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#11
(03-07-2012, 04:03 PM)Sleepster Wrote:
(03-07-2012, 11:58 AM)SnorkelTodd Wrote: The clear airways spike as I come down in pressure, then subside with a day or two.

So, this is some kind of rebound effect. Therefore, if you eliminate CPAP therapy altogether, essentially setting your pressure to zero, you may temporarily induce some clear-airway apneas. These could be why you feel like crap with just the oral appliance and no CPAP. On the other hand, you could be experiencing genuine blocked-airway obstructive apneas.

You could wait and see how you feel after a few days of no CPAP therapy, but as far as I know the only definitive way to make a determination is to have a sleep study done with the oral appliance in place.

Oximetry data would be informative too.

Netskier
My age is none of my mind's business. --- Netskier
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#12
The sleep dentist told me that I will probably feel tired when I drop off the CPAP. He said your body is used to breathing with the CPAP pressure and it take some time for it to adjust back to no CPAP. A withdrawal effect. I think as Sleepster mentioned, it seems to me that dropping my pressure causes a spike in clear airway apneas. This is probably what the dentist was saying about the withdrawal effect. That is why I reduced my pressure on my own as a way to lessen the withdrawal effect.

Here is the tough spot I am in and as far as I know, anyone that switches to a oral appliance has the same problem. How to know how well it is working if you don't have your CPAP machine with data? So just using the O.A, am I wiped out due to apneas or just the withdrawal from CPAP? My machine only goes down to 4cm and using it that low feels like a can't breath. Although I can handle 4.5cm.

So the process forward is to adjust the oral appliance and then sleep and see how you feel. If you feel tired, adjust it some more the next night until you find the "sweet spot". Once I have done that and think its working, I will have a sleep study done with the oral appliance. This is to confirm/see how well it actually works.

I see the sleep dentist tomorrow to get adjustment instructions and I will see what he says about my process of pressure reduction and progress Smile
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#13
I had an oral device for a while but after some time with it I got TMJ (jaw pain) something awful. Also I choked on something in my sleep and had to rip the device off my teeth while I was half asleep. After that I found the device on the floor in the morning. I had thrown it across the room in my sleep.
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#14
I also ended up with TMJ. I haven't used the device in about a year, and I am still having problems with my jaw. When I first started using the device I did stop snoring for a little while. After a bit it didn't matter whether I was wearing it or not, I was snoring again. From my experience it was a very temporary fix, and did more harm than good. I hope you have better luck.
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#15
(12-29-2013, 02:30 PM)Lukie Wrote: I had an oral device for a while but after some time with it I got TMJ (jaw pain) something awful. Also I choked on something in my sleep and had to rip the device off my teeth while I was half asleep. After that I found the device on the floor in the morning. I had thrown it across the room in my sleep.

A custom fitted oral appliance combined with a "bumper belt" to discourage sleeping on my back has been working pretty well for me for almost a year now. I rate success by perceived quality of sleep and a recording pulse oximeter. Jaw discomfort is minimal.

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#16
(12-29-2013, 08:25 PM)Don in Austin Wrote:
(12-29-2013, 02:30 PM)Lukie Wrote: I had an oral device for a while but after some time with it I got TMJ (jaw pain) something awful. Also I choked on something in my sleep and had to rip the device off my teeth while I was half asleep. After that I found the device on the floor in the morning. I had thrown it across the room in my sleep.

A custom fitted oral appliance combined with a "bumper belt" to discourage sleeping on my back has been working pretty well for me for almost a year now. I rate success by perceived quality of sleep and a recording pulse oximeter. Jaw discomfort is minimal.

I am just curious if you ever had a sleep study and if so, what were the results of your sleep study? Have you used CPAP before and it wasn't working for you?

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#17
(12-29-2013, 08:43 PM)me50 Wrote:
(12-29-2013, 08:25 PM)Don in Austin Wrote:
(12-29-2013, 02:30 PM)Lukie Wrote: I had an oral device for a while but after some time with it I got TMJ (jaw pain) something awful. Also I choked on something in my sleep and had to rip the device off my teeth while I was half asleep. After that I found the device on the floor in the morning. I had thrown it across the room in my sleep.

A custom fitted oral appliance combined with a "bumper belt" to discourage sleeping on my back has been working pretty well for me for almost a year now. I rate success by perceived quality of sleep and a recording pulse oximeter. Jaw discomfort is minimal.

I am just curious if you ever had a sleep study and if so, what were the results of your sleep study? Have you used CPAP before and it wasn't working for you?
Two sleep studies at two different clinics. First clinic was really crummy. Sleep study said maybe just positional therapy would work for my high moderate OSA. Second sleep study with far better doctor, (actually an excellent certified nurse practioner) they put me on CPAP. I tried all manner of different masks and leaks and discomfort would wake me up repeatedly. So I went to a sleep dentist. I now make it through the night with maybe one awakening or often none, whereas I had been waking up every hour or two before treatment. I understand the pulse oximeter is not as comprehensive as a full-fledged sleep study and does not give you the same data as CPAP software, but it makes it clear that staying off my back helps and that the dental device helps. I bought my own recording pulse oximeter so I could take many readings and not rely on just one night's data. The two approaches combined seem to be doing a decent job and my sleep specialist agrees.

I have received strong criticism for using the dental device. It has been pointed out that it is not as good as CPAP. Sometimes that criticism failed to address the fact that I supplement the dental device with positional therapy. The positional device is not as good as CPAP, the dental device is not as good as CPAP, I freely acknowledge. But both together make for something viable IMHO. Perhaps if my OSA were more severe the combination would be insufficient.

Anyway, this is what works for me. AHI before treatment was about 15. I have not had a full fledged in-lab sleep study with the combined dental device and "bumper belt." I don't think medicare would pay for it and I would be reluctant to fund it myself. Also, I am sceptical about the absolute validity of data from any one specific night, let alone in a sleep lab which is nothing like my own bed. Using the pulse oximeter it is clear that not every night is the same. I look for staying in a decent range and my own -- inevitably subjective, of course -- perceived quality of sleep and greatly reduced daytime sleepiness.

My wife has far worse OSA than I do and none of the masks from the DME were at all tolerable to her. She bought a fabric mask through the internet and the first night she tried it felt she could easily live with it. It has been working well ever since. Ironically, when she tried to get a replacement under insurance, she was told "it is not approved." Fabric mask did not work for me because I am a mouth-breather.





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#18
My minor TMJ was worsened with the OA. Too bad as it was working very well. Now I'm back on the machine. I'm hoping the TMJ settles as it is very uncomfortable.
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#19
A few points I would like to make after reading through these posts:

1. The standard lowest pressure for any CPAP is 4.0cmH20.

2. While it is ok to stop using CPAP while acclimating to an oral appliance. Eventually a second set of studies (both a baseline and possibly a titration) is necessary. (owning an AUTOPAP may be the only way around this) The only way you will be able to tell if an oral appliance is effective is by having a SECOND baseline sleep study to determine your new AHI with the appliance.

3. It is very important that ALL CPAP users understand the difference between an OBSTRUCTIVE APNEA and a CENTRAL APNEA. By adjusting your own pressure without a doctors Rx ..... you risk giving yourself CENTRAL APNEAS, which can bring on a whole new set of problems.

THERE IS A SCIENCE BEHIND CPAP machines. They are not simply glorified leaf blowers.

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#20
(01-22-2014, 04:42 PM)ob13 Wrote: 3. It is very important that ALL CPAP users understand the difference between an OBSTRUCTIVE APNEA and a CENTRAL APNEA. By adjusting your own pressure without a doctors Rx ..... you risk giving yourself CENTRAL APNEAS, which can bring on a whole new set of problems.

THERE IS A SCIENCE BEHIND CPAP machines. They are not simply glorified leaf blowers.
Hi ob13, welcome aboard
It depend on your machine, whether an S9 or S8 and if the machine listed in user profile RESMED AUTO is S9 AutoSet or S9 Escape Auto. S9 AutoSet can distinguish between obstructive and central apnea, S9 Escape Auto don,t
FYI, the software listed in user profile "EncoreBasic Performance Manager" don,t works with ResMed machines. ResScan does and SleepyHead works with the S9 Autoset and S9 Elite


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