Somnodent Vs. Tap III

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Re: Somnodent Vs. Tap III

Postby Pmac » Wed Mar 21, 2012 10:14 pm

I too am looking at both the TAP3 and somnomed. Trying to evaluate how they will feel in my mouth. What are the areas that can bother people? I am concerned the Tap3 will crowd the tongue and my lips cant close over it so my mouth will get really dry. it seems like the tray do not allow much movement and you may not be able to talk or drink.
Somnomed seems to not have these concerns, seem like biggest drawback is that the apparatus is bulky on the sides.

if theses are rare issues with tap3 sounds like that is a safer bet to invest it. But just by looking at them it looks like the somnomed is more comfortable. Any other things that impact comfort to talk about with my dentist?
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Re: Somnodent Vs. Tap III

Postby a.b.luisi,d.m.d. » Sat Mar 24, 2012 7:58 pm

Pmac wrote:I too am looking at both the TAP3 and somnomed. Trying to evaluate how they will feel in my mouth. What are the areas that can bother people? I am concerned the Tap3 will crowd the tongue and my lips cant close over it so my mouth will get really dry. it seems like the tray do not allow much movement and you may not be able to talk or drink.
Somnomed seems to not have these concerns, seem like biggest drawback is that the apparatus is bulky on the sides.

if theses are rare issues with tap3 sounds like that is a safer bet to invest it. But just by looking at them it looks like the somnomed is more comfortable. Any other things that impact comfort to talk about with my dentist?

I am a dentist working in dental sleep medicine. Obviously, the number one concern is if the appliance will adequately treat your OSA. The number two concern is that it be comfortable enough so that you can sleep with it. The problem with the Somnomed is that what is good about it is also what is bad about it. You get a lot of freedom of movement with the Somnomed to open your jaw, talk, drink etc. which could aid comfort. Unfortunately, there is strong clinical evidence the most effective oral sleep apnea appliances limit the amount of mouth movement. Please see: www.ncbi.nlm.nih.gov/pubmed/8542125. Specifically, when the device allows your mouth to drop open and move around when you sleep, your tongue and soft palate may be able to partially drop back against you throat and block the airway, even with the mandible protruded. Just picture a person snoring with the jaw dropping open and you know what I mean.One of the reasons that the TAP is more effective than the Somnomed is that it limits potentially harmful jaw movement. Also the TAP has a greater range of protrusive movement, which could be critical to the success of the case. Even though the TAP has a central hook, most people find the tongue room adequate, if not abundant. The TAP is easily adjustible by the patient with a removeable hex key and the somnodent must be bilaterally adjusted which is too tough for some patients to do. And most patients find the TAP comfortable enough. Remember, you are SLEEPING, not singing an opera or eating Thanksgiving dinner. There is some range of lateral motion.
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Re: Somnodent Vs. Tap III

Postby a.b.luisi,d.m.d. » Sat Mar 31, 2012 12:03 pm

Pmac wrote:I too am looking at both the TAP3 and somnomed. Trying to evaluate how they will feel in my mouth. What are the areas that can bother people? I am concerned the Tap3 will crowd the tongue and my lips cant close over it so my mouth will get really dry. it seems like the tray do not allow much movement and you may not be able to talk or drink.
Somnomed seems to not have these concerns, seem like biggest drawback is that the apparatus is bulky on the sides.

if theses are rare issues with tap3 sounds like that is a safer bet to invest it. But just by looking at them it looks like the somnomed is more comfortable. Any other things that impact comfort to talk about with my dentist?

A few other thoughts about the TAP vs. the Somnodent. If you look at both devices side by side, you will notice that both are well made out of quality materials with good workmanship. It is not apparent in photographs, but over-all, the TAP is quite a bit less bulky than the Somnomed. This will make a difference to many patients. The extra bulk of the Somnodent comes mostly from the bilateral adjustment and bumper system that definitely will impact some patients cheek areas.Also the framework in general is somewhat thicker than the TAP. The Somnodent does give some extra tongue room, but over-all, I think that is outweighed by the over-all bulk comfort-wise.
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Re: Somnodent Vs. Tap III

Postby chico74 » Mon Apr 02, 2012 6:16 pm

Hello all,
I have a mild OSA residue left after having surgery and significantly reducing its severity (from AHI=65/RDI=72 to AHI=7/RDI=19). Now I'm back on CPAP as my day fatigue levels deteriorated and sleep study recommended treatment. I'm no friend to the CPAP so I started looking for a dental solution as my apnea is no longer in the severe range. From reading this forum I learn that the TAP comes out advantageous to the Somnomed (or Somnodent) in several respects.. So what puzzles me - I've been to 3 different sleep specialist dentists in my area. 2 out of the 3 only do the Somnomed and when I asked them about the TAP they said they stopped using it several years ago (and kinda gave me the look that it is "old-school" compared to the Somnomed). If the TAP is better - wouldn't all specialists work with it, or at least the majority?
Second question: the one specialist that does work with the TAP actually does the "TAP Elite" as opposed to the "TAP III". On the face of it - it seems to be better coz it allows for more jaw movement/ freedom. Are there any darwbacks to the Elite over the III? (He'd prolly make me a III if I insisted...)
Thanks for any thoughts!
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Re: Somnodent Vs. Tap III

Postby a.b.luisi,d.m.d. » Wed Apr 04, 2012 7:53 pm

chico74 wrote:Hello all,
I have a mild OSA residue left after having surgery and significantly reducing its severity (from AHI=65/RDI=72 to AHI=7/RDI=19). Now I'm back on CPAP as my day fatigue levels deteriorated and sleep study recommended treatment. I'm no friend to the CPAP so I started looking for a dental solution as my apnea is no longer in the severe range. From reading this forum I learn that the TAP comes out advantageous to the Somnomed (or Somnodent) in several respects.. So what puzzles me - I've been to 3 different sleep specialist dentists in my area. 2 out of the 3 only do the Somnomed and when I asked them about the TAP they said they stopped using it several years ago (and kinda gave me the look that it is "old-school" compared to the Somnomed). If the TAP is better - wouldn't all specialists work with it, or at least the majority?
Second question: the one specialist that does work with the TAP actually does the "TAP Elite" as opposed to the "TAP III". On the face of it - it seems to be better coz it allows for more jaw movement/ freedom. Are there any darwbacks to the Elite over the III? (He'd prolly make me a III if I insisted...)
Thanks for any thoughts!
I am a dentist working in dental sleep medicine. I will tell you exactly why the dentists prefer the Somnnodent over the TAP. The Somnodent is MUCH, MUCH easier for the dentists to fit in the patients mouths. The TAP TL inner liner is an elastomeric material that is devilishly difficult to adjust and shape. If you overshoot with the adjustment just a little, you ruin the whole tray. It takes real talent and real patience to place TAPs properly. I hate to say it, but dentists interested in speed and maximizing profit would certainly be attracted to the Somnodent. That is not to say that they don't really believe in it. I assume that they do really believe in it. The extra freedom of movement with the Somnodent is a great selling point. However, I have carefully researched the published efficacy tests on both devices and the TAP is strikingly superior. Remember, OSA is a serious, sometimes life threatening condition. It is critically important to get good results. I don't care how tough it is for me if the patient is saved and I think that is the only attitude you can take. I work with sleep disorders centers in my area and treat many severe OSA patients, some with life-threatening medical histories. There is no way I am going to attempt to treat those patients with a Somnodent. I guess that says it all.
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Re: Somnodent Vs. Tap III

Postby poster999 » Sun Apr 15, 2012 1:15 am

After trying and hating CPAP for a couple of months, I decided to give OA a try. I am slightly into the severe zone, so my doctor was against using an OA. However after reading things like this forum, I learned that OAs can work for many people with an AHI in the 30's. I researched specialists in the field and made an appointment with a dentist whose practice is primarily sleep apnea. I went to the appointment and asked to be fitted with a TAP3. He said he used to use TAP's all the time, however he has now switched to Somnodent. He said in his experience it is pretty much as effective at TAP, and is more comfortable, thus increasing compliance and patient satisfaction. Naturally he said its my choice, however I went with his recommendation.

I used the device with 100% compliance for about 3 weeks. Then I got some significant jaw pain and my dentist suggested I give my mouth a rest for a few days. I took a couple of weeks off to let my jaw get back to 100%, and decided to ease my way back into it by not using it every night, and not always using it all night. I also exercise my jaw differently. I have done this for about a month, and I have had only mild jaw pain in the morning, and it goes away in about an hour. I use it about 5 nights a week, and use it all night about half the time. Hopefully this easing in will allow me to be close to 100% compliant with little to no pain shortly. I will advance the device about 2 turns per week until I get to where I need to be. Apart from my jaw, I have no other side effects.

As for effectiveness, even though the device is not advanced as far as it usually needs to be, my wife says I never snore, and I feel more rested and alert than I have in years. Last week my dentist gave me a pulse oxymeter test, which shows my oxygen levels while sleeping. The results showed my oxygen levels dropped very little while asleep. My dentist said suggested I advance the device 5-10 more turns before my sleep test. Based on my pulse oxymeter results, he thinks I have a very good chance to get my AHI under 10, and a decent chance to come in under 5.

Given my dislike of CPAP, I thought that if I can get my AHI under 10, I would not consider trying CPAP again. If I can get it down to 5 that would be fantastic. So, even though the consensus seems to be TAP3 is the best, Somnodent seems to be working for me. The true test will be my next sleep test. I will post my results when I get them.
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Re: Somnodent Vs. Tap III

Postby a.b.luisi,d.m.d. » Sun Apr 15, 2012 3:46 pm

poster999 wrote:After trying and hating CPAP for a couple of months, I decided to give OA a try. I am slightly into the severe zone, so my doctor was against using an OA. However after reading things like this forum, I learned that OAs can work for many people with an AHI in the 30's. I researched specialists in the field and made an appointment with a dentist whose practice is primarily sleep apnea. I went to the appointment and asked to be fitted with a TAP3. He said he used to use TAP's all the time, however he has now switched to Somnodent. He said in his experience it is pretty much as effective at TAP, and is more comfortable, thus increasing compliance and patient satisfaction. Naturally he said its my choice, however I went with his recommendation.

I used the device with 100% compliance for about 3 weeks. Then I got some significant jaw pain and my dentist suggested I give my mouth a rest for a few days. I took a couple of weeks off to let my jaw get back to 100%, and decided to ease my way back into it by not using it every night, and not always using it all night. I also exercise my jaw differently. I have done this for about a month, and I have had only mild jaw pain in the morning, and it goes away in about an hour. I use it about 5 nights a week, and use it all night about half the time. Hopefully this easing in will allow me to be close to 100% compliant with little to no pain shortly. I will advance the device about 2 turns per week until I get to where I need to be. Apart from my jaw, I have no other side effects.

As for effectiveness, even though the device is not advanced as far as it usually needs to be, my wife says I never snore, and I feel more rested and alert than I have in years. Last week my dentist gave me a pulse oxymeter test, which shows my oxygen levels while sleeping. The results showed my oxygen levels dropped very little while asleep. My dentist said suggested I advance the device 5-10 more turns before my sleep test. Based on my pulse oxymeter results, he thinks I have a very good chance to get my AHI under 10, and a decent chance to come in under 5.

Given my dislike of CPAP, I thought that if I can get my AHI under 10, I would not consider trying CPAP again. If I can get it down to 5 that would be fantastic. So, even though the consensus seems to be TAP3 is the best, Somnodent seems to be working for me. The true test will be my next sleep test. I will post my results when I get them.

I am a dentist working in dental sleep medicine. Remember, although the TAP is the best, the Somnodent is one of the better choices. Somnomed provides an efficacy study on their web site that indicates a 62.5% efficacy rate for mild, moderate, and severe OSA combined. They define a success as either a partial or complete response. See: A Randomized, Controlled Study of a Mandibular Advancement Splint for Obstructive Sleep Apnea. Compare this with the TAP results that I have posted at: Do Oral Appliances Really Work- The Best Study Ever Done in the Oral Appliances Section of the forum and you will see the TAP is substantially better. However, at 62.5%, there will be a number of patients for whom the Somnodent will get the job done and you appear to be one of them. One other tip. Since the Somnodent is adjusted bilaterally, be very, very sure that you have both sides advanced EXACTLY equally. If they are unequal by even .10mm, you could get jaw pain. Good luck to you!
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Re: Somnodent Vs. Tap III

Postby chico74 » Sun Apr 15, 2012 4:01 pm

Hey, Thanks for sharing info. I went to check three local dental specialists and two of them said what yours did: Tap was being used in the past, now they're doing Somnomed... I went back to the one specialist who stayed firm with his Tap recommendation. He said Somnomed looks more cool and user friendly so paitients might prefer it, yet more expensive so both dentist and lab profit more off it. Also there's the explenation I got here that Somnomed is easier to be fitted.. I don't know!! I guess we should do what feels most comfortable. I decided to order the Tap Elite (which I think is an improved version of the Tap3) and tomorrow I should be getting it.. Very excited and looking to put my breathing machine (aka cpap) back in the closet :)
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Re: Somnodent Vs. Tap III

Postby a.b.luisi,d.m.d. » Sun Apr 15, 2012 4:25 pm

chico74 wrote:Hey, Thanks for sharing info. I went to check three local dental specialists and two of them said what yours did: Tap was being used in the past, now they're doing Somnomed... I went back to the one specialist who stayed firm with his Tap recommendation. He said Somnomed looks more cool and user friendly so paitients might prefer it, yet more expensive so both dentist and lab profit more off it. Also there's the explenation I got here that Somnomed is easier to be fitted.. I don't know!! I guess we should do what feels most comfortable. I decided to order the Tap Elite (which I think is an improved version of the Tap3) and tomorrow I should be getting it.. Very excited and looking to put my breathing machine (aka cpap) back in the closet :)

Good for you! You did your research and I think that you did the right thing! Your dilemma points out the problems that we all face. Dental sleep medicine is a relatively new discipline and the truth is often hard to find. As a professional, I am deluged by claims from manufacturers that their appliances are the newest and the best, often not backed by scientific studies. It took me years of clinical experience and diligent research to cut through the garbage and come to an understanding of the facts, so what chance does a layman have to get to the truth. Well, actually pretty good IF he reads this forum!
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Re: Somnodent Vs. Tap III

Postby poster999 » Sun Apr 15, 2012 10:24 pm

Thanks for your comments doctor and chico. I was quite interested in the observation that Somnodent is easier and quicker from a dentist's perspective. While I would hope my dentist would have recommended the Somnodent for reasons other than his bottom line, that explanation is not inconceivable. He did say right from the start that everyone's physiology is different, and if Somnodent didn't work for me, we could try the TAP. We didn't discuss how much of a discount (if any) there would be if we had to try the TAP. I can't wait to see what my AHI will be when I am retested. If I can come in close to 5, all is good. If not, I'll assess the situation then. I will be away for most of May, so I likely won't be retested until close to June.

Regardless of whether we use Somnodnet of TAP, we are addressing our problem with a quality product. I was talking to someone today who also has apnea and quit CPAP. I told him he should try an OA, as it seems to be working well for me. He just shrugged it off and said he is addressing his apnea by using a type of nose tape that he bought. Oh well, I tried.
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Re: Somnodent Vs. Tap III

Postby a.b.luisi,d.m.d. » Fri Apr 20, 2012 8:42 pm

I am a dentist working in dental sleep medicine. In view of the fairly intense interest this Somnodent VS. TAP III thread is generating, I have decided to present the actual studies upon which the respective claims to efficacy are based. For the Somnodent see: http://www.ncbi.nih.gov/pubmed/11371418. The abstract is skimpy. Go to the full text. However I will summarize the basic findings for the Somnodent. They define a complete reponse as the resolution of symptoms and a reduction of the AHI to less than 5 per hour. 1. for mild OSA the efficacy rate was 37%. 2. For moderate OSA the efficacy rate was 44%. 3. For severe OSA the efficacy rate was 33%. They also define a partial response as improved symptoms plus a reduction in AHI equal to or more than 50%, but remaining above 5. 1. For mild OSA the efficacy rate was 18%. 2. For moderate OSA the efficacy rate was 28%. 3. For severe OSA the efficacy rate was 33%. They also present reduction in AHI rates for all severities combined. In 37.5% of cases AHI was reduced below 5. In 54% of cases AHI was reduced below 10. In 75% of cases AHI was reduced below 15. Now let me editorialize a bit. I my view, these stats are not particularly impressive. Please contrast with efficacy results for TAP III posted on my thread, "Do oral appliances really work- the best study ever done." in the Oral Appliance section of the forum. One further note: Some of the results for the Somnodent study are presented in bar graph form. These are pretty hard to read and my figures may be off a percent or two due to inability to read the graph, but I did the best I could.
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Re: Somnodent Vs. Tap III

Postby Kent Smith » Sun May 06, 2012 7:09 pm

Wow. OK, let me first say that I, too, am a dentist working in dental sleep medicine. In fact, I'm a Diplomate, boarded by the American Board of Dental Sleep Medicine, so I'm no novice here, having made appliances for treating sleep disordered breathing for more than 15 years. Let me also state that I have spoken for Somnomed on more than one occasion, but this is because I started using their appliances years ago, and became a raving fan. I am not employed by Somnomed, nor do I benefit in any way if someone chooses a Somnodent over a different appliance. I own no stock in the company, nor do I get any discounts over any other dentist using the product. I'm just a fan, and I had to speak up here, as it seems to be getting abused on this forum.

A study was posted earlier (http://www.ncbi.nlm.nih.gov/pubmed/8542125) that was purported to show the SomnoDent was inferior due to the fact it allows a patient to open, but this study says nothing about holding the mandible in a protruded position during opening, as the Somnodent does. It appears as if some on this forum believed that assertion, so I wanted to clear this up.

Next, the study quoted above (http://www.ncbi.nih.gov/pubmed/11371418) did not even involve the Somnodent. The poster mistakenly believes that when an appliance is called a MAS, it must be the Somnodent, but in reality, it is a generic term for an appliance that holds the mandible forward through stabilization. In fact, the study was published 11 years ago, before the SomnoDent was even born.

To comment further, it was emphatically stated that those of us who use the Somnodent might do so because of its easy delivery. I do admit that it's quite easy to deliver, primarily due to the extreme customization employed during fabrication. The quality control is excellent. When you see more dentists using these, as some on this forum have stated, I would rather assume that they are doing so due to patient comfort and compliance, and not due to laziness or profitability. In fact, our lab fee is significantly higher for a SomnoDent, so if we were more concerned with our bottom line than with patient comfort, we would be using the TAP or something even cheaper.

It seems clear to me that there is an agenda, but I sincerely hope that is not the case. I use the TAP, Somnodent and many others in my practice, and each has their advantages and disadvantages, but please, let's use honesty in our posts here. The apneics on this forum deserve that.
Last edited by Kent Smith on Wed May 09, 2012 4:22 pm, edited 1 time in total.
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Re: Somnodent Vs. Tap III

Postby poster999 » Wed May 09, 2012 3:17 pm

Thank you for your feedback Dr. Smith. Interesting debate. I have been pretty successful in easing my way into my Somnodent. I wear it all night now, and use it about 4 nights on 1 night off to give my jaw a break. I still have some minor discomfort in the morning, but that usually goes away in about an hour. Apart from the minor jaw discomfort, I have no problems and hope to get up to over 90% compliant soon. My original sleep test showed I had an AHI of 40, but I have gone from 25 pounds overweight to 10 pounds overweight, so I presume my AHI is somewhere in the 30's now, but of course I don't know. My dentist has a table showing the results of his work. He has many patients in the 30-40 AHI range, and the results for people in this group show that about 75% got their AHI under 10, and 37% got down to 5 or better. The table does not however distinguish results among the different models. My next sleep study is at the end of May, so I should know my results in about a month from now.

I feel perfectly well rested now, so I just hope my AHI is at a point where it is not dangerous to my physical health. Even if I still have an AHI of around 10, I can't imagine I'd feel that much better under 5. Then again, I didn't know how tired I was before, until I started my OA and weight loss treatment.
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Re: Somnodent Vs. Tap III

Postby Kent Smith » Wed May 09, 2012 4:31 pm

Sounds like you are on the right road, and that you also have an excellent dentist handling your case. I am quite impressed that he has a table showing the success rates of his patients. That is quite unusual in the ranks of dental sleep medicine. There are many studies showing the effects of weight loss on AHI, but generally, you can expect to lower your AHI by 35% if you lose 10% of your body weight (assuming you NEEDED to lose 10%).

Keep us informed!
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Re: Somnodent Vs. Tap III

Postby Laura3 » Wed May 09, 2012 6:25 pm

I have a Somnodent also. Poster999, I am interested in knowing how much your Somnodent cost? Thanks.
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