Obstructive sleep apnea affects around 20 million Americans and can lead to hypertension, heart attack, stroke, depression, muscle pain, fibromyalgia, morning headaches, and excessive daytime sleepiness.

Thursday, April 8, 2010

Oral Appliances and Sleep Study results. What are my options

QUESTION: I have a dental appliance that works great. I sleep soundly, my mental alertness has increased since changing from the CPAP. The problem is I had a sleep study and it did not go well. There were a lot of noises that woke me up. The leads kept pulling my body hair so I never really could relax enough to sleep well. Is the sleep study the end all be all for determining the effectiveness of a dental appliance? I can't go back to using a CPAP. Do I have any recourse for insisting on using the dental appliance?

ANSWER: There are actually several questions. First, like many patients you feel great with the appliance and symptoms have been resolved. When you said the sleep study did not go well you discussed problems with the study not your results. Did they still show you have sleep apnea and if so how severe?

Important considerations are the apnea hypopnea index and oxygen nadir. Think of the sleep test as a opportunity to continue to improve the effectiveness of your oral appliance. It sounds like it was not an ideal situation , sometimes sleep medication can help for study night. The only way to know treatment is successful is a sleep study but it is posible to do home studies. I prefer to use a lab study because your appliance can be titrated uring the night for improved quality of treatment but this means your expert in Dental Sleep Medicine has taught the lab how to titrate appliances.

Some sleep labs are very negative about oral appliances and only offer CPAP. This is an example of poor medical treatment. Stuies have shown that the majority of patients reject CPAP. Oral appliances are a safe and effective treatment and it is medically-legally incumbent that all options are offered. For severe apnea oral appliances are an alternative when CPAP is not tolerated or refused by the patient. MANY PATIENTS CAN CONBINED POSITIONAL TREATMENT WITH ORAL APPLIANCE THERAPY AND VASTLY IMPROVE RESULTS. Frequently an oral appliance can be combined with nasal surgery to reduce turbinates or correct deviated septums improving results. I suggest that patients avoid labs and physicians that are completely negative about oral appliances. These labs often have financial intreasts in CPAP treatment. I would also suggest patients avoid dentists who are not careful in doing follow-up sleep studies with physicians your health is always the primary concern. The I HATE CPAP site is sometimes seen as being negative about CPAP but that is certainly not the case. CPAP is excellent treatment and highly effective, when used. The I HATE CPAP site is interested in insuring that patients who do not tolerate CPAP find effective alternatives.

I would suggest you continue to work to improve the results you obtained with your appliance. You are definitively better with some treatment than no treatment but your health is at stake.

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posted by Dr Shapira at 7:51 PM