I just posted this under another topic and I thought I should repeat it here for anyone looking for answers.

I found myself in a very desperate situtuation - for me cost was not a consideration because I thought I was going to die! I have sleep apnea and was CPAP intolerant. Having been a paramedic for eight years prior I understand quite a bit about the airway and breathing but just could not acclimate myself to the CPAP. After a few terrifying episodes in the night I knew I had to find an alternative. It was then I met Dr. Jonathan Greenburg in Valencia, California. I had not compared different devices and thought that at the time that CPAP was the only thing out there. Fortunetely, Dr. Greenburg's device has been a Godsend. I too was told that my device would be covered 50% by insurance and they were right. The important thing though was that I had less than 10 minutes of actual "face time" with my original sleep doctor, a CPAP that was ineffective, night episodes that had me fearing for my life, and a family to raise - I was in real trouble. Dr. Greenburg and his staff spent an extraordinary amount of time and testing on me. I immediatly realized I was in the hands of professionals. Interestingly, I also have some TMJ issues including a jaw click when I yawn. The Full-Breath Solution doesn't seem to affect it. I've been using it for about one year now and I am completely convinced that it has saved my life.

Yes, I am a real person and this really is my story. I would be happy to talk to any one of you if you want to know more so let me pass this info on to you: I have been invited to participate in a teleconference this Wednesday, November 7th 2007, at 7pm. I will be sharing my experience and I have been assured that those who sign up for the call will be able to submit their individual questions and address them to me or to Dr. Greenburg. At the risk of sounding too much like a commercial, all I can say is that I know there are many of you out there like me who are desperate for a solution. I am extremely grateful to have found one. <link removed>

Again, I am not knocking the CPAP because apparently it is effective for many people. It just didn't work for me. You may not be in such a critical situation like I was. Still, if you care about your health or the well being of those you love, you owe it to yourself to at least get the basic info about any new advancements. Like the previous poster said, there's not a lot of info out there.

<link removed>

One last thing, I'm interested in getting some feedback after the tele-seminar. I've never had the opportunity to give my testimonial in this fashion and I'd like to know that all interested participants get their questions and concerns answered. My name is Jon and I can be reached at fastracker@roadrunner.com  I hope this info is helpful.

I have also posted on another forum and think that it might be of interest to all - http://www.apneasupport.org/viewtopic.php?p=91623#91623

[quote="sleepapnea_ed"]In the interest of understanding approved oral appliances, please post your questions and comments here.
I have "mild" sleep apnea and obtained a sleep apnea appliance about four years ago.  After being followed about four times, I was sent on my way with no exercises to "correct" my jaw placement in the mornings.  I recently noticed a BIG problem with my bite.  I had had about seven crowns done and my appliance fitted very loose.  I went back and forth between the dentist who did the crowns and the one who did the appliance and finally have located another one who is doing a retainer to move my front teeth forward to "correct" for the damage done to my bite.  Does anyone have any other suggestions for me?

thanks in advance, sita

You are now doing the right thing, Sita. Additionally, moving your upper teeth forward will increase the airway even more. Whatever you do, don't allow the dentist to move the lower teeth back. Were the crowns done prior to the appliance fitting, or while you were wearing it? What type is it? BTW, if a retainer alone can correct the bite, it can't be too far off, but even a little can bother you if you have a "positive occlusal sense".


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Kent Smith DDS

Kent Smith wrote:

You are now doing the right thing, Sita. Additionally, moving your upper teeth forward will increase the airway even more. Whatever you do, don't allow the dentist to move the lower teeth back. Were the crowns done prior to the appliance fitting, or while you were wearing it? What type is it? BTW, if a retainer alone can correct the bite, it can't be too far off, but even a little can bother you if you have a "positive occlusal sense".

Thanks so much for the response.  The crowns were done after I had my appliance.  I really don't have any idea of the type of appliance...it is hard plastic with bands that hold the top and botton molds (of my teeth) together.  I have quit using it because my bite was getting so bad and have noticed an improvement in my bite.  However, I am foggy from not sleeping as well.  I am really afraid to go back to the appliance and certainly don't want a CPAP; are there any other choices?

sita

The only other options you have would involve either surgery or some good sleep hygiene, but this depends on so many things, and I would probably have to see your sleep study to know what might work in this area. I would personally suggest you continue with the appliance, but first tell me what problems you were having with the bite change.

I also have to wonder how you had so many crowns done while using the same appliance unless it is a relineable TAP (thermocryl liner). I think a new appliance would be in order. You might have a Silent Nite or an EMA from the sound of it, and you can't reline those to retrofit to a change in your dentition.


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Kent Smith DDS

Kent Smith wrote:

The only other options you have would involve either surgery or some good sleep hygiene, but this depends on so many things, and I would probably have to see your sleep study to know what might work in this area. I would personally suggest you continue with the appliance, but first tell me what problems you were having with the bite change.

I also have to wonder how you had so many crowns done while using the same appliance unless it is a relineable TAP (thermocryl liner). I think a new appliance would be in order. You might have a Silent Nite or an EMA from the sound of it, and you can't reline those to retrofit to a change in your dentition.

Dr. Smith
I had two sleep studies, one done after getting the appliance.  The first found 20 apneas and 34 hypopneas, with an ovrall RDI of 8.3.  Of 93 arousals, 42% were associated with respiratory events, and 55% were spontaneous.  After getting the appliance, there were 91 arousals, 50% associated with respiratory events and 50% described as spontaneous.  The number of hypopneas greatly exceeded apneas and the RDI was 9.2.  It was pointed out, and I am very aware of the fact that sleeping on my side decreases the number of apnea episodes, but I have neck problems which are aggravated by sleeping in that position.  

In regards to the crowns, I took the appliance with me each time and made sure that it still fit after each crown, but it got progressively looser, with increased movement on wearing it.  It could not be adjusted except very minimally with heat, but it would not have been enough.  I was all set to get another one, but when I pointed out to the dentist who made it that I felt like my jaw had moved forward and that my front bottom teeth hitting under my top teeth were preventing me from being able to hit on my molars, he did not offer that the new appliance would/could fix that.  His suggestion was that I replace crowns #18 and #31 in gold to start and make those crowns higher.  The change in bite showed me hitting only on 11, 9, 7, 6 and 2.  

In terms of sleep hygiene, I can definitely get more disciplined about going to bed and getting up at the same time daily, not having caffeine after noon, making sure my bedroom is dark, etc.  I am wondering if I had had exercises if I could have prevented the dramatic bite changes.  Or if there are any exercises now that can help with the current situation.  The retainer hopefully will help by moving only my front upper teeth forward, but it can also cause spaces between my teeth. That is my current concern with getting it, and the cost; my portion will be at least $540.

I am also wondering if since my jaw has re-located if technically it can/has helped my apnea...this is all speculative and I don't expect you or anyone to have the answers.  I truly appreciate your thoughtful and informative answers and your taking the time to respond to me.  I live in Albuquerque, New Mexico and sometimes we are behind the times here in the wild west!

Many  thanks, sita

Sita,

Doesn't look like you improved much at the protrusion level of the appliance, so if that is all you can advance your mandible, it may not be the answer for you. However, my guess is that you could advance more if given the chance. You didn't mention if you were wearing the appliance in the 2nd study, but I will assume so. I also do not know if this was an attended study, or one done at home, which might make a difference, but the fact you mention arousals sounds like an attended study.

We advise any of our TMJ and head/neck pain patients to sleep on the back, so I can understand your situation, and agree that you should sleep on your back if this is best for your neck.

It is impossible to retrofit crowns to the specific design of the appliance, so it is not surprising that it became loose. Again, I think a new MAD is in order. If you have a bite change, I might advise seeing a dentist who knows how to make an orthotic that can be adjusted for changes in your bite for now. You can then undergo orthodontia or other techniques for "fixing" your bite.

I do not know, nor is there any way to know, if your bite would not have changed if you had used the techniques suggested for retaining the current bite. Bites can change for many reasons, and sometimes, it is actually a good thing. As an example, the cartilage disk in your TMJ might have been "recaptured" by wearing the MAD, making for a healthier joint. Personally, I wou dnot get a retainer that would open spaces by protruding your upper incisors, but that's just me, and I really can't advise you in that direction. There are really no exercises you can do that I know of that will reverse the condition, but again, this might be a better position for your mandible.

Yes, your apnea could have been positively affected by the new position of your mandible, so a new study may be in order. However, I doubt your numbers will have improved much, knowing the difference between the 2 studies you cited. BTW, do you know how your RDI differed between REM and NREM sleep?


_________________
Kent Smith DDS

Hi Dr. Smith
My sleep study does not state any differences in RDI between REM and NREM.  Both studies were done at a sleep lab.  I do have a marked bite change from what I had prior to wearing the sleep appliance; when you refer to a dentist making an "orthotic" would it function as a new sleep appliance, or would its function be to "fix" my bite?  Right now, with not wearing my sleep appliance, my bite has improved to the point where I can eat more than soup and my next step was going to be the retainer that moved my top front teeth forward.  I have had concerns about that retainer and think that I will try to cancel it.  I am also concerned about getting a new sleep appliance since that is what I believe changed my bite in the first place.  Since the second sleep study did not show a difference in apnea episodes when I was wearing the appliance, I am wondering if the appliance actually did anything for my apnea.  I am also wondering if the apnea is mild enough so that I don't have to treat it; I have very low blood pressure.  I do understand that this is speculative, and that another study would provide more answers about my current apnea status.  This process has been very educational to me.  I really had no idea that a bite change could occur with an appliance, or that there were exercises that could have prevented it.  I thank you for your knowledge and responsiveness.

sita

Kent Smith wrote:

Sita,

Doesn't look like you improved much at the protrusion level of the appliance, so if that is all you can advance your mandible, it may not be the answer for you. However, my guess is that you could advance more if given the chance. You didn't mention if you were wearing the appliance in the 2nd study, but I will assume so. I also do not know if this was an attended study, or one done at home, which might make a difference, but the fact you mention arousals sounds like an attended study.

We advise any of our TMJ and head/neck pain patients to sleep on the back, so I can understand your situation, and agree that you should sleep on your back if this is best for your neck.

It is impossible to retrofit crowns to the specific design of the appliance, so it is not surprising that it became loose. Again, I think a new MAD is in order. If you have a bite change, I might advise seeing a dentist who knows how to make an orthotic that can be adjusted for changes in your bite for now. You can then undergo orthodontia or other techniques for "fixing" your bite.

I do not know, nor is there any way to know, if your bite would not have changed if you had used the techniques suggested for retaining the current bite. Bites can change for many reasons, and sometimes, it is actually a good thing. As an example, the cartilage disk in your TMJ might have been "recaptured" by wearing the MAD, making for a healthier joint. Personally, I wou dnot get a retainer that would open spaces by protruding your upper incisors, but that's just me, and I really can't advise you in that direction. There are really no exercises you can do that I know of that will reverse the condition, but again, this might be a better position for your mandible.

Yes, your apnea could have been positively affected by the new position of your mandible, so a new study may be in order. However, I doubt your numbers will have improved much, knowing the difference between the 2 studies you cited. BTW, do you know how your RDI differed between REM and NREM sleep?

Sita,

Do you mean there are basically no differences between REM and NREM RDI, or that the study does not address the differences?

The orthotic I mentioned is something LVI dentists are most familiar with, and it opens your bite and allows you to eat with it comfortably. Then at such time as your bite stops changing, you can do ortho or a full mouth reconstruction. It is not a sleep appliance or anything that "fixes" your bite. It's more like crutches that allow change to go undisturbed.

I think the reason the appliance showed little change is due to the amount of protrusion, but obviously this is a guess. I wish your dentist had warned you of possible bite changes and told you about exercises, but at least you know now. This is one of the most important things I teach in my seminars - going over ALL potential side effects from wearing an appliance before you ever deliver one to a patient.

Keep us posted, Sita!


_________________
Kent Smith DDS

Dr. Smith
The study did not address differences between REM and NREM RDI.  Your input has been very helpful to me.  I have cancelled the retainer that would move my front teeth forward and re-scheduled to get a new sleep appliance.  I will be consulting with the dentist that did the old appliance to see if it is possible to do an a new appliance that would just maintain the current bite which has improved some since I quit wearing the appliance.  I will ask him about exercises, it is wonderful that you teach these in your seminars.  I read somewhere that chewing gum upon removing the appliance is helpful; would you suggest that?  Can send exercises to me or to my dentist to decrease the likelihood of further bite deterioration? Or is there somewhere that I can obtain these exercises?  Is there a way that I can have my dentist contact you if he wants to do that?  Thanks again, Dr. Smith.
sita

Kent Smith wrote:

Sita,

Do you mean there are basically no differences between REM and NREM RDI, or that the study does not address the differences?

The orthotic I mentioned is something LVI dentists are most familiar with, and it opens your bite and allows you to eat with it comfortably. Then at such time as your bite stops changing, you can do ortho or a full mouth reconstruction. It is not a sleep appliance or anything that "fixes" your bite. It's more like crutches that allow change to go undisturbed.

I think the reason the appliance showed little change is due to the amount of protrusion, but obviously this is a guess. I wish your dentist had warned you of possible bite changes and told you about exercises, but at least you know now. This is one of the most important things I teach in my seminars - going over ALL potential side effects from wearing an appliance before you ever deliver one to a patient.

Keep us posted, Sita!

I would be happy to talk with him, Sita, or he can email me if he likes. Rather not leave my phone or email here, and I don't want my web site banned by leaving it here, so just google my name and sleep apnea, and you'll find more than you need to know about me.

As far as exercises, I recommend chewing gum in the shower if you take one in the mornings (but most women don't, I am told), and if not, just chew it for a while upon waking. Next thing to do is lean on your chin, but in the direction that would push the jaw back toward your ears.


_________________
Kent Smith DDS

Dr. Smith
I won't see him until Feb. 6th, but I will let him know.  Thanks very much for the information and your help!  I really appreciate it and you!
sita

Kent Smith wrote:

I would be happy to talk with him, Sita, or he can email me if he likes. Rather not leave my phone or email here, and I don't want my web site banned by leaving it here, so just google my name and sleep apnea, and you'll find more than you need to know about me.

As far as exercises, I recommend chewing gum in the shower if you take one in the mornings (but most women don't, I am told), and if not, just chew it for a while upon waking. Next thing to do is lean on your chin, but in the direction that would push the jaw back toward your ears.

Are there any "over-the -counter" devices that would lessen snoring temporarily?  For example...an airplane ride?


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Good luck...

firecoach wrote:

Are there any "over-the -counter" devices that would lessen snoring temporarily?  For example...an airplane ride?

Probably some you could find online, but you might develop some TMJ dysfunction if you aren't careful. I am definitely biased, but would strongly advise you see someone who knew what they were doing in airway management.


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Kent Smith DDS