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[Equipment] Oral Appliance NOT An Effective Treatment [Swedish Study]
#1
For those considering a non-CPAP solution offered by Oral Appliances (for mild-moderate sleep apnea patients), a new Swedish independent study proved...

(1) no improvement in snoring over a placebo mouth piece that didn't move the lower jaw forward -- both placebo and the $1000-2000 jaw advancing technology showed the same slightly improved results

(2) no actual improvement in daytime sleepiness

Source: June 1, 2015 JamaNetwork "Oral Appliance Therapy in Patients with Daytime Sleepiness and Snoring or Mild to Moderate Sleep Apnea"
Sleep Apnea has given me a terrible memory. Please forgive me if I've repeated myself.
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#2
That is certainly a data point to keep in mind, but seems rather sweeping, and we don't know how detailed or exacting this study was. Di they test 10 people or 10,000? Were they qualified with mild OSA, or severe?

For mild OSA, the appliance can indeed help. It still is probably not the best approach, unless you just can't acclimate to the mask. But it is not snake oil, it is proven at least partially-effective in many cases.

Will it work for a particular patient? Hard to say.

Also hard to say is how we verify this. One of the great features of modern xPAP is that you know immediately how well you are doing, and trends can be easily, automatically graphed out informing your path to better therapy. Or you press one button after waking up and get an immediate summary index (AHI) of how well you did that night, generally speaking. The data is significant, pretty accurate, and available. A mouthguard has no data; its a lump of plastic. A lump of plastic that can cost more than a modern full xPAP machine, which is a proven, non-invasive, safe, virtual 100% cure for OSA.

For me, this places the appliance in the "alternative" category only. I'd love to have one on a night when my power goes out, but otherwise, I think there are a lot better options.
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#3
I've read several articles (by dentists, SA experts and even oral device manufacturers) that mentioned that the best oral appliance technology would be one that...
(1) moved the lower jaw forward
(2) still kept the mouth relatively closed
(3) kept one's tongue pulled away from the back of one's throat

I'd love to see that technology come out along with a decent independent case study.
Sleep Apnea has given me a terrible memory. Please forgive me if I've repeated myself.
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#4
Me too. I think those features are available, and part of the common design.

I know my airway opens up dramatically if I jut my jaw forward, but I can't do that in my sleep. At least not without some sort of mechanical help.

It is important to know that a dentist has a conflict of interest (the same one every doctor has), which if the device is right for you, everybody's happy. But it the device is only right for his kids' 529 college fund, then only the dentist is happy. So he will always be happy, and you, maybe not so much. Bottom line, there is motivation for him to get you the appliance, and it may not be purely based on your medical need. Pure altruism is a rare quality.
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#5
http://archinte.jamanetwork.com/article....id=2296119
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#6
Would love to know who funded that study.

Wife's big boss has a jaw appliance and swears by it. Next time I see him I'm going to ask him about it. I used an OTC boil-it fit and it helped a great deal. Is one reason I put off cpap as long as I did.

I am very interested in as I know it works for me but boil-it fit wore out quickly.

Lest anyone want to challenge my experience I spent personal study time bending my neck slowly forward until I began to feel obstruction and then forced my jaw forward which cleared my throat instantly. It actually costs a lot more for dentist fit jaw appliance which is why I am on cpap.

I will report back when I have news.
I use my PAP machine nightly and I feel great!
Updated: Philips Respironics System One (60 Series)
RemStar BiPAP Auto with Bi-FlexModel 760P -
Rise Time x3 Fixed Bi-Level EPAP 9.0 IPAP 11.5 (cmH2O)
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#7
This is a study from 2011 with 805 partipants comparing the effectiveness of fixed to adjustable dental appliances which were alot more effective in getting the AHI below 5 for mostly mild to moderate ranges.

https://advancedbrainmonitoring.app.box....7pjn8s11y4

As an FYI, the web formatting is horrible on my computer so if that is the case for you,definitely download the PDF document.

Unlike the other link posted, this gives extensive details so it can be fairly evaluated.

49er
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#8
(06-03-2015, 02:15 PM)WakeUpTime Wrote: For those considering a non-CPAP solution offered by Oral Appliances (for mild-moderate sleep apnea patients), a new Swedish independent study proved...

(1) no improvement in snoring over a placebo mouth piece that didn't move the lower jaw forward -- both placebo and the $1000-2000 jaw advancing technology showed the same slightly improved results

(2) no actual improvement in daytime sleepiness

Source: June 1, 2015 JamaNetwork "Oral Appliance Therapy in Patients with Daytime Sleepiness and Snoring or Mild to Moderate Sleep Apnea"
THIS: Custom-made oral appliances reduced episodes of sleep apnea, snoring, and restless legs symptoms in patients with daytime sleepiness and snoring or mild to moderate obstructive sleep apnea (OSA).

2. Oral appliances did not improve daytime sleepiness or quality of life versus a placebo appliance in this population.

This study proves NOTHING to me. The one from 2011 quoted elsewhere in this thread seems better.

So this study says REDUCED EPISODES PF SLEEP APNEA AND RESTLESS LEGS SYMPTOMS with a custom-made oral appliance, BUT PATIENTS DID NOT FEEL ANY BETTER? Makes no sense! Or maybe its good to know sleep apnea really doesn't have any effect on us!

We have no way to know if the custom made mouthpieces were properly dialed in. This takes work and repeated testing. You don't just pick a measurement for jaw advancement and go with that. You need to work up to optimum advancement and if you go too far results start deteriorating on that side of the curve.

I suspect they are making the all too frequent mistake of using the term "restless legs" when they really mean "periodic limb movement disorder." These are NOT the same despite near universal confusion. HINT: "restless legs" is when you are sitting in your easy chair and and your legs are nervous == you have to keep moving them or you are uncomfortable. PLMD is you kick your legs while asleep. Now these may often or sometimes go hand in hand but they are NOT the same. Doesn't matter that too many doctors often use the terms interchangeably in their ignorance.

How can you have a "placebo" mouthpiece? I would know immediately if my jaw was being cranked to a different position. It took a few weeks before I could even extend my jaw to optimum AHI readings. It was dialed in with a pulse oximeter.

The Epworth Sleep Questionaire is pretty worthless. Every time I fill one out, the choice of answers are so arbitrary and meaningless my score is essentially random.

This study seem pretty suspect to me.

Don in Austin
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#9
Don in Austin you are doing exactly what I would do if I could swing it. I would love to see how I would score with a jaw appliance and my machine set just high enough to overcome mask resistance but not. A home jaw appliance effectiveness study if you will.

I use my PAP machine nightly and I feel great!
Updated: Philips Respironics System One (60 Series)
RemStar BiPAP Auto with Bi-FlexModel 760P -
Rise Time x3 Fixed Bi-Level EPAP 9.0 IPAP 11.5 (cmH2O)
Post Reply Post Reply


#10
(06-03-2015, 02:15 PM)WakeUpTime Wrote: For those considering a non-CPAP solution offered by Oral Appliances (for mild-moderate sleep apnea patients), a new Swedish independent study proved...

(1) no improvement in snoring over a placebo mouth piece that didn't move the lower jaw forward -- both placebo and the $1000-2000 jaw advancing technology showed the same slightly improved results

(2) no actual improvement in daytime sleepiness

Source: June 1, 2015 JamaNetwork "Oral Appliance Therapy in Patients with Daytime Sleepiness and Snoring or Mild to Moderate Sleep Apnea"

I started 15 years ago with a Resmed CPAP machine set at 9. I used it for about 5 years and then went to a VERY expensive orthodic known as OSB (Oral Systemic Balance) This device cost $5,000, the insurance paid half. This device moved my lower jaw forward and was adjusted a little at a time to move it further forward. It worked very well for 7 years but now I find that its not working so well. I don't know what happened. I am now back on CPAP and struggling with finding a mask. I really liked the orthodic. Just put it in and go to sleep. This same device is now $6500 dollars and beyond what I want to pay for it. I think for some folks this is the way to go. There are less expensive devices now although I don't think they are as effective as the device I had. Worth looking into though. My two cents
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