SomnoMed Mas

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SomnoMed Mas

Postby big2007sky » Sun Jan 18, 2009 9:03 pm

Hi all,

I've been diagnosed with "relatively" mild sleep apnea. My oxygen saturation doesn't dip below 92% and most of my issues are with hypopneas. My sleep doc has stated my extreme fatigue must be caused by lots of fragmented sleep. I'm 5' 10", about 192lbs (lost about 11 pounds over the last few months). Not too much overweight as I do lift weights but I could use to lose about 10 additional pounds. I exercise most days during the week. I've tried all of the recommended sleep hygiene steps to no avail.

Anyway, last August I had a cpap titration (no sleep that night) and was given a machine to take home. Unfortunately, even with such a low pressure (6), I can't seem to fall asleep with any mask, this includes using the "ramp" setting at a pressure of 4 for a half hour. The best I've been able to do is sleep for about four hours using a Swift II Nasal Pillow and either .5mg Xanax or 3mg Lunesta. Without the drugs, I can't seem to fall asleep. It's not that I can't stand wearing the mask, I just can't fall asleep with it on.

So I decided to see a dentist who specializes in sleep medicine. He seems to be well know in my area (Lexington, MA). So I went with a SomoMed Mas device. Last night was the first night I had used it. I can't seem to remember what number the device is extended at. Last night I used the device with about .5mg Xanax (only using the Xanax because I've been using something to assist in sleep for about two months and don't want to start using the device with rebound insomnia). I was able to fall asleep but awakened about four hours later with some sharp pain in my lower teeth. My jaw doesn't seem to hurt but some of the teeth located at the front of the lower jaw begin to hurt. Today I do have some teeth soreness but my jaw seems to be ok.

Has anyone tried the SomoMed, or any other dental device for that matter? I'm looking to see if anyone has had some success with these devices. Have you experienced tooth pain? If so, how long did it take to go away? I understand everyone's anatomy is a little different so what works for one may not work for others. I do understand this may be a long process as I'm sure the device will have to be extended.

Any feedback would be appreciated!
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Smnodent MAS

Postby papahemi » Mon Jan 19, 2009 11:02 am

big2007sky-Welcome to the Oral Appliance board. I have been using the Somdodent MAS since March of 2008. I have experienced no teeth pain or teeth movement. The only discomfort I had was a slight jaw soreness that soon went away during the adjustment period. You can click on my username (papahemi) and read all my posts. I have been one of the very fortunate severe apnea suffers who actually benefited from dental appliance therapy. Although I have not reached an AHI of less than 5 ( I am at 8) my O2 levels are constantly above 91% and I no longer suffer from headaches or day time sleepiness. I am over weight and I now have the energy to excercise. Since March I have lost 53 pounds. This may have also helped with my AHI numbers. I have gone from 80mg of blood pressure medicine to 20mg a day. My advice to you is take your adjustments slow and allow your jaw to acclimate to the movement. I highly recommend using the "bite tabs" after removing the Somnodent MAS to return your jaw to its "normal" position. I also brush and rinse my dental device every morning with toothpaste to keep it clean. I hope the tooth pain subsides and I wish you success. If you have any specific questions I will try to answer them or maybe one of the experts that watch this forum can answer you. Again welcome to the forum.
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Postby big2007sky » Tue Jan 20, 2009 1:21 pm

papahemi

Thanks for the reply. Congrats on losing the weight and being successful with the SomnoMed device.

Last night I had yet another sleepless night with the device. The teeth pain is just unbearable. I'm wondering if the mold isn't configure properly? When you place the plates on your teeth, do you notice any tightness on your teeth? As soon as I place the plates on my teeth, it feels rather tight. My dentist said it may require a "break in" period? Also, I've already been back to the dentist once as the left "fin" would touch my plate before the right fin, resulting in too much pressure on the front left teeth. If I look at the device, I can see that the left side is retracted as far in as possible. The right side is adjusted forward. In other words, they are not evenly adjusted. I'm wondering if this is normal. If not, maybe the mold isn't properly configured? I'll be seeing my dentist soon as I can not sleep with the device and will be sure to ask him the same questions. Just hoping to get some feedback from a "patient's" point of view.

Thanks again
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Somnodent MAS fit

Postby papahemi » Tue Jan 20, 2009 2:13 pm

I am really sorry to hear you are having problems. I at first wasn't too sure I made the right device choice but I am glad I went with Somnodent. Stay with it and try to work out the fit problems.
Does your Somnodent MAS device consist of all acrylic material or does it have the new softer lining that I have heard of (called FLEX-FIT)? I can feel my plates as soon I as put them in but by the time I get into bed I don't notice them at all. In the morning I can actually feel no forward pressure on the fins at all . Maybe your initial adjustment from the manufacture is too far forward. I believe its is set at 60% to 70% of your maximum lower jaw movement forward. ( Mine was about 3-4 mm forward of the natural position.) I have adjusted 5.5 mm forward since receiving my device. I had Watch-PAT 100 PSG tests three different times to measure the effectiveness of the Somnodent device. The readings showed the improvement I was looking for along with actually feeling the change in my sleep effectiveness.
I would definitely let your dentist know that it doesn't fit right. They do have a one year warranty for the device if its made wrong. It sounds like to me the pressure is all on the front teeth instead of being distributed over all the lower teeth. Is it easy to remove from your mouth or does it feel like its going to fall out? When its in does it feel like it pulls the lower jaw to the left or right? The tabs or the adjustment blocks may not be in the same location causing the difference you describe in their relative location to each other. My is device is .025 inch different from left to right. My teeth look aligned when device is in place. My upper and lower molds were made at separate times so I really don't see how they can know where to put the adjustment blocks to be at the same distance. I believe there would have to be some degree of allowance for contact adjustment. Just my opinion though.
You can also email or phone contact Somnomed for great information. they were very helpful answering the more technical questions for me. Let us know how it goes. Here is the link to Somnomed:
http://www.somnomed.com/Contact_Us.aspx
Last edited by papahemi on Wed Apr 15, 2009 10:24 pm, edited 2 times in total.
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RE

Postby big2007sky » Sat Feb 07, 2009 8:13 pm

papahemi

Thanks for the info. Your input is greatly appreciated. I had to return to the dentist twice over a two week period. This was due to waking up with the tooth pain after only about two hours sleep. The doctor shaved some of material away from the "problem" areas and it seems to be much better now. Last night was my first night with the new adjustments. I was able to sleep with the appliance for about five plus hours. After waking up at 5am, I did have some tooth discomfort so I removed the appliance. I have two "canine" type of teeth on each side of my mouth. I believe they're taking most of the pressure and do believe this will go away in time.

I'm not extended too far but even after one evening with five hours sleep, I noticed a difference. If I sleep without the appliance, I wake up with extreme fatigue and have a very difficult time leaving the house. After using the appliance last night, today I was still rather tired upon wakening, but I was able to function the entire day. I'm sure with additional sleep and more adjustments, I will continue to feel better.

Thanks again!
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Glad to hear the news

Postby papahemi » Sun Feb 08, 2009 3:21 am

big2007sky- I am glad to hear that things are improving. Keep working with your dentist to get the fit right and i believe you will enjoy good results. Keep us posted on your progress
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Postby BJH » Sat Mar 07, 2009 1:04 am

I have severe OSA. I have had 3 sleep studies in the last 12 years. I wore the SilentNite oral device for the first 12 years with moderate sucess. I just got the SomnoMed and am truely surprised as to how well it works. At night, my wife was reaching over to touch me to see if I was in bed because I was breathing so quitly she couldnt even hear me. This is a well designed oral appliance. BJH
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Postby hymaneric » Sat Mar 14, 2009 11:31 am

BJH wrote:I have severe OSA. I have had 3 sleep studies in the last 12 years. I wore the SilentNite oral device for the first 12 years with moderate sucess. I just got the SomnoMed and am truely surprised as to how well it works. At night, my wife was reaching over to touch me to see if I was in bed because I was breathing so quitly she couldnt even hear me. This is a well designed oral appliance. BJH


What were your AHI values before and after? Were you able to eliminate CPAP?

I am a CPAP user with severe OSA (AHI=40) and just got a SomnoMed 2 days ago and am interested in knowing whether I will be able to drop the CPAP.
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Postby big2007sky » Mon Mar 16, 2009 4:32 pm

papahemi

It seems as if I may be making some progress with the Somnodent MAS. I'm still experiencing teeth pain but it has subsided and I'm now able to obtain 5-7 hours of sleep each night. Some nights I'll use 3mg's Lunesta and other nights I'll sleep without. I still can't seem to acquire more than 5-1/2 hours sleep without the Lunesta but it's certainly an improvement over the 2-3 hours. Still I wake up not feeling very refreshed and I'm still quite fatigued during the day but I have noticed I'm having numerous dreams, my eyelids have stopped twitching and I can at least get through the work day. This is while adjusting only 1 MM from my original starting point.

I'll continue to visit my dentist every two to three weeks for adjustments. In the mean time, I have scheduled an appointment to see Dr. Steven Park at West Side ENT in NY. I'm hoping he may be able to shed some additional light on my symptoms. Most of the sleep specialists I have visited here in the Boston area seem to approach apnea treatment with a "cookie cutter" mentality. Also, I have another sleep study scheduled for early May. Hopefully I'll see some improvement on my numbers by then.
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Great news!

Postby papahemi » Mon Mar 16, 2009 9:28 pm

I am so glad to hear you are improving. I on occasion use some Advil PM when I overdue it on the weekend.
I just finished reading Dr. Parks book "Sleep Interrupted". Great book. He sounds very knowledgable concerning OSA.
I know what you mean by "cookie cutter " mentality. Thats one of the reasons I went to a dental device. Got zero help from my medical doctor.
Keep on plugging away and keep us posted. I really started to feel better at 3 MM of adjustment. Go slow and it will come.

One of my co-workers got his Somnodent MAS on Monday. He said he is sleeping better already. He is still waiting for his first adjustment.

Good Luck to you.
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Postby jwpegram » Fri Mar 27, 2009 12:25 pm

I've been using the Somnodent MAS since November 2008 and it is amazing at the difference it makes. I'll make a suggestion based solely on my experience. Adjustment of the MAS is made in 1/10 millimeter increments, so 10 "adjustments" equals 1 millimeter of movement (you might know that already). I read all the stuff about why the dentist should do this and why a PSG should be done periodically during this adjustment period. having discussed it with my dentist who also uses the device we decided I'd just do the adjustments myself. Sleep studies are a pain, I hardly ever sleep and honestly, beyond the potential for over adjustment of the lower jaw could see no reason to follow some strict protocol. My guess is it will be different for different people, the biggest concern is like I said, over adjusting to the point of pain in the jaw. My device started at 3mm and I have adjusted out to 5.5mm, that took me a couple of weeks and I did based on how I feel the next day. human vs. not human. I have gone to 5.8mm but didn't feel as good as I did at 5.5mm. This is the reason I went in for another PSG to get a bearing on how this is helping, I felt I'd hit a plateu in adjustments I could readily tell.

All that said, two things:
First, if you're having teeth pain while wearing the device or continued pain after taking it out (say beyond an hour) then the mold most likely isn't quite right and it should be something the dentist can fix in the office. Otherwise it may be normal, I got crooked teeth and he told me it would probably move them initially, much like an Invisiline would do albeit only minorly but still enough to cause some initial discomfort that should go away.
Second if you chose to make your own adjustment the biggest concern is the jaw pain. If you have jaw pain while wearing it or pain that doesn't fade away in a half hour or so or your jaw begins to click, pop or stick, the adjustment is too much, just back it off. I made adjustments in 3mm turns the first week, at about 4.8 or so I could tell significant difference in how I felt and morning discomfort so I slowed it down. Listen to your body it'll tell you whether your going too fast or not. Just be aware of how you feel, there will come a point where you won't be able to tell if it's doing anything and that's when you need to probably has a PSG to get an idea where it's at.
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Postby hymaneric » Tue Apr 14, 2009 8:57 am

While the CPAP certainly helped me feel and look better, I am very happy that a PSG confirmed that the Somnomed mandibular advancement device with a setting of 4.2 mm of jaw advancement will allow me to stop using the CPAP machine. I previously had an AHI of 40 and am not obese.
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RE:

Postby big2007sky » Tue Apr 14, 2009 7:13 pm

What is your AHI while using the Somnodent?
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Postby hymaneric » Wed Apr 15, 2009 2:31 pm

Will let you know when I get the PSG report later this week, but the AHI must be less than 5 because at that level they were supposed to wake me up to increase the adjustment on the Somnomed and they did not need to do that. The technician told me that my results looked very good and showed very little snoring.
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Postby TXLadybug » Wed Apr 15, 2009 4:28 pm

How can I find out who in my area makes the Somnodent product?
ResMed Auto Set II w/hi4 Pressure 9 - 20 EPR at 3 Mirage Softgel or , FitLlife
Orig AHI 30.4 RDI 36 & RLS/PLMB
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