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Take sleep study WITH dental guard or WITHOUT?
#1
Hi!

I have a HOME sleep study test coming up. ($349 mailorder special) This is my first formal test, though I know I have sleep apnea from reports. (OSA and maybe some CSA)

Here is the situation: Through experimentation, I've found that my OSA is greatly reduced when using a dental mouth guard and sleeping on my side. In fact, I feel so much better now that I feel like the OSA problem is almost licked. However, I want to be sure there is not a residual OSA still lingering.

Should I take the Home sleep study WITH the dental guard in and sleeping on my side OR do it without the guard, sleeping on my back and whereever the night takes me? I wonder if it makes sense to get the worst case statistics or the best case statistics?

I asked the supplier and he said if I were to spend 1/2 the night in worst case mode and 1/2 the night in best case mode, I would get an average overall, which is probably not what I want.

They are using a ResMed sleep apnea plus device that records the data which is shipped back and forth. I don't want to pay for two separate studies if possible.

My tentative plan for the test is to use the mouth guard and sleep on my side, and if I get OSA results in the study, then to pick up an S9 ResMed Autoset and work it out myself. Maybe I would use the dental guard too, with the S9, and see if it helps the data.

Any ideas on the best approach?

Tom
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#2
I don,t know anything about mouth guard. IMHO if using the S9 AutoSet you don,t need the mouth guard as the machine adjust the pressure breath by breath during the night to keep the airways open in response to snoring, flow limitation and apnea.
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#3
Hi Tom,

Dental devices for Obstructive Sleep Apnea are normally only effective for borderline or very mild OSA cases. They are not good solutions for the majority of sleep apnea patients.

Dental devices do have some positive effect, which is probably why you felt better with the device than without. What counts is your Apnea-Hypopnea Index or AHI. You first need to find out what your AHI is without the device, so you know where your baseline starting point is.

Do the test without the device in your mouth. Look at the results and if your AHI level is higher than 15, my personal opinion is that you cannot be properly treated with a dental device. If it's below 15, you may wish to consider a dental device as a possible option.

Simply "feeling better" after a night's sleep with a dental device is not a good reason to think that your sleep apnea can be treated effectively with such a device. All that indicates is that you most likely have OSA and that re-adjusting your jaw helps to some degree. But that does not prove that a dental device is a better solution than a CPAP machine for you. You need something less subjective to give you more of the facts (like the study you're going to take).

Don't skew the data by using a dental device during the test. Find out how bad your sleep apnea is FIRST (AHI), then look for solutions after you're armed with good, solid, objective data to make an informed decision.

Smile
SuperSleeper
Apnea Board Administrator
www.ApneaBoard.com


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
By the way, "dental devices for OSA" are often pushed by.... guess who???

That's right: DENTISTS.

It's my personal opinion that these devices are made to line the pocket of dentists more than to actually treat Sleep Apnea.

It's an easy way to massively expand their practice from dentistry into the sleep medicine field. (in other words, make more $$$)

Don't go to a dentist for advice on sleep apnea. Go to a sleep specialist... (and no, the training that dentists receive on these dental devices doesn't qualify them as sleep specialists).

Good luck.

Coffee
SuperSleeper
Apnea Board Administrator
www.ApneaBoard.com


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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#5
Thanks for the advice SS and Zonk.

The mouthpiece I've been using is actually a pair of stacked $5 athletic mouth guards. When taped together staggered, they hold the jaw slightly forward. Over a month's time I've felt the effects of chest pain and tiredness drop way off - and now dream in REM. So it helps somewhat. It's a joke to pay a dentist $600 for something a simple boiling pot of water can fit for almost free.

OK, then I will take the sleep study without the mouth guard in. That does make sense. Might as well get a prescription that is reasonably accurate in case the AHI is possibly high as you suggested.

BTW, I see some of the high end VPAP machines ($5K types) being discontinued and sometimes going for 20% of original cost. I've also read that some people are not getting the great results they expected treating CSA and problems requiring a variable auto machine like this. Are these complex machines a disappointment or is it my imagination?

If I DO have a slight CSA problem (and I'm told I do) and OSA combined, I am wondering if I should still buy an S9, even though an S9 is not designed to treat CSA - or consider one of these higher end VPAPs. The bipap is desirable too, as I have a problem breathing against back pressure with my exisiting older ResMed Plus CPAP.

Tom
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#6
I would do the sleep study, both with and without the sleep guard. However, there is no need to average the results. Look at the portion of the night where you are wearing the guard. If your AHI for that portion of the night with the guard is less than 5, but goes up beyond 5 without the guard, you know you have OSA that could be treatable with just the guard and sleeping on your side. Down the road, however, your OSA could worsen and XPAP may be necessary.

My bet, however, is you will have OSA even with the guard and need XPAP, since you have already been wearing the guard and still seeing a need for a sleep study.
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#7
(07-18-2012, 08:42 AM)BabyDoc Wrote: I would do the sleep study, both with and without the sleep guard. However, there is no need to average the results. Look at the portion of the night where you are wearing the guard. If your AHI for that portion of the night with the guard is less than 5, but goes up beyond 5 without the guard, you know you have OSA that could be treatable with just the guard and sleeping on your side. Down the road, however, your OSA could worsen and XPAP may be necessary.

Not sure if I'm thinking correctly on this, but there might be a problem doing a "split study" like this... One's AHI levels change throughout the night based upon which sleep phase you're in. If you have the first half of the night with the mouth guard in, that might be the part of the night that has less apnea events anyway, simply because you're not yet in REM sleep. So, it would give a skewed view, falsely indicating that the mouth guard works, when in fact the lessor amount of apnea events is due to the sleep cycle during the first part of the night.

SuperSleeper
Apnea Board Administrator
www.ApneaBoard.com


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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#8
(07-18-2012, 08:55 AM)SuperSleeper Wrote:
(07-18-2012, 08:42 AM)BabyDoc Wrote: I would do the sleep study, both with and without the sleep guard. However, there is no need to average the results. Look at the portion of the night where you are wearing the guard. If your AHI for that portion of the night with the guard is less than 5, but goes up beyond 5 without the guard, you know you have OSA that could be treatable with just the guard and sleeping on your side. Down the road, however, your OSA could worsen and XPAP may be necessary.

Not sure if I'm thinking correctly on this, but there might be a problem doing a "split study" like this... One's AHI levels change throughout the night based upon which sleep phase you're in. If you have the first half of the night with the mouth guard in, that might be the part of the night that has less apnea events anyway, simply because you're not yet in REM sleep. So, it would give a skewed view, falsely indicating that the mouth guard works, when in fact the lessor amount of apnea events is due to the sleep cycle during the first part of the night.
Most people can achieve REM sleep within a couple of hours or less, particularly in your own bed at home. It shouldn't take most of the night to achieve a REM state, unless there are already frequent "awakenings" because of apneic events. In that case, where OSA is more severe, it probably won't matter if one is wearing the guard or not. You are still going to have an abnormal AHI.

If you think you will be in deeper sleep ONLY later in the night, you could wear the mouth guard only then. While everyone is different, most people with significant sleep apnea have events througout the night, and not just in REM sleep. In my own case, I have mild sleep apnea, that was diagnosed in in a sleep lab, with only 2 hours of sleep towards the end of the night. I am not sure, that even then, I achieved a REM sleep. Before that, I just couldn't fall asleep.



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#9
If it were me, I would do thi without the mouthpiece. You have already stated that it is a home made mouthpiece so you really don't know how much good it is doing you. It may be better or worse than a professionally made unit. I think that you should just strap on their equipment without any interferane and go to sleep. This allows them to get a true DX without any "alterations" and will give you the bottom line. From there if you get a data capable machine you can see how much good that dental appliance is really doing. Along the same lines my RX has obviously changed over time. My original pressure was set to 9 if I recall correctly. I thought I felt so much better turning it up to 11! I thought that was great, doing me a world of good, etc. With my new data capable machine my 95% is 14cmH2O for the past 15 days. There is really nothing like data to help you know what is going on rather than going by feel. JMHO!
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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#10
I read good reasons for doing the test without the guard. Also, doing it 1/2 the night with and without - since the readout will show both sessions.

Another good suggestion was to do the test without it and then get the S9 - then try the guard to see if the data gets better afterwards.

I am convinced the guard does help since my chest pains have disappeared and I feel much better rested. But I am still suspicious and want get some hard data.

So, I'll do it without the guard and sleep on my back some of the night to get the worst case scenario.

I'll post the results is a week or so and go from there. The potential for CSA will dictate whether I go with an S9 or some kind of VPAP.

Thanks for the replies and sleep well!

Tom
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