Are the appliances worth the money? I have an appt with a Dental sleep specialist next week; I demanded an appt soon since nobody has ever actually examined my airway/jaw to find the cause of my OSA. I'm not interested in a lifetime treating only the symptoms. cPAP isn't doing me any good (i'm a light sleeper and a mouth breather) and I don't want to be discharged from the military, so I'm looking into other things.

Unfortunately my insurance won't pay for an oral device (but I do think they'll pay for surgery, which is my ultimate goal) and I will have to pay the $2k+ out of pocket. Obviously I don't want to throw away $2K if it isn't going to work.

Have you guys with retrognathism as the cause of your OSA seen much success? Does anyone know of an insurance comp that will pay for the devices?

Hello, I'm new to the forum and have sleep apnea for over 7 years. I'm now 47 yrs old. I'm not over weight, don't smoke and drink very little. I have an Adjustable Mandibular Device, which consists of an upper and lower molded seperate mouth piece which are locked together by a pin on either side of the device. The pins are on the upper mouth piece and lock into the lower bringing the lower jaw forward. The sleep study concluded that the device fixed my apnea. After one year problems developed. My lower jaw would not return to its original position causing my bite to change, possibly requiring me to get braces if the jaw does not return to it's correct position. It has been two months since I have Not used the appliance and the jaw has not fully returned. I have never needed braces as a child and I sure don't want them now. I return to the Dr. in two weeks hoping that everything is back to normal. There are many oral devices available. This device did work but has caused other problems. My insurance did not pay for this. I payed $1600.00 for this and I'm not sure if I'll get anything back due to it's complications. I do use a CPAP now but there is no way I can continue through the rest of my life wearing this ungodly mask. I hope this helps. Good luck on your search as I know I'll require as much luck as possible to get a good night sleep.

Do either or both of you have dental insurance? Have you explored the benefits allowed w/both your dental AND your health insurance? The billing code for the surgery could make THE difference in receiving ANY insurance coverage for the surgery you are contemplating. Getting such surgery covered by insurance requires a pretty savvy dental surgeon or at least that he have a very savvy insurance coder on the payroll. Even then there may be only partial or no coverage but it is worth investigating in detail. Coding can often make THE difference between full reimbursement and out of pocket or at least partial reimbursement and out of pocket.

Tho why anyone would prefer surgery (what they take out, they can't put back in, and EVERY surgery creates some scar tissue in addition to which most surgeries cannot be undone or if they can, leave even more scar tissue) is way beyond my ken.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity & Micro masks, ResScan 3.4, S8 ResLink, Embla oximeter.

The bite chnge is not uncommon.  Many people have it and about half find the changes favorable.  Others find the changes tolerable.  Changes can be prevented or slowed by spending a couple of minutes doing the exercises you were taught when you recieved your appliance.  Most of my patients are people who were not using their cpap and bite chaanges are better than heart attacks, strokes, high blood pressure or memory loss.

The reason changes occur is that your bite (orthopedically was wrong to begin with.  That is why you had a collpsible airway.  Google NHLBI   AND GO TO SITE.  Enter TMJ in search box and you will get the NIH paper that explains this is a TMJ problem.

You can see my site at ihatecpap.com it is written in patient language

Ira

clamhead wrote:

After one year problems developed. My lower jaw would not return to its original position causing my bite to change, possibly requiring me to get braces if the jaw does not return to it's correct position. It has been two months since I have Not used the appliance and the jaw has not fully returned. I have never needed braces as a child and I sure don't want them now. I return to the Dr. in two weeks hoping that everything is back to normal.

Has your jaw gone back into position?

BC7

Well, I went to Ira's site, and I also went to the NHLBI . . . discovered a few interesting things.

First being - there are dozens of oral devices on the market. Second, according to the study by NHLBI, "The efficacy of oral appliances (primarily mandibular advancing devices) in patients with mild to moderate SDB and of upper airway surgical procedures over a range of apnea severity has been evaluated. However, more information is needed before their roles can be clearly delineated."

So the jury is out on this subject - I'm sure there have been cases of demonstrated success with these devices, but  the good doctor should know better than promoting his own site in this forum.

Byron,

Right............adverts here are not allowed as I understand it.

The sites u went to that u referenced.  You did not say what the findings are.  ??

BuzzCap7

You did not say what the findings are. ??

I believe the quote from NHLBI was self explanatory with respect to whether these oral devices are color=red]Worth the Money[/color], "more information is needed before their roles can be clearly delineated"

I encourage you to go the the NHLBI site, read their reports for yourself. This is the article I was quoting . . .
nhlbi.nih.gov/health/prof/sleep/res_plan/section5/section5a.html

Got it thank you.

BuzzCap7

The NHLBI paper was published in 2001.    LINK       http://www.nhlbi.nih.gov/meetings/workshops/tmj_wksp.pdf

The new parameters of care for the American Academy of Sleep Medcine were published in February 2006 in Sleep based on newer research.

Ira

September 17th.....My jaw has returned without any problem but my doctor has taken the device and I have not used it for 9 months. Surgery is an option that I am exploring.

There are two surgeries that are extremely effective in treating apnea.  The first is a tracheotomy and the second is maxillary/mandibular advancement.  All other surgeries have mixed to poor resuts.

I can't give you the author but  the quote says it all.       "There are practically no disorders or diseases that can not be made worse by sticking a knife in them"    

This does not mean do not do surgery but proceed with caution.  You stated that you did not need braces as a child and you do not want them now.  The reason you have apnea may be that oral conditions were not addressed at a young age.

All surgery has risks and many have limited success.  Proceed with caution and ask lots of questions about what could go wrong and what your chances of success are.  Also is success a cure or reduction in AHI.  Many patients go thru surgery and still end up needing CPAP or appliances.

Dr Ira L Shapira

Thank you Dr. Shapira. I visited a Dr. at Jefferson U. in Philadelphia and the surgery option was to extreme. Maybe you have heard of this type of operation? The Dr. said that my tonsils, adenoids and uvula would be removed. A small bone that attaches to the tongue, would be dislocated and moved forward by entering through the lower jaw and reattached allowing the tongue to be moved forward opening the airway. He did tell me the name of the procedure but I have misplaced that information at this time. Anyway, this is to radical and extreme for me. The more discussion I have with people (and ppl who know ppl) who have had any type of operation for sleep apnea, the opinions are the same as yours. I'm interested in your statement about the childhood development of my teeth. I would imagine that at 47 years old, the damage is done and I must live with what I have. O well, like I read on another wed site, If CPap is the only problem, I'm doing pretty good. People in wheel chairs, people with missing limbs and other major challenges, I should just shut up and except it with grace. Thank again Dr. Shapira, every opinion/advice that is received is accepted with appreciation.

Dear Clamhead,

Sounds funny to address a message that way, but what the heck. Thanks for your comprehensive description of the surgery. My father used a CPAP for 15 years and never once complained. He realized how lucky he was to have a condition that was treatable. I was recently diagnosed only after insisting with my doctor and against the recommendation of a Ear/Nose/Throat guy that I get tested in a sleep study. The results? I have severe sleep apnea. I'm 51 and I feel so much better now that I'm on the CPAP.  So I too am happy to look at my condition and thank God that it is not something worse. I'm using the nasal pillows and they seem to be working fine. I didn't have any problem with the mask either.

My mother told me a horror story about a guy she knew when my father first got the CPAP - he was about 30 and decided he wasn't going to wear anything like that. So he had the surgery. He also happened to be diabetic. The surgery didn't go well and it got infected, and well - he nearly died from it. And worst of all, it didn't cure his sleep apena.

So I would have to agree with you, the description of the surgery is too extreme for me. The dental devices sound interesting but from your description, it is not a great option either if it causes all that trouble. I have heard they are good for some people, but for me, I'll stick with CPAP.

Stick with cpap  change to  oral appliance or  do  surgery  (after carefully evaluating)
 
lots of choices all have pros and cons the important thing is that you are treated.  I tell all successfully treated patients that they have a new problem, they need to save more for retirement because they are going to live longer.  Most patients find that is a side effect of treatment they can live with.
 
The problem are patients who are not treated they put their health at risk and others lives if they drive while debilitated.  A study at American Thoracic Society showed 300% increase in motor vehicle accidents with SERIOUS INJURIES BY drivers with mild apnea even if they had no symptoms of tiredness.
 
Ira