I wear an oral device for sleep apnea. After reading many responses from various people I have some information that may help some of you.  Oral appliances for sleep apnea demostrate a variety of results.  From my experience, if worn correctly, the appliance stops snoring but does not always stop the symptoms of sleep apnea.  I have studied numerous appliances and have settled on the TAP (Thorson Anterior Positioner).  This works when you have teeth for support.  I have not yet found an oral appliance that works well when there are no teeth or implants for support.

The appliances that work advance the lower jaw forward to open the airway.  This can not be done in one day or one week.  It takes about one month to properly advance the device for effective use (many reasons for this to numerous to mention here).  The appliance should be adjustable by the wearer.  As you can imagine having a device pushing your jaw forward for 6 to 8 hours daily there are some considerations that must be looked at.  The muscles of the jaw are streched for the time the appliance is being worn.  These muscles will be sore.  Some people can not stand this.  The Temporomandibular joint will be sore.  Some people can not stand this.  The bite is altered and if you are not careful the bite can be altered perminently.  These are problems that each person must assess for themselves.  Your mouth will be dry in the morning and you will drool during the night when wearing this oral appliance. So, is it worth it?  For me it is worth it.  For me snoring stops and symptoms of Sleep Apnea stop.  The appliance should be self-contained (adding extra spacers or parts for advancing the appliance can be costly and inaccurate).  So far medicare has not paid a dime.  Some insurance programs pay for oral appliances, some do not.  I hope this helps answer some questions.


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I am a dentist. I wear an oral appliance for sleep apnea. It works for me.

Sleep Apnea has completely changed the person I am and the person I had hoped to be.  I am 50-year-old woman who was diagnosed with sleep apnea three years ago.  I've tried different masks, different doctors, different techs-- and am still suffering.  I am very discouraged.  I am using an APAP maching only two hours a night sometimes-- and am tired all the time.  Plus, I'm depressed, irritable and can not work even parttime.  Insurance doesn't pay for the oral appliance device-- which did not help at all and was just as hard to adjust to as the CPAP-APAP MACHINE I was given.  I'm hoping that Science and research comes up with something better very soon.  

bagaason wrote:

I am a dentist. I wear an oral device for sleep apnea. After reading many responses from various people I have some information that may help some of you.  Oral appliances for sleep apnea demostrate a variety of results.  From my experience, if worn correctly, the appliance stops snoring but does not always stop the symptoms of sleep apnea.  I have studied numerous appliances and have settled on the TAP (Thorson Anterior Positioner).  This works when you have teeth for support.  I have not yet found an oral appliance that works well when there are no teeth or implants for support.

The appliances that work advance the lower jaw forward to open the airway.  This can not be done in one day or one week.  It takes about one month to properly advance the device for effective use (many reasons for this to numerous to mention here).  The appliance should be adjustable by the wearer.  As you can imagine having a device pushing your jaw forward for 6 to 8 hours daily there are some considerations that must be looked at.  The muscles of the jaw are streched for the time the appliance is being worn.  These muscles will be sore.  Some people can not stand this.  The Temporomandibular joint will be sore.  Some people can not stand this.  The bite is altered and if you are not careful the bite can be altered perminently.  These are problems that each person must assess for themselves.  Your mouth will be dry in the morning and you will drool during the night when wearing this oral appliance. So, is it worth it?  For me it is worth it.  For me snoring stops and symptoms of Sleep Apnea stop.  The appliance should be self-contained (adding extra spacers or parts for advancing the appliance can be costly and inaccurate).  So far medicare has not paid a dime.  Some insurance programs pay for oral appliances, some do not.  I hope this helps answer some questions.

You are absolutely correct and anyone considering a dental appliance should read your thread.  I have mild to moderate sleep apnea and tried the Silent Nite.  I used it for about a week but my front teeth really hurt when I woke up for about 10-15 minutes.   I went back to the dentist and he adjusted it but I still had the problem.  He told me it couldn't be adjusted anymore and gave me my money back.  Perhaps my overbite had something to do with it.  I'm now trying the Cpap but it's not working out.


_________________
"To be ignorant of one's ignorance is the malady of ignorance."
- Amos Bronson Alcott, American philosopher, teacher, reformer

mild6 wrote:

Mike,
I'm 37, newlywed.  My wife doesn't complain about my snoring.  She uses earplugs all nite.  Hey, can you tell me more about the UPPP?  It doesn't work at all??  Btw, if you happen to meet your ms. right, can you tell her frankly that you have OSA before taking her home?  just tell her that you have to sleep with CPAC, explaining to her why before she actually sees the darn thing.   I'm a newly diagnosed, also researching alternatives....  I've tried CPAC for about a week, finding it quite cumbersome and hard to comply.  Having said that, I must say that those few mornings after hooking up CPAC I felt much less tired.

Are you using the full face mask or nasal pillows?  I have mild to moderate OSA and have a auto Cpap machine on loan for 2 weeks so they can figure out what pressure to set my permanent machine at.  I was prescribed the Swift8 nasal pillows with a chin strap. I have only slept for 2 nights out of 7, mostly because I find it difficul to exhale thru my nose.  I start out inhaling and exhaling thru my nose but before long I start exhaling thru my mouth which causes all these sounds and wakes me up.  After waking up several times, I can't get back to sleep and have to take the headgear off.  I am beside myself as I only slept 4 1/2 hours last night.  Before I was diagnosed I slept 6-7 hours a night and got up only once to urinate.  I do take 1/2 of a sleeping pill.  I was never tired before the study and since I've been using this machine, I have been so tired.  I am very active and play tennis 3x a week.  I don't know what I'm going to do as I can't bear the thought of a full face mask.


_________________
"To be ignorant of one's ignorance is the malady of ignorance."
- Amos Bronson Alcott, American philosopher, teacher, reformer

Thank you, Bagaason, for your post. I have mild apnea, more hypopneas than apnea actually. I was seriously considering refusing a C- or Bi-PAP until I had at least tried a dental device. UNFORTUNATELY, you answered my dilemna right off the bat. I wear dentures, full upper, partial lower. I do tend to grind my teeth or at least clench my jaw when sleeping or at least when drifting off to sleep. Back to considering the C- or Bi-PAP for me, I guess.

LadyHawke, if your problem is exhaling have you discussed maybe a Bi-PAP instead of a C-PAP or even A-PAP. I think that I've read that for some of us the C- and A-PAP don't provide enough of a pressure drop during exhale and that the Bi-PAP can be a better choice for us. I'm just a newbie at this so this is just something I read and thought I would toss out at you.

How neat that your sleep doc would give you a two week loaner to try out! I just had a titration study. We couldn't find a mask that didn't leak amongst the 3-4 the tech offered. I did much better w/the nasal pillows tho I don't know the brand. At one point we had the pressure set great, the best and most comfortable breathing I had all night. Other than that I had problems w/exhaling. It was just too much effort to breathe! In exaspiration I just started breathing thru my mouth which I could do w/these nasal pillows. Of course, that was defeating the entire purpose of the PAP machine, titration study and sleep relief. But the point is, if I could breathe easily at one stage but had problems exhaling at the other and they couldn't lower the exhaling pressure enough then maybe the Bi-PAP where they can manually adjust both inhaling and exhaling pressure separately is the better choice for us. What do I know? I'm just a newbie at this.

Hey ChronieToo,

As a matter of fact, I took impressions for a dental device today on a patient who wears a partial on the lower and a full upper denture. If you still want to consider a dental appliance, the OASYS is the one for you. It has only a lower jaw component (can be fit to lower teeth if you have at least 6 or so), so it works for someone in your dental condition.

hey TiredMike,

If you are in New Jersey, and your ENT is also, how far are you from Allentown, Pennsylvania? Dr. Barry Glassman is the most knowledgable dentist I know on sleep apnea, so your ENT should know about him (he's just across the border), and if you can get there, it would be worth the drive.


_________________
Kent Smith DDS

Thank you, Kent. I just might check into the OASYS after this titration study and I get the results and hash things over w/my sleep pulmo and regular pulmo. I'm quite content w/my overnight 02 but do want to make sure that I'm doing the right thing by myself as much as is possible. Still these docs have to make things make sense to ME before I'm agreeable to anything. I still am doing fine w/a lot of my innards the docs and surgeons wanted me to part w/years ago and not regretting it in the least!!! On the other hand, I did part w/a couple of things that it made sense to ME to part with but still REALLY RESENT that the surgeon blackmailed me into removing my healthy appendix which I didn't agree with at all but had no choice in if I wanted the rest of the surgery. NOW they are finding that appendix removal tends to protect against Ulcerative colitis BUT tends to make one a little more suceptible to Crohn's. Guess who developed Crohn's 4 years later??? One of the more trivial reasons I'm skeptical of advice from medical professionals w/o double-checking what they have to say thoroughly.

Kent, do you have OSA? Do you use the OASYS device yourself or have you had to resort to a PAP machine? I notice you mentioned a patient but not your own situation regarding apnea. It will be interesting to learn how your patient does w/his/her OASYS.

TiredMike

I found this site that gives a list of dentists that do the TAP ( the device that works on severe sleep apnea!):

http://amisleep.com/insurance.html

that page will show you how to get the codes and things the insurance company needs.

Just hit the box that says find a Dr. to locate one in your area.
 
Maybe you can find a gal who is on a CPAP machine.

Best of luck and good snozzzzzzzzing,

Bob

Hey ChronieToo,

No, I do not have OSA, but have delivered many appliances over the years, and am very familiar with quite a few, such as the TAP and OASYS. I did have an OASYS made for myself to see how it feels in my mouth. I believe in knowing how something will feel (when possible) before suggesting treatment to a patient. I will try to remember and post how this specific patient does, but it takes 3 weeks from impressions to receive the appliance (about the same for all appliances), then we do titration checks, etc.. over the course of several months, so it might be a while.

When you are ready to make a decision, feel free to email me privately (anyone else may do that as well), and I will always answer you. Regular dentistry pays the bills. Helping people live better lives by breathing better is just something I love to do.


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Kent Smith DDS