Sleep Apnea Mouth Guard

November 30, 2005 8:40 AM

Sleep Apnea filter: Looking for advice on how to get fitted for one of those mouth guards that apparantly keeps your airway open.

Recently I read about a prescription mouth guard that is custom created for each patient that apparantly shifts the lower mandible forward while sleeping thus keeping the airway open. I can't for the life of me find where I read this, but I thought I recalled that an ENT is the person to talk to for a prescription. I just called an ENT and they have no idea what I'm talking about. Anyone know what I'm talking about or have experience with it? What kind of doctor do I need to speak with?

Some background: I've had several sleep tests and I have a CPAP, which is useless and which I've abandoned after trying numerous types and adjustments. So, I'm not looking for 'go get a sleep test' or 'go get a CPAP'. Also, I'd rather not pay the 15 bucks to sit in my sleep center's wait room for two hours just to get a referral. I'd like to just call and make my own appointment.

posted by spicynuts to health & fitness (16 comments total)

Well, this website seems like a decent place to start. They do have a page with reviews of oral appliances for sleep apnea. You may want to ask you dentist for advice.
posted by cosmicbandito at 9:04 AM on November 30, 2005

Those oral devices are crap and have no clinical relevance to them at all. If CPAP is not working you might want to consider surgery.
posted by cdcello at 9:50 AM on November 30, 2005

cdcello...just so i can judge the merits of what you're saying before i ditch the idea, do you have any personal experience with them or are you a doctor? Are there studies that show there is no clinical relevance?
posted by spicynuts at 10:09 AM on November 30, 2005

I've heard comments similar to those of cdcello from CPAP users. I've suffered from sleep apnea for about five years now. My girlfriend is begging me to do something about it, as it's obviously pretty scary to hear your loved one stop breathing while they are asleep. I looked into meds, CPAP, and just today, I saw this. I have an appointment next week to see one of the docs in my area who does the procedure.
posted by weirdoactor at 11:59 AM on November 30, 2005

WeirdoActor..I had read about that as well but I don't know if I want to jump right to an invasive procedure without first trying all the non-invasive stuff first. Will you let me know how it goes?
posted by spicynuts at 12:02 PM on November 30, 2005

fwiw I just scored a sleep study that was split, 1st half of the night without an oral appliance, 2nd half with.

The oral appliance reduced snoring to minimal amounts and cut the respiratory distress index by half. That said, CPAP would have been more effective for this patient and likely eliminated the respiratory events completely.

My opinion on OAs is that they're somewhat effective for quite mild cases, I don't believe they are ever recommended by our sleep lab.

Have you tried speaking with your dentist? That would be where I would make my first inquiry if I were to want one.
posted by skinnydipp at 12:27 PM on November 30, 2005

The CPAP, even if it does help me, isn't an option; as I've heard that it's louder than snoring, and my GF can barely stand that. Plus, we have four cats who would never, ever sleep in our bed again, and as any human owned by a cat knows; it's really their bed. Of course, there's the "I might die" factor...

Anyway. Because of my body mass, I may not even be a candidate for the Pillar thing. And just to be clear, the appointment is just for an exam to see if I'm a candidate, not for the procedure.
posted by weirdoactor at 12:32 PM on November 30, 2005

My CPAP is not loud at all, weirdactor. It sounds about half the decibel level of a dehumidifier. I don't see how having a CPAP would affect the cats, unless they are scared by plastic tubing.

In any event, I'd like to hear your experience with the the exam - the kinds of questions they ask you, what they say about the risks/benefits, what your feeling is after being exposed to the whole thing. My email is in my profile if you'd be so kind as to follow up. Good Luck!
posted by spicynuts at 12:56 PM on November 30, 2005

My apnea was cured with the removal of my tonsils. Mind you, they were roughly the size of Oprah so your mileage may vary.

Wierdo, if you're really ranking your cats and keeping your girlfriend from having to wear earplugs above your NOT BEING DEAD you might want to reconsider your priorities.
posted by phearlez at 1:30 PM on November 30, 2005

I have very mild sleep apnea - measured at about 20 events per hour in 1999, about 10 per hour in 2005 (that 10 per hour wouldn't even qualify me for treatment by insurance standards). Though this is considered mild from a medical standpoint, using a mouthguard makes a huge difference in how well I sleep; when I don't use it, even for a few hours, I tend to wake up with a headache and be tired until I get real sleep. CPAP might work even better; but the mouthguard is portable and doesn't keep me awake. It may not work for everyone, but it works very well for me.
Both my mouthguards, I got from a dentist. Insurance gave me a big runaround on these things (when my events/hour was 20), considering them dental devices rather than medical devices; managed to get the first paid for, but not the second several years later. I believe just about any dentist will know how to measure you for these devices, but if yours doesn't, your sleep doctor may know of a dentist who can, or you can call Great Lakes Orthodontics for info on a local dentist with experience.
Caveats about using these things: I have at least one friend who can't sleep with it because he feels like his mouth is full. (Of course, he can't stand CPAP either, so he uses nothing.) Also, that friend experienced mild soreness in his mouth because of the device; and I've found it's pretty permanently shifted my lower jaw forward, enough so I no longer have an overbite.
If I knew surgery would work for me and would not screw up anything in my mouth or throat, I'd go that route; but no sleep doctor I've talked to has guaranteed (or even given a "works 90%+ of the time" statement) that it will work, so I've decided not to risk surgery.
posted by mistersix at 2:25 PM on November 30, 2005

Caveats about using these things: I have at least one friend who can't sleep with it because he feels like his mouth is full. (Of course, he can't stand CPAP either, so he uses nothing.) Also, that friend experienced mild soreness in his mouth because of the device.

I already have mouth and throat pain from the apnea; so no worries there. I might look into that device. Thanks!

Wierdo, if you're really ranking your cats and keeping your girlfriend from having to wear earplugs above your NOT BEING DEAD you might want to reconsider your priorities.

Hmmm. I was going for humor there; and I obviously failed.

I don't see how having a CPAP would affect the cats, unless they are scared by plastic tubing.

My cats are scared by random stuff. I have heard from other CPAP users that their cats hated the machines.

I'll follow up with you about the exam, spicynuts. I have real concerns about ANY surgery on my mouth or throat, and the effect that surgery might have on my acting, singing, and voiceover work.
posted by weirdoactor at 3:20 PM on November 30, 2005

Hmmm. I was going for humor there; and I obviously failed.

You may have been trying to be funny with the ending comment about death but your initial statement that it isn't an option didn't seem to be at all couched in humor. Take the threat that apnea poses seriously. You may be young enough to poo-poo the risk cardiac arrest poses but the sleep deprivation takes a constant low-grade toll on your general health. You need to be strong enough to fight off that bird flu, after all, and not getting enough rest lowers the strength of your immune system.

Your girlfriend may initially not be thrilled with the idea of ear plugs but I bet she likes living with them better than living without you. They take some getting used to but most of my friends who have adopted them are quite happy with the result and say they sleep better now. Your cats might not give a crap who feeds them so could live without you but really, if the little fuckers are that particular about their situation they should evolve some thumbs and get a job.
posted by phearlez at 3:29 PM on November 30, 2005

What is about the CPAP that you find useless, spicynuts? When I first got my unit, my two problems were air leakage around the nasal mask that would blow into my eyes, and throat and nasal dryness. I rememebr getting so frustrated that I ripped my mask off and threw it across the room. I got the mask to fit better by removing the gel spacer that sits on the bridge of my nose, and the dryness went away after I got a pass-over humidifer.

If you say your CPAP doesn't work for you for whatever reason, I'm not going to argue with you, but maybe there is a remedy for your specific CPAP problem.

FWIW, my cats aren't bothered by my CPAP. My one cat that likes to sleep on the bed has slept on the bed the 3 years I have had him.
posted by Fat Guy at 5:43 PM on November 30, 2005

I've used a CPAP for quite a while.

I quickly found that nasal pillows (which fit into your nostrils) were better for me than a mask. Like Fat Guy, I found that a mask leaked around the edges. The pillows can leak, too, but the area is smaller.

I don't use the "start slow" feature. I found that as soon as I drifted off, the pressure wasn't high enough to prevent apnea, and I was awakened by the machine ramping up to full speed. For me, it's just as easy to get to sleep on full speed as on slow.

For dryness, there are humidifiers that you can put between the pump unit and the head unit. However, they mostly don't work. You have to get a humidifier that heats the water. Otherwise you don't get enough vapor. And the water reservoir is a pain to clean out.
posted by KRS at 7:10 PM on November 30, 2005

Here is an interesting site collecting and summarizing recent research on OSA, by an M.D. with sleep apnea where I saw this device, which looks interesting to me. Invented in Israel, not yet FDA aproved in the USA.

I never thought I'd be able to tolerate CPAP, but with a heated humidifier, I have little problem with it. It is not loud, and my cats don't mind it, my problem is those situations where CPAP is impractical, especially camping, but traveling, and casual sleep-overs too. I'd like to find a good oral appliance for these times.
posted by bephillips at 1:49 AM on December 1, 2005

Spicynuts, I used to use the appliance you speak of - You have to go to a dentist to have it fitted, and not all dentists do it. Call around until you find one that knows what you are talking about, or ask for referrals. In my case it was the U of MN medical school dentists' office that had the right guy.

That being said, the thing worked only marginally and messed up my bite so that I cannot close my jaw comfortably. Now I use the CPAP with a humidifier and could not be more pleased. Except it causes me intense gas overnight and in the morning, from the compressed air working its way into my alimentary tract. That's rare, though, and Gas-X helps.

Good luck! I have to tell you, whatever hassles and noise the CPAP generates, IT"S WORTH IT!
posted by BigLankyBastard at 4:12 PM on December 1, 2005