Jaw Alignment as a cause of OSA

[Hydrangea]

I’ve spoken to my sleep doctor and his thinking is though the CPAP machine thinks I’m doing well, he isn’t convinced, he is now saying that perhaps I’ve got issue with jaw alignment issue that is causing my tongue to collapse and block my airways during sleep causing the OSA. He is saying the CPAP isn’t going to make things better and potential it can make things worse...

Has anyone else heard this, been treated for this type of problem?

I've not heard of CPAP making things worse.  Although I'm sure not a doctor.

Was your doctor recommending myofunctional therapy?  I've been exploring that, for strengthening my throat & tongue muscles.

[Sleeprider]

You are using a pressure range of 4-20 with EPR at 3 which s the minimum and maximum pressure range for your machine and the highest EPR setting. That means you rarely get to use the full EPR and the pressure is so low you may feel a bit starved for air. We use a rule-of-thumb that minimum pressure should equal 4+EPR, or in your case 7.0 cm. That allows pressure to start at 7.0/4.0 (inhale / exhale). If you want to start at 6.0 then set EPR to 2. I don't know how sensitive you are to using pressure, but very low pressure is not refreshing or very effective, and it results in excessive pressure swings. The higher pressure will result in more consistent "feel" and will be much less disruptive to your sleep.

[hallra]

Hi SleepyRider,

At the start I was advised to set it to a min of 7 and a EPR of 3, the lowering to 4, was me just playing around, I’ve been adjusting min between 4 & 6, haven’t touched EPR yet.

I can give min 6 and EPR of 2 a go...

That all well with playing with the CPAP which of course we can continue with and see what happens...

However, what are your thoughts on what this doctor is saying about jaw alignment...

To me, what he proposes doesn’t make sense... He wants to do another sleep study, a home based one this time, one which is less detailed than the lab based one...

He proposes the Alice One home study over two consecutive nights without the CPAP machine... now how is that going to help prove anything more than the sleep lab tests from last year??

The differences I see are:

1) I had to be given zopiclone to make me sleep, this time it won’t be used.
2) I’ve lost weight about 14kg.

However, he mentioned neither as a justification, in fact this whole business with the jaw alignment threw me a curve ball... At the start of the call he threw it in... which totally confused me and lead the whole conversation off on a tangent...
- thinking back he most likely did it on purpose to deflect the conversation... he is a psychiatrist for god sake... he manipulated the conversation away from where I wanted to take it... so all the questions I had lined up were never asked, never discussed, never answered...

So I’ve got two doctors who are supposed to be looking at my sleep problems, both who are messing me about...

All I want is to get some sleep...

[SarcasticDave94]

My humble opinion is that I couldn't quite buy the doc info. For some reason I envision the doc saying "I suspect this or that. Let's do a series of tests. This may hurt a bit. Hmm not sure but it may be something else. More tests are needed." I would think long and deep on volunteering to be Guinea Pig Guy.
My 2 cents.

[Sleeprider]

Hallra, I think dental devices are great for making your dentist's boat payments or sending his kid to college. I'm not a believer, and of all the mechanisms of apnea, mandibular advancement is a real stretch (pun). I have seen a lot of money spent, a lot of pain and dysfunction caused by that surgery, and while it may have valid application, I think it is used far to often on normal anatomy to very little good effect. Clear enough?

[hallra]

Thank you both for your input, I’m not convinced either.

I don’t see the evidence in the CPAP data... I also have a video camera on me and that isn’t highlighting anything...

I think I need to write to the sleep doctor and debunk this jaw theory... I don’t see any justification for this further sleep study... the only thing I can think of is he is trying to get a study done without the sleeping tablets... is he now thinking that the sleeping tablets have skewed the lab results??

- FYI, I did have this home based sleep study (Alice One) done in 2010, by the same doctor, I’ve got the results on file, if I put them up, can you tell me what the conclusion was, I don’t think it was OSA, I think it was something else...


To me what I can say is that I’m on steroids for my arthritis and adrenal insufficiency, both which mess with sleep, plus I’m on Topiramate, which has messed with my daytime alertness...

So I’m more inclined to say that my sleeping problems are more drug induced than anything else...

[SarcasticDave94]

I really don't know what to think hallra. I do know as was already said that proposed action doesn't sound to be the answer. I know things are difficult and that seems to be an understatement. Hang in there and keep doing research and communication with the Docs. Never quit going forward.

[sheepless]

scroll through your flow rate graphs at a 2 to 5 minute zoom looking for patterns or anomalies that might suggest a reason for your lingering fatigue. pay particular attention to the last few minutes of each sleep session to see if there's anything that explains your mask offs. one way to zoom is to adjust the slider at the bottom of the events tab.

[hallra]

Hello Sheepless,

Scrolling through my flow rate graphs at 2-5 min intervals I don't see anything that sticks out... I will post the ends of the sessions (for the periods I think I slept) for the 22,23,26 Apr.

- Trouble is a lot of the sessions I'm not actually sleeping, I've my eyes closes, i'm comfortable, just not falling asleep... 

- A fair few of the 2am-6am periods I am actually sleeping, however, I've got two cats, one of which insists on waking me up around 5:30am, a habit my ex wife installed in him... Unfortuantely I haven't been able to put a stop to... I've tried to shut him out of the bedroom and he just rips the shreds out of ther carpet or both cats fight to ensure they wake me up.... Actually you know what I've just thought how to put a stop to this... I've recently installed a automatic time managed cat flap in the lounge area that hasn't got carpet that I can seal off from rest of house... I can lock them in there and keep them away from me... it's far enough away that even if they fight, cry, whatever they can't desturb my sleep... I think I need to take control of this situ... Get my sleep and then let them out afterwards...

[hallra]

26th Apr Flow Rate 2 Min Interval End Sessions