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Newly diagnosed. Dr. Recommending oral appliance instead of CPAP
Hi all-

After 3 in lab sleep studies, and 2 home studies, I finally have a diagnosis. My most recent in lab study showed an AHI of 9.4 during NREM, and 16.9 during REM sleep.

I understand that this is moderate sleep apnea. My doctor recommended trying the oral appliance first before a CPAP machine. After searching through this board, it seems like most people opt for CPAP. Is there any reason I shouldn't try the oral appliance first and go straight for a machine?

Any input would be greatly appreciated.

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IMHO. I would go with CPAP. I had an oral appliance and it gave me TMJ and ultimately ended up in the trash can. My sleep study showed an AHI of only 7. I am so happy I have CPAP now and it is much better than the oral appliance in my book if you can get used to it.
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You'll likely get a dozen opinions on that question.
Why not try the oral appliance first. Getting accustomed to CPAP can be a real challenge for some people.
Some start it and give up. After nearly 5 years I still find it a pain to go through the ritual every night.
But, I do it because I must.

Now, some people have such severe apnea that immediate intervention is called for; and CPAP is the fastest route; and is the "gold Standard" for treating severe apnea.

Another consideration is financial -- who pays for the oral appliance or CPAP?
If you would be out-of-pocket for both (should the oral appliance not work for you) then it might be advantageous to argue for CPAP to start.
Do you travel much? Easier to pack the oral appliance than a CPAP machine.

Your mileage may vary.

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Hi danf183,
WELCOME! to the forum.!
In many cases, people who try the dental appliance have to wind up going with a CPAP machine anyway.
Why not just start now by getting used to the CPAP machine, just a thought.
Hang in there for more answers to your question and best of luck to you as you start your apnea journey.
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I think any oral appliance that displaced your jaw (I am assuming that's what it does) would hurt. But what do I know I have not tried it, sounds like a cramp waiting to happen. Cpap is no picnic so it's up to you. I didn't have a choice and I am happy for Pap and that it works.
Good Luck!

Doc J (despite my nickname I am not a doctor)

Remember to donate to the board if you can, it has helped a lot of people including myself.
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I would ask your doctor how he intends to track the effectiveness of the oral appliance. I think for some people they can do wonders, the main problem with them is there's very few ways to tell if it is actually working.

The best home method is to use an oximeter at night. But this only works if you are one of those whose blood oxygen saturation rate dropped during the night due to obstructive sleep apnea.

The most expensive method is to wear it during yet another sleep study.
Apnea Board Moderator

Breathe deeply and count to zen.


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The American Academy of Sleep Medicine describes CPAP as the most effective treatment for obstructive sleep apnea.
Read more: http://www.apneaboard.com/forums/Thread-...-Your-Life
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I tried an oral appliance briefly before I went to PAP. I found that having my lower jaw forced into an abnormally forward position was very uncomfortable during the night. It took half the morning to get my jaw back to normal and my bite realigned. Also, as mentioned by others, I had no way of knowing whether it was effective. After 8 months on APAP, I am relatively comfortable and am certain that it is effective.
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Thanks for your responses. Dr. plans on tracking the efficacy of the oral appliance by doing another sleep study after a month or so. My only concern is that apnea did not show up on 2 at home sleep studies and 3 in lab studies. Perhaps I should insist on a cpap.
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(07-27-2014, 05:10 PM)danf183 Wrote: My only concern is that apnea did not show up on 2 at home sleep studies and 3 in lab studies.
You wrote " My most recent in lab study showed an AHI of 9.4 during NREM, and 16.9 during REM sleep"

Apnea Hypopnea Index (AHI)
The AHI is the number of apneas or hypopneas recorded during the study per hour of sleep. It is generally expressed as the number of events per hour. Based on the AHI, the severity of OSA is classified as follows:

None/Minimal: AHI < 5 per hour
Mild: AHI ≥ 5, but < 15 per hour
Moderate: AHI ≥ 15, but < 30 per hour
Severe: AHI ≥ 30 per hour

Sometimes the Respiratory Disturbance Index (RDI) is used. This can be confusing because the RDI includes not only apneas and hypopneas, but may also include other, more subtle, breathing irregularities. This means a person's RDI can be higher than his or her AHI.

Oxygen Desaturation
Reductions in blood oxygen levels (desaturation) are recorded during polysomnography or limited channel monitoring. At sea level, a normal blood oxygen level (saturation) is usually 96 - 97%. Although there are no generally accepted classifications for severity of oxygen desaturation, reductions to not less than 90% usually are considered mild. Dips into the 80 - 89% range can be considered moderate, and those below 80% are severe.

Read more http://healthysleep.med.harvard.edu/slee...ng-results
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