Greetings

I have severe apena and have been trying to wear a CPAP mask for the last three years with no luck.  I then went in and had surgery on my knose,sinus cavity, and throat with no results(worst pain in all my 36 years).  Im looking for any help.  My sleep center keeps having me to try new masks with no results.  My last study they had me at pressures over 20 and I was still having apneas.  I believe I have a issue with my tongue because when I either sleep on my side or in a recliner I feel better in the morning.  I have been trying to loose weight with still no luck.  I'm 5'9" 192lbs

Any info on what device or the next step I should try.  I have a co-worker who told me to switch to a different sleep center for another diagnosise.

Thanks
Kelly

Kelly,

Find a dentist that knows about Sleep Apnea or a dental sleep specialist. I got lucky in that my dentist already had severe OSA and got himself a TAP3 oral appliance. I tried the CPAP for 4 months and never could wear it longer than about an hour, even using copious amounts of drugs. The TAP3 however, I think is the best money I've spent in a long, long time. If your OSA is caused by tongue issues (mine is) then an oral appliance could very well help you out, I feel 1000 times better in 2 months with the TAP3 than I ever did in 4 with the CPAP. Sounds like you've tried everything else, can't hurt to try this as well but it is important to get a dentist that understands what OSA is vs. one that uses these appliances to just treat chronic snoring.

Dental device are meant for mild to moderate apnea, not for severe apnea.

^^ That's your opinion and an uneducated one at that. There are many patients out there with severe OSA that are being treated successfully with oral appliances.

That was a bit of a rude response and not completely accurate or educated.  The American Academy of Sleep Medicine and the American Academy of Dental Sleep Medicine (AADSM), who are the experts and licensing board of dental sleep doctors in the U.S., both say that:

"Recent studies show oral appliances to be most effective in treating snoring and mild to moderate obstructive sleep apnea. However, some appliances have been shown to effectively treat severe apnea in some cases."

http://www.aadsm.org/Faq.aspx

BTW Kelly, if you are in the U.S., find a dentist licensed by the AADSM.

Vicki


_________________
Being defeated is often a temporary condition. Giving up is what makes it permanent.
Marilyn Von Savant

That which does not kill you makes you stronger-Friedrich Nietzsche
Friedrich must of had apnea.

That may be the case Vicki, but you left out part of that quote.

Quote:

Recent studies show oral appliances to be most effective in treating snoring and mild to moderate obstructive sleep apnea. However, some appliances have been shown to effectively treat severe apnea in some cases. While oral appliances are often effective, it is important to know that they are not adequate for everyone and to date, it is not possible to predict the successes from the failures prior to treatment.

The same thing is true for CPAP which is touted as he only 100% effective treatment for OSA (particularly on this board), which is bold face lie because stats show only 30%-40% of people can actually tolerate the thing, so it's really not all that effective and probably even less when you factor in effectiveness is gauged solely on a 4 hour use window to be compliant. There is no difference in saying using a CPAP for 4 hours is good for you because you're at least getting some benefit vs saying an oral appliance used all night may reduce your OSA by some x factor.

Quote:

CPAP is effective at treating the majority of cases of sleep apnea for patients that regularly use CPAP. The major problem with CPAP is that some individuals have difficulty tolerating CPAP. Some complain of a claustrophobia. Others report an uncomfortable air pressure sensation in the nose or throat.

http://www.sleepassociation.org/index.php?p=whatiscpap

In my own case AHI of 75 the certified specialist I saw and the ENT both said they wouldn't recommend CPAP as first line treatment due to the cause of my OSA. The point being, it's impossible to know what will work for any one individual, so while my comment may have been a tad bit rude, blatantly casting off an option is borderline reckless and does nothing for boosting Kellys moral over the whole ordeal. Anyway, sorry, wasn't meaning to be rude about it, but the hosehead mentality is a bit frustrating.

Kelly,

Exactly what are the difficulties you are having using a CPAP?  If you post them, we can suggest some things for  you to try.  You may have some difficulties whose solution is simple.

What is your AHI?  Just to be clear, the severity of your apnea is based on AHI, not the pressure required to open your airway.

For most people, their apnea is worse when they are on their back no matter what the cause.  Gravity pulls all of the tissues down.  Therefore, we tell people to sleep in a recliner or prop themselves up with pillows as much as they can until they get treated.  The point being that it is hard to know exactly what is causing your apnea without a thorough evaluation and perhaps even an endoscopic exam.  What matters is just to get your airway open.  As your unfortunate response to surgery demonstrates, the success rate of an UPPP (if that is what you were saying you had to have your throat opened) is unacceptable in cases of severe apnea.

Vicki

Vicki


_________________
Being defeated is often a temporary condition. Giving up is what makes it permanent.
Marilyn Von Savant

That which does not kill you makes you stronger-Friedrich Nietzsche
Friedrich must of had apnea.

I have severe sleep apnea (49.7 AHI) and have been unable to succeed enough in CPAP therapy to be prescribed a CPAP machine.  While I address my medical problems in my nose I have succeeded (in my opinion) to help improve a major portion of my sleep apnea symptoms using a dental device.  I am 100% compliant for at least 8 hours each night wearing my Somnodent MAS device.  Has it cured my sleep apnea? NO. Has it eliminated my snoring? YES  Has it eliminated my morning headaches?  YES!  Has it eliminated my afternoon sleepiness? YES!   Has it increased my O2 levels while sleeping? YES!  Has it help increase my energy levels? YES!  Will it help me pass a titration sleep study to obtain a CPAP machine?  I can only pray that it will.  A dental device is not a magical cure for everyone, just as being 100% compliant with CPAP is not possible for everyone.  Both are treatments that need to be utilized to fight sleep apnea.  Even partial relief with a dental device is much better than zero relief from a CPAP mask that is thrown on the floor from frustration.  For all who have conquered CPAP therapy and are 100% compliant I applaud your success.  For those of us that have not succeeded keep up the fight by whatever means necessary.

That's awesome paphemi, please let us know how your sleep study goes if you do another one. I plan to but have to resolve some issues with the design of the TAP3 the manufacturer is working on first but if I had to guess I'd say a 60% improvement. Maybe not a 100% if I could wrap my head around the CPAP but it's certainly better than the 0% I get currently with CPAP. It's kind of aggravating they aren't given more consideration simply because insurance rarely covers them but I think that will change in the near future.

As part of the treatment package I paid $2200 out of pocket for, the Somnodent MAS dental appliance included three sleep studies using the "Watch-Pat 100". (before treatment, mid treatment and after final adjustment).  Due to the distance I have to travel I go for adjustments every two to three weeks.  I am nearing the final adjustment and expect to do one final sleep study to obtain actual AHI and O2 desaturization numbers.  I am also having a deviated septum repaired, turbinate reduction and surgery to repair a collapsing nose valve (NO UPPP). I am also under going a major lifestyle change including weight reduction , more excercise, no alcohol or coffee.  I think all of this is having an major impact on the quality of my sleep.

Bearded One wrote:

Dental device are meant for mild to moderate apnea, not for severe apnea.

This is a common misconception.  I had severe OSA.  I'm a very big dude -- 6'6" 340.  I had a CPAP pressure of 19.  I was told at best the device would let me lower my CPAP pressure (which would have been a huge benefit in and of itself).  The TAP appliance COMPLETELY solved my problem.  This isn't the case for everyone, but the folks I worked with said you can never be sure who will and who won't benefit.  I blogged about it here [Moderated. Please adhere to postng guidelines].



Last edited by KoiFish on Sat Feb 28, 2009 4:10 pm; edited 1 time in total

After adjusting to 5.5 mm I just completed another sleep study using the Watch-PAT 100.  I must say that I was pleasantly surprised by numbers.  I was not totally surprised because I have felt so much better.  I will have another test in 3 months as I continue to lose weight.  The latest numbers are as follows:

pRDI---14.0
pAHI---9.9
ODI---4.8

O2 Mean%---92
O2Minimum%--82
O2Max%--97
MeanNadirs%---89

Pulse Rate
Mean---58
Minimum--42
Maximum--88

Study Time---6 Hrs 42 Min
Sleep Time---5 Hrs 41 min

%Rem of sleep time--22.4

Desaturation events
4-9%--26 for a total duration  of 9.2 min
10-20%--1 for a duration of 0.2 min
>20%---0

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.   It worked pretty good when it was new.   I just got the SomnoMed MAS and am truely surprised and pleased with 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

How did the oral device work out?

Just did a sleep study last night! I am ecstatic! My severe sleep apnea index of 66/hr came down to 3 per hour using my new appliance. I will have to get you guys the actual name of the appliance. I don't know what it's called. I went to a sleep center here in Ohio and they made it for me. It is a two piece unit. the upper and lower is custom fitted. the lower protrudes my jaw so that I will have better air flow. I never thought I would have such incredible results! When I went to make it, they told me it may only "help" my apnea, bringing it down some, to a more moderate level. This is truly amazing. Do not say it won't work unless you try it. Everyone is different. I only wish I did this many years earlier instead of suffering as much as I have been. I could not stand the cpap and just suffered the sx's of my apnea! Today is a wonderful day....there is hope for me....and I wish for you too! Smiles....Diane