I have mild/moderate sleep apnea and my AHI is 19.5.

In my initial follow-up appointment to review my sleep study and options, he did mentioned my tongue was slightly large for my mouth and my allergies and extra 20 lbs of weight are all partial contributors.  He suggested the UPPP or the Pillar treatment.  After research, I called them to find out more about the  oral appliance thinking this would be the best first option for me.  They told me that b/c my SA problem is related to my palette that the oral device wasn't a good option.  They said the oral devices best for people that have SA as a result of a large tongue.  

From what I understand the oral devices move your jaw forward to open up the throat.  It wasn't my understanding that it depended on whether the palette vs the tongue being the main contributor to a patient's SA.  

Is my ENT right that the oral appliance isn't the best for me?  They also discouraged me from going with the oral device b/c it's not covered by insurance.  They are suggesting UPPP or Pillar as my best option.  After reading about all the UPPP stories- that is not my first option.  I would consider Pillar procedure but want to read more about it ... of course i know it's not covered right now by insurance.  They claim if I'm going to spend the money on an oral appliance that I may as well do the Pillar procedure.

Right now I'm going around and around in circles trying to figure out what to do first.  I am going to be fitting for a CPAP in the meantime b/c I need some relief.

As a prior intra-oral device user, I would say, from personal experience, that if you are going to go through with the CPAP that you would do better with it.  I say this because it is adjusted while you are being monitored, so they have documentation of its effectiveness.
   I will also add that my experience comes from severe sleep apnea, not from mild.


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There's a simple way to know if you are a candidate anatomically. You'll have to find an ENT that's willing to do this...

Have your ENT look at the space behind the base of the tongue and the back of the throat with you sitting up. This is called the retrolingual space. With a fiberoptic camera (through your nose) at the level of the soft palate, you should normally see all or most of your voice box and vocal folds. Remember that distance. For most people with small or narrow jaws, you won't see very much.

Then lay flat on your back and and repeat the procedure and notice how much your tongue falls back due to gravity—you may be surprised how much it falls back and how narrow your airway is (sometimes 1-2 mm). Then thrust your lower jaw forward as much as you can and observe the space again. Usually, there will be a significant improvement.

I've had a handful of patients that bought mandibular advancement devices and it didn't work. When performing this maneuver, either the tongue doesn't move forward at all, or sometimes got worse!

Unfortunately, you won't know what'll really happen until you try the device. The pulling action will work, but for other reasons, you may not like it. This is why it's very important to go to a dentist that specializes in this and knows how to deal with all the potential problems that can occur.