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Oral Appliance Therapy {OAT}
#1
Hello all, newly-diagnosed Sleep Apnea patient here; good to see I have some company!

I see most of the threads here are about CPAP machines, but has anyone have any suggestions or recommendations [conversely, any wasted-time stories] about OAT?

My doctor gave me many reasons why surgery was not really an option for my 'severe' sleep apnea, but I am still unsure of how well the OAT option may work. A dentist in my area [who also suffers from apnea] claims to have a high success rate with this device, and it would certainly be easier than the CPAP; I was given one on a trial basis and for measuring results but it was very hard to get used to.

Thoughts appreciated, and I may also have some questions about getting a CPAP if the OAT option really isn't viable. Thanks very much!

*50-year old male, slightly overweight, nocturia sufferer, haven't gotten a good nights sleep in over a year, diagnosed with OSA in early July.
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#2
Hi Route67, First of all, WELCOME! to the forum.! I don't know the answer to your question, but, in my opinion, you didn't give CPAP therapy long enough, just a few days is not enough time to form a good assessment, because CPAP therapy can take quite a while to get used to. It takes LOTS OF PATIENCE.! I know you think the oral therapy might be easier, but it's not necessarily the best.
I'm not sure about dentists giving advice on sleep apnea, despite the fact that he has it. Hang in there, someone else will be along shortly to give you more suggestions. Best of luck to you.
trish6hundred
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#3
From what little I have seen of oral devices as treatment for sleep apnea, if you have a gag reflex, it won't work. There's several different styles.

Some are like mouth guards and they pull the lower jaw forward (which also pulls the tongue forward). I would assume folks with TMJ disorders or similar would have difficulties with these.

Another I saw had some sort of hook that went into the throat and held the tongue in place. It looked like some sort of torture device but my view is tainted because I have a horrible gag reflex.

There's trials for an implant that stimulates the tongue, keeping it from relaxing and thus keeps it from blocking the airway. It is like a pacemaker in that it is placed under the skin but is attached to a nerve in the throat.

If you have severe sleep apnea (an AHI over 30) then an oral device might not work for you. Perhaps a combination of position (not on back) and an oral device along with weight loss and good luck, you may have success.

But, really, CPAP is much easier. Some folks have a hard time in the beginning (stomach gas, leaks, etc) but many many of us settle down into the routine within a few months or less. Finding a mask that fits is the main obstacle, from what I have observed here. That and stupid docs and DMEs that treat the patient as if we are idiots and cannot push a button without permission.
PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.




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#4
Hi Route67,

Welcome to the Apnea Board!

I am not sure how one would go about deciding if the OAT option is actually working. Seems as if there would still have to be a sleep study of some kind to show that the device was even effective. I suppose that a home oximeter could be used with and without the OAT device and the results correlated with the oxygen saturation levels.
"Goodnight Chesty wherever you are!"
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#5
(08-13-2012, 09:38 PM)PaulaO2 Wrote: If you have severe sleep apnea (an AHI over 30) then an oral device might not work for you. Perhaps a combination of position (not on back) and an oral device along with weight loss and good luck, you may have success.

Believe it or not, my AHI is 29.5!

I was told it's 'severe' ....... diagnosed at a sleep clinic in Mexico, where I have a second home. Now I am back in New Hampshire and need to address this for real; the clinic let me use a Fisher/Paykel machine for a week with 2 different masks and I couldn't get used to it and I knew I was coming home on 8/1 so I put off actually buying one.

I found some links on one of the pages here for suppliers.....the device I used is less than 700 dollars [they wanted over 2K in Mexico City] and the masks are below 150; from what I have read here however, it seems I would need a "DME" to set it for me? And maybe occasional follow-ups with a sleep specialist? May I ask exactly what a DME is and what they do?

I have insurance but I have a 2500 dollar deductible, so pretty much either direction I choose will be out of pocket no matter what.

Thanks all! Looking forward to my first good nights sleep in over a year!

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#6
(08-13-2012, 10:48 PM)pssnn Wrote: Hi Route67,

Welcome to the Apnea Board!

I am not sure how one would go about deciding if the OAT option is actually working. Seems as if there would still have to be a sleep study of some kind to show that the device was even effective.

Not sure if links to Doctors are allowed here, sorry if not.....but this is the dentist who lives nearby.....he seems to be pretty confident [but of course he wants more business]. My mother sent me this, one of her friends was treated there; [link removed by moderator]

Moderator: in the future, if you are not sure about a link, send the link to the person via the PM forum feature. You can also say: The doctor's name is Bobbit and is a dentist. Just Google him.


I *think* I will need a CPAP machine in the end, but I was curious to see if any people have had luck with the OAT.
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Moderator Action: Link Removed
To maintain our status as an educational organization, the only commercial links allowed in this forum are to CPAP-related manufacturer websites. This is stated in the Apnea Board Rules with details given in the Commercial Links Policy section.
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#7
Good luck, I think a mandibular maxilla advancement device (just another name) is a fine place to start. I it doesn't work you can go to CPAP. The advantages to the oral device are many- smaller to carry when spending the night out or traveling, no problem if the power goes out. Easy to use.
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#8
Welcome
Hi Route67. Never went the oral direction. I don't even have to try it out to know I would never get a minutes sleep with something in my mouth!
I have heard that the higher your AHI the less chance one of those Oral Appliances will work though. If that is the direction you wish to go, I want to wish you good luck.
On the other side of the coin, you already found the page with the suppliers listed, so since your deductable is so high I wanted to draw your attention to Supplier #2 on the list. Many of us have purchased gently used CPAP machines from Secondwind and I would not hesitate to do so again! My machine had very low hours on it and the price was fantastic! Add to that the fact that the folks there are always open to answering questions and such by email or phone. Just a though as it could save you a good bit of money.
Again, good luck with your Oral approach.
As always, YMMV! You do not have to agree or disagree, I am not a professional so my mental meanderings are simply recollections of things from my own life.

PRS1 - Auto - A-Flex x2 - 12.50 - 20 - Humid x2 - Swift FX
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#9
I used the oral appliance and although it took a long time to get used to and there is a definite "drool" problem, once I got used to it I could certainly feel the difference in the mornings that I did not use it. Although it wasn't 100% effective, I could feel the difference in the air flow during the night. My wife said my snoring decreased, but it did not completely go away. The appliance was over $1000 and it lasted several years. However...I'm going to try the CPAP because both my doctor and Cardiologist feel the CPAP would be more effective.
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#10
Quote:from what I have read here however, it seems I would need a "DME" to set it for me? And maybe occasional follow-ups with a sleep specialist? May I ask exactly what a DME is and what they do?

Sorry, I forget not everyone is aware of all the acronyms.
http://www.apneaboard.com/wiki/index.php?title=Acronyms

DME is durable medical equipment but it is also used for the companies that sell such equipment.

No, you would not need the assistance of a DME to set it up if you buy out of pocket. You can get the clinician's manual (which tells how to set it up) through the forum. Be sure to read the bits about how to do it and the potential risks involved.
http://www.apneaboard.com/forums/Forum-P...-and-Links

I think with your deductible, it would help you to go through your insurance since the money you'd pay out would automatically count toward that deductible. It is only the middle of the year and later, if you need insurance, you're that far ahead. Check to see if you can purchase out of pocket then submit the bills and get credit that way or if you need to go through their dance (see doc, get diagnosis, etc etc).

If you decide to go out of pocket without involving the insurance, Supplier #2 is the way to go. You would want an AutoPAP such as the Resmed S9 Autoset or the Respironics DS510 AUTO (I think that's the correct model name). Do not get any Resmed with 'Escape' in the name or Respironics with 'Pro' in the name. They are non-data capable and not want you need.
PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.




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