I have recently been to a new doctor for my sleep apnea and she has suggested trying an oral appliance. I discovered my apnea about 9 years ago and have tried several CPAP machines and facial equipment, the oral appliance is new to me. I have been told that my apnea is obstructed due to a small hard pallette but the same amount of skin in the area.

I haven't made my appointment with the orthodontisit yet but is there a statistic stating the success of an oral appliance. To be honest I would much rather have the surgery available to take care of it permanently.

Thanks, this is my first post to this forum.

I recently read that the rate of help with the mouthguards is about 65%.  I use the full breath mouthguard and find it very comfortable but am not really certain it is helping all that much based on an in-home sleep study that my dentist did.  Since then they changed the shape to that like a sting ray fish.  I am awaiting the results of the last in-home sleep study.

Cheryl

The success rate of the oral appliance is dependent on the severity of your apnea.  It is most helpful in curing mild to moderate sleep apnea.  Below is a link on the success rate of an appliance:

http://health.nytimes.com/health/guides/disease/sleep-apnea/dental-devices.html

It seems as if the appliance may help you since your apnea is mainly due to throat obstructions (as opposed to being caused by obesity).  The oral appliance will gradually move your lower jaw forward to increase your airway opening.  I am not the typical sleep apnea sufferer - I'm female, thin and young but due but for some reason I have apnea (I think it's because of my tongue but have not confirmed this with an ENT visit).  An oral appliance is very expensive, I paid about $2500 for my TAP device since my medical and dental insurance wouldn't cover it but it cured my apnea so it was worth it.  It didn't take that long to get used to, about a couple days but it takes several months before you feel its benefits. Before plunking down a lot of money I suggest you see an ENT (ear, nose, throat specialist) to see if this appliance would benefit you.

Just an update, I did go to an ENT and he felt the although a valid option, the oral appliance is a less successful option. I have applied to and have received appoval for the surgery, I can't even pronounce it never mind spell it.

Webdad-- Did the ENT tell you that the surgery will 100 % " take care of your problem"?  Mine gave no guarantees and surgery is so permanent and non reversible.  With a dental appliance the only drawback is the cost if it don't work.  My friend had UPPP surgery and still has apnea.  Just a thought but I wish you luck on what ever treatment you choose.  Please let us know the results as it will benefit those that still have difficult decisions to make.



Last edited by papahemi on Tue Jun 10, 2008 5:01 pm; edited 1 time in total

papahemi,

No, he did not give a 100% guarantee but given the fact that my apnea is only moderate, he has said I have a more promissing chance overcoming it. I do have to work on losing some weight as I am overweight and of course that is contributing to the apnea. He did tell me that he has seen mixed results with the oral appliance. Some of his patients have used the device and have had to have dental work because of it, saying that the oral device played havok with their bite, so it may not be just the cost of the appliance, it could cause me some serious dental work down the line. I have had experience with dental work and crowns, and it seems that I don't bite properly to begin with, I could only imagine additional issues later.

Here's my thing, I have a better chance with the surgery than the CPAP and the oral appliance. In combination with weight loss I could be rid of it. I don't believe in treating the symptoms of apnea for the rest of my life and to me since my apnea is due to obstruction, I'm dealing with the problem.

Webdad
I wish 100% success in your surgery option. I would be interested in the results that you acheive from the surgery the ENT recommends.

phoebe368,

You are not alone! I am 32, male, and thin. I was diagnosed with sleep apnea 3 years ago but know that I have it for at least 10 years. I complained about my sleep problems to all kind of doctors for many years but no one suspected that I had sleep apnea (and hence, did not suggest a sleep study) since I did not fit the typical profile of SA patients. Finally, an ENT recommended a sleep study that detected mild to moderate sleep apnea.

I have been using CPAP since 2005 and have been very compliant, but it is only partially effective since my sleep apnea is because of deviated nasal septum as well as a large tongue base. To make the matters worst, I recently got a lot of sinus problems (i.e., constant nasal congestion leading to sinus infections every few months) and CPAP only makes these matters worst.

I had a surgery to treat the deviated nasal septum last year but it didn't help much. My new ENT is recommending another surgery that involves removing tissues from many sinus areas. He thinks that it will help with OSA.

Considering my first surgery experience, I am fairly hesitant to go for this second surgery so I talked to my sleep doctor and we decided to get a second opinion from a dentist that specializes in OSA.

The dentist thinks that the primary reason for my OSA is the large tongue base, and CPAP can't be of much help with that (and so is sinus surgery). He ordered a TAP appliance for me which I am expecting to receive on Monday.

I hope that the oral appliance will help! Will keep all of you posted.

At the end, an observation (which may help webdad): I saw many sleep doctors (pulmonologists), ENTs, and now the DMD. Sleep doctors tend to favor CPAP, ENTs tend to prefer surgery, and DMDs off course tend to prefer oral appliances, primarily because they specialize in these areas (and also because they make their living out of these treatments...). So keep your options open and try to objectively analyze what is the best option in your specific case.

Welcome to the forum logicators. Let us know how the TAP works for you.

Logicators,

I too have had sleep problems all my life, whether it was difficulty falling asleep or staying asleep.  I tried to cure this problem myself by taking over the counter sleeping pills etc.  This insomnia continued into my adult life and affected by whole well-being.  At various stages in my life I have dealt with crippling anxiety, depression and panic attacks as a result of this problem.  The doctors I went to just said it was stress and prescribed me prescription sleeping pills.  Since I didn’t look like the typical sleep apnea patient, young, thin, female etc. I was incorrectly diagnosed.  At age 27 I finally had a sleep study or polysomnography done which revealed that I had mild sleep apnea and UARS – cut and paste this link on a UARS article into your browser:

http://web.mac.com/sypark/iWeb/West%20Side%20ENT/UARS.html


I got a CPAP machine and TAP dental device which solved the problem – I finally have my life back!  I hope the TAP dental device works for you – it’s supposed to help people who have a large tongue base (such as yourself).  They key to effective treatment with TAP is to advance the device very, very slowly.  I have the TAP 1 dental device.  For the first 2 weeks I had it at 0 turns then I would advance one turn on the first night, wait 3 nights, then advance again on the 5th night.  It took me approx. 3 months to really feel its benefits.   Be patient with the treatment and keep us posted!!

phoebe368,

Thanks for the interesting link. With an exception of a complete inability to sleep on the back (I sleep on the back 30-40% of the night), I have many of the UARS symptoms.

I fully believed the doctors when they suggested that I couldn't sleep because of stress (full time, a family, and pursing a doctorate concurrently).

I used ambien, lunesta, and sonata for many years (each of them either became ineffective after some period of time, lunesta lasted the most but caused many other problems...). I was asked to continue using them even after sleep apnea was diagnosed. But frequent excessive daytime sleepiness remained, as well as periodic anxiety and depression. I learned the hard way that using sleep medications along with CPAP, and having sinus problems can make the matters even worst.

Not to mention that some doctors even suggested that exercising or using herbal teas at night would cure all my sleep problems.

Looking forward to try the TAP!

Receiced the TAP device yesterday. Its a TAP-TL. I assumed that the dentist will order the latest version (i.e., TAP 2 or TAP 3), but apparently he was not familier with these versions. Anyway...

He advised me to wear it in the neutral position first night, and then make a half turn every night until it reaches 75% of the maximum movement allowed by my lower Jaw. This means that it will take me a little more than a month to reach to the required setting.

I tried the device last night in the neutral setting. It was a little unfomfortable at first (and there was a lot drooling, as expected). I was able to tolerate it for about 5 hours and then took it off. Hopefully that will improve with time.

Update: I used TAP for another 3 nights, and have been advancing it a half turn each night (so its at 1.5 turns at this time). I am now able to tolerate it for the whole night. I also tried to use the CPAP along with it (as it will take me a while to reach a state where it could treat OSA), but I couldn't tolerate them together for any more than a few hours.

Interestingly enough, I already started to feel some improvement. Hopefully it will continue at a steady pace.

Webdad

Be VERY careful before you go for a UPPP!! The success rate is VERY low and it hurts like the dickens!!

Most ENT's that i work with have drastically reduced the amount of UPPP and are going towards Cpap's or OA. As your OSA is only moderate, your ENT should not have suggested a UPPP but only in cases of severe OSA.

Pls, think again and get a second opinion.


_________________
Gary J. Sagiv
Vice President
Itamar Medical Inc
sgary@itamar-medical.com

Gary,

Thanks for your comments...

My UPPP is scheduled for the 17th of July. It's because my apnea is moderate that he suggested the UPPP and said I would have better success than those with severe obstructed apnea. He's one of the top ENT's in his field and has performed well over 400 UPPP surgery's and was very up front about any problems that may araise and the pain I was in for but I think for myself it will be worth it. I've done research and there isn't one method I couldn't find that is 100% effective and there is nothing that is going to take away the obstruction, that's always going to be there. I could lose some weight and possibly reduce the effect of the obstruction but what happens to 99% of the people who lose weight?

This was more or less a second opinion. Before the ENT, I went to another sleep doctor who wanted send me to an orthodontist to be fitted for an oral appliance which may or may not be covered by insurance. I've been to three sleep doctors plus the ENT and all except the ENT want to treat the symptoms rather than the problem.

I can't imagine myself using a CPAP or oral appliance for the next 40 years of my life, to me that's not living a full quality life,  and that's not to say that it's not for others but I know myself and I would not be happy. I have 3 children, 2 of which are twins and as a stay at home dad and web designer, I am up until wee hours of the morning at times. Even with the amount of sleep I get I am not refreshed, my personality has changed over time and so has my weight, and my wife tells me I'm costantly grouchy particularly in the morning. I don' want to go through this any longer if I can attack the problem.


Bob