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.

Wednesday, June 2, 2010

SUAD not Working: what about combination therapy?

Comment: Steve Would like information about OPAP treatment for sleep apnea.

Comment Christy
Hello,
Steven my name is Christy I work with Dr. Ira Shapira in the Chicago-land area. He is the founder of the ihatecpap web site. The site is dedicated for alternative treatment to the machines. We have sleep apnea trained dentist all around the country. Where exactly do you live what the closest larger city. Please forward me this info and I will try to locate someone in your area to help you.
Keep Smiling
Christy

Steve:
I live closest to Philadelphia. I have a custom made oral appliance (Suade device/?spelling). While I have noted some improvement, I still have sleep apnea. I suspect I could tolerate and would benefit from CPAP if the machine were attached to an oral appliance with appropriate connections. I was unable to tolerate conventional CPAP with face mask.
I have not been able to find any local practitioners who offer that particular option (oral appliance with connector to allow connection to CPAP unit), but rather only offer oral appliances.
Thanks for your help. It is really, really appreciated.

Dr Shapira

I frequently see out of town patients in my Gurnee office but I am sending you contact info for George a regional sales manager for TAP who has the best appliance interface but would require a new appliance. I am copying this e-mail to George.

The OPAP is not my favorite appliance. There is considerable danger of inflating stomache which is problematic

CPAP Pro also makes an appliance that attatches to an appliance but does not advance the mandible.

It is possible to add an extension to the maxillary portion of the SUAD and connect a nasal mask with Velcro to the appliance extension. It is also possible to connect to CPAP Pro

Without access to you sleep study I do not know details but some patients can use a positioner to stay off their back in conjunction with an appliance if there is a positional component to the sleep apnea.

Another option is to revamp SUAD and reshape to remove retrusive reflex contacts to tongue and/or add protrusive tongue reflex aaptations.

Occasionally adding an anterior vertical stop to a SUAD can improve success as can additional anterior moverment. I usually do not use a SUAD as an initial appliance but titrate with TAP ! and then make SUAD to the titrated treatment position.

The TAP 1 appliance is still the the most effective appliance due to ability to advance mandible beyond maximum protrusion and ease of titration during sleep study. The TAP 3 fits the new interface that Keith Thornton designed. They also can make a custom fit nasal mask connected to TAP 3

There are always custom appliances that can improve efficacy but are not FDA approved.

The full Breath appliance invented by Bryan Keropian also works via a different method of maintaining airway by rstraining the tongue.

I hope this is helpful.

Dr Ira L Shapira

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posted by Dr Shapira at 7:33 PM