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MAD and\OR CPAP
#1
MAD and\OR CPAP
I recently learned that there was a device called MAD (Mandibular advancement device) It is my understanding that it helps in reducing OSA. Has anyone had success with MAD or heard success stories? There is also research paper that suggests that combining MAD and CPAP has additive effects. Has anyone ever reported combining them successfully?

Adding to above, the reason I started searching down this path is my dentist said I suffer from teeth grinding and suggested a night guard. While searching found that MAD is a different kind of guard. So, is it also common to combine night guard and CPAP? does it improve\lower effectiveness of CPAP? or it is just another level of comfort issue if you are not used to night guard but can help keep mouth locked?
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#2
RE: MAD and\OR CPAP
according to my doctor a MAD can correct only 50% of the sleep apneas (OSA only), that's why it's used only for up to medium cases
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#3
RE: MAD and\OR CPAP
I'm trying out a MAD at the moment. I'll let you know how it goes. I'm hoping to have an alternative to my CPAP that doesn't rely on electricity.
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#4
RE: MAD and\OR CPAP
Ditto for me. I am presently using APAP for mild to moderate OSA. But I also need a guard for a dislocating TMJ and I like backpacking. So, I told the dentist heck, go for it! (and see how much insurance covers, 'cause these things ain't cheap) And I now have 2 new devices. So far I can tell you:

1) Research your dentist. I have had TMJ splints before. The first was a similar construction as below, and worked like a charm - no dislocations after using it a week. Then it finally broke and the replacement was useless. Now, after a couple decades of noncompliance, the new one looks like the first one and viola! my jaw no longer dislocates after 3 days.

2) The guards are both quite comfortable. Mine are both a clear plastic with embedded wire reinforcements. The MAD has an upper and lower jaw piece with interlocking flanges and a screw on each side that can slowly advance your jaw over time, and the mandible is prevented from sliding back by the flange, but you can freely open your mouth without disengaging it. It has little hooks for rubber bands to hold your mouth closed. They told me the rubber bands are optional, but if you are trying to use it with CPAP, I think they would be necessary. The TMJ is essentially the bottom part of the MAD without the flanges. Since my jaw dislocates because the mandible needs to shift forward, I figured the TMJ splint basically is a free-sliding MAD, and so my jaw would not get mixed messages. So far that is the case. The dentist made a big deal about how you are supposed to use a morning splint for 15 minutes to shift the mandible back to where it is "supposed" to be, but that is not an issue for me.

3) My MAD cannot be used with a full-face mask, as the flanges hit at the area of the mask seal, and it irritates the inside of the cheeks. I have ordered a nasal mask and am planning to try it with the MAD with rubber bands and see how that works. I am hopeful this may actually be an improvement, as the face mask I presently use by its nature pushes the jaw back. I have used the TMJ splint with the face mask, and it is comfortable, but you need the flange structure to hold the jaw forward against the pressure of the mask.

4) I concur that it is unlikely, for me anyway, that the MAD will work as reliably as CPAP. The only adjustment is how far the jaw is shifted forward, which may or may not be sufficient. While waiting for the APAP to arrive (and to get an appt for the MAD dentist) I got one of the OTC semi-custom MAD's (SnoreRx2). It works well but is less comfortable than the custom one, and significantly bulkier. My sats were better but not great with it alone. But if your insurance will not cover a MAD, and you want to try one, the semi-custom is 10x cheaper.

So, I'm hoping the MAD will complement the APAP and allow me to unhook safely from the machine for trips to the boonies. I will post an update when I have more experience.
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#5
RE: MAD and\OR CPAP
I would do research on MAD devices. I would only take advice for doctors that has no financial incentives from selling MAD devices. From what I've read around, it doesn't sound promising, and there are chances that it will make TMJ problems worse.

I could not trust my last doc that sells Herbst devices. I would not take his advice from doctors that is incentivized to sell them to you.

As somebody that has issues with TMJ, I recommend not using full-face masks. It's possible that the bottom strap is causing jaw to be pulled back.

Go with something that has no straps there. Go with nasal masks.
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#6
RE: MAD and\OR CPAP
Yeah, I totally concur. Be cautious. I've got a chicken and egg issue myself; without the MAD I am a mouth-breather, so I need a full-face mask, but now that I have the MAD and/or the TMJ splints I am hoping to change to a nasal mask.

MAD's should cover both your upper and lower teeth so it may help tooth wear from grinding, but I have heard of them causing pain from shifting the bite.
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#7
RE: MAD and\OR CPAP
- Hi,
_ Based on the ENT Steven Park (blogs and his book Sleep Interrupted), and others, it may happens primary cause for teeth grinding may be some kind of unresolved sleep breathing disorder (even subtle ones on the UARS domain);
So, why not, first of all, try hard to work out SDB with a proper machine (the best one I know, maybe the single one, would be the Resmed Bilevel PAP)and mask? In my case, an UARS and RLS, I also need some 0.4 mg of Clonazepam (no side effects) for doing well.

all the best and good luck
Mper
I am not a doctor. Nothing that I say here is medical advice
All my posts include only outcomes/learnings from my own/other therapies and medical literature



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#8
RE: MAD and\OR CPAP
Yes, in a perfect world I think you should get a (lab or in-home) sleep study first to better define the problem and see if the tooth grinding is a symptom of apnea itself. And consider a CPAP (APAP is likely mandated by your insurance before BiPAP) as your main sleep apnea therapy. Once you are comfortable and have good saturations on the machine, reconsider a MAD if you still want one.
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