I was diagnosed originally with severe apnea with a repiratory distrubance index of 64.4 episodes per hour, and placed on CPAP.  After several months of successful weight loss, I was re-tested and my respiratory disturbance index was down to 17.2.   Might this make me a candidate for switching from CPAP to an oral appliance?  (I note that depsite the weight loss and lower rdi, there was no change in the required CPAP oxygen level, 8 cm).

David,

Sounds like the CPAP is working for you and congrats on the weightloss as that obviously made a huge impact. There's more knowledgeable people than myself about why there was no pressure change but as for the question I think it's really a matter of whether you just want to try it or not. Me and the CPAP could never come to terms with one another but even if I could use it without issue I think I would still have sprung for the OA just for the chance of not being stuck to the machine. The downside is, unless you can figure a way to get a trial one, it's a very expensive thing to just test out so you need to weigh that option. There's tons of devices out there but I like the SomnoDent MAS, it is a very well made device and is comfortable to wear and has great reviews. So really, unless you're one of the few who's insurance will pay for one, or you feel the chance at getting away from the machine is worth potentially tossing away a couple grand then you should probably stick with the machine. I got a feeling it won't be long before insurance companies are pressured into paying for these so in your case it might be worth the wait. Would it work? That's hard to say in any case, but given your AHI probably, still the only way to find out is buy one, unfortunately.

If you have a nasal mask couldn't you use a mandibular advancement device as well as the CPAP and see if you can get away with a lower pressure? You could gradually decrease you pressure until the treatment stops working. If you reach the lowest pressure you might be able to do away with the machine altogether! Is that a silly suggestion? What do you think?

Also, a MAD shouldn't cost the earth (well at least not as much as a CPAP machine). You pick up decent ones for < $200.


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Links: The Teeth Grinding Forum | The Bruxism Association

Your post was in June and it is now August.  My situation has changed and I just decided to check out the forum.  My answer may be late for you.  However, in answer to your question, I will tell you my story.  After a sleep study done with my mouthpiece, three years ago, my doctor recommended that I use it instead of the CPAP (I was having trouble sleeping with it) as my average AHI was 13 and O2 levels were acceptable.  Now, 3 years later I had a "recheck" using the mouthpiece at a different sleep center and ordered by  a different doctor.  This doctor is the only board certified doctor specializing in sleep apnea here.  The results were read differently than the first study.  In the latest study, AHI was given in each level of sleep instead  just a nightly average.  Most people have more events during the REM stage, and I had 37 with the mouthpiece and spent 1 1/2 hours in REM.  I am back on the CPAP and just had another study for titration.  If you want to change to using just the mouthpiece, my advice would be to ask your doctor for the readout during REM sleep and not rely on just the all night average.  Oxygen deprivation for 1 1/2 hours is not acceptable (in my case).  I was happy as a lark with the mouthpiece and am back to trying to adjust to Darth Vader masks and a hair dryer blowing up my nose.  Good luck.