Sleep Apnea Appliance

Frequently Asked Questions

1. QUESTION:
   How much should a sleep apnea dental appliance cost w/treatment?

   • ANSWER:
     Sleep apnea has more to do with breathing than dental. A C pap machine runs around 2 to 3 G.

     Dental appliances such as gaurds for grinding and such are good for your teeth but, they don't address the sleep apnea. Sleep apnea is a suspension of breathing during your sleep that cause your heart to have to work harder attempting to get oxygen. This is the real worry about it.

     If you go on a C pap, you will most likely stop grinding as well.

2. QUESTION:
   Legal question... About 4 years ago, I bought a new sleep apnea appliance (see more)...?
   ... called a Thornton Adjustable Positioner, which is a brand name for a mandibular advancement appliance you wear like a mouth guard. My dentist had to take molds of my upper and lower teeth, then sent the molds to the company, who made the appliance to fit over my teeth at night. The two pieces hook together, and you can adjust it to pull your lower jaw forward when you sleep, which opens your airway and alleviates sleep apnea.

   Anyway - turns out that the device, over the years, has pushed my front lower teeth forward almost a half an inch, so now I have a severe underbite. It has totally changed the bite pattern in my mouth so that now my back teeth don't even touch or come together at all.

   I went to an orthodontist who said that the appliance has caused this problem, and it's going to take 6,000 dollars worth of orthodontia (braces) and 18 months to solve it.

   There was no warning about this problem from the TAP maker. Should I get a lawyer and try to sue them for the
   cost of the braces? My orthodontist said he would have NEVER offered these appliances, because even when they first came out, he foresaw that these kinds of problems were going to occur. Wish I had known him back then, but...

   • ANSWER:
     Yes, you can sue for personal damages. At the least, they would have to pay for the medical bills. You could probaly get alot more aswell. Get yourself a good lawyer though

3. QUESTION:
   do you have to have perfect teeth to get a oral appliance for sleep apnea?

   • ANSWER:
     Few patients with sleep apnea have perfect teeth, and even healthy people.

     You can have a dental device for your teeth, however you must consult a dentist first. He will explain what to do in this situation.

4. QUESTION:
   Does a dental appliance help sleep apnea?

   • ANSWER:
     Hi Murray!

     There are dental appliances that can treat your sleep apnea (as long as you wear them), and for some people they are very effective.

     A dental device for sleep apnea is used to relieve upper airway obstruction and snoring by modifying the position of the mandible and tongue.

     There are two types of sleep apnea dental device:

     1.mandibular advancement appliances (MAAs) or Thornton Adjustable Positioner (TAP). The TAP is a medical device that treats sleep disordered breathing. It alleviates snoring and sleep apnea by holding the mandible forward during sleep to prevent the tongue and soft tissue of the throat from collapsing into the airway.

     By repositioning the lower jaw and tongue, the oral appliance keeps airways open and prevents the appearance of snoring and apnea events.

     2. Tongue retaining devices (TRD) - this device reposition the tongue in an anterior position by securing it with negative pressure in a soft plastic bulb that directly contacts the base of the tongue. Other type of TRD uses a suction cup that attaches to the front of the tongue, pulling the tongue forward to prevent the back of the tongue from collapsing.

     You should know that there are some side effects when you use dental devices, such as discomfort, salivation, more successful in patients with non severe obstructive sleep apnea.

     I hope it helps!

5. QUESTION:
   best dental appliance for sleep apnea?
   what type of dentist does this and which appliance is best thanks

   • ANSWER:
     Any General Dentist can take impressions and send them to Great Lakes Orthodontic Laboratory and they will fabricate the appliance. It is called a Herbst appliance. I have never seen it fail. The devise is used for snoring as well. It is made to fit both upper and lower at the same time and it keeps your jaw positioned forward, keeping the airway open. There is some muscle tenderness at first as you adjust to sleeping in this position. I rec. Motrin for the first few nights. You can google Herbst.
     I wish you the best

6. QUESTION:
   SLEEP APNEA - Anyone here use the Dental Appliance?
   I'm wondering if anyone here has used one of these, and if it worked for you?
   Or if you're a dentist, and you know how these work?

   (I'm not interested in any answers about anything other than the dental appliance. I know all about CPAP machines.)

   OK, well if you know about the surgeries, I'd be interested in that.

   • ANSWER:
     The dental device uses gentle lower jaw relocation to move the soft palate out of the upper airway, effectively decreasing snoring in mild cases of OSA. It basically moves it forward to relieve this problem.
     The surgery is recommended in more serious cases of OSA, moderate to severe. A procedure that I'd recommend you looking into is the Pillar procedure, where a few rigid cylinders are placed into your soft palate, making it less mobile. It's an office procedure and it's been shown to be very effective. You may consult a participating ENT in your area for availability. Research on www.restoremedical.com for more information.
     I hope you find the solution that you seek, God bless.

7. QUESTION:
   Obstructive Sleep Apnea: CPAP Machines vs. Oral Appliance Therapy?
   My father has Obstructive Sleep Apnea and will be going in for a sleep study soon so I am looking at CPAP Machines and doing research.

   My father came across an add for this "Oral Appliance Therapy" thing and I am wondering if you have any info on if it works or if it is a scam.

   Oral Appliance Therapy

   http://www.tiredofcpap.com/

   I'm looking at the CPAP Machines and if you could share your stories with me, I would greatly appreciate it!
   Obstructive Sleep Apnea Info:

   http://en.wikipedia.org/wiki/Obstructive_Sleep_Apnea

   • ANSWER:
     The first thing to do is let your dad get his polysomnogram done and find the results of how severe his sleep apnea is.

     CPAP is the gold standard for the treatment of sleep apnea, because it can be titrated or individually set on the optimum pressure to preserve your father's upper airways at night. The brand of CPAP machine isn't as important as having a quality titration done to arrive at the proper pressure for him, and finding the right mask type that makes him the most comfortable and likely to wear the system consistently all night, every night.

     Oral devices are for very mild cases of sleep apnea. However, I would be very wary of any devices that are mail-order/internet. These devices are usually prescribed and fitted by a dentist or ENT specially trained in their use. Any device that is 'plug and play' without being fitted is a scam.

8. QUESTION:
   Is there a new device for sleep apnea sufferers?
   One of my co-workers heard about a new device on the radio one day, but could not remember what it was called. I have tried the CPAP machine and the oral appliance. I found out I have a deviated septum and plan to get that fixed, but thought I'd check out what is new in treating sleep apnea.

   • ANSWER:
     I don't know anything about a new device in treating sleep apnea. I read a lot about treatments for sleep apnea patients, and I should know something about it. Maybe if you could tell me more about this device...

9. QUESTION:
   What do you know about sleep apnea surgeries?
   I hate the mask (as many people do). I have severe obstructive sleep apnea. I am considering surgical options but I've been told the only one that may work for me is the mandibular advancement (when they break your jaw and move it forward). Has anyone had this before? What were your experiences? Did it work? Do you know of any other surgery that may help? Oral appliances?

   • ANSWER:
     I had a mandibular advancement back in the day when they still wired your mouth shut for 6 weeks. (Many surgeons now opt for a screw and plate closure along with tight rubber bands that allow more mouth movement and a little more eating options!)

     I did have about a year of orthodontics before I could have it done, incidentally, so it was not a quick fix by any means.

     The surgery itself sounded far worse than it actually was. The most pain I had was like a dull headache in my jaw area. Pain management was not a problem at all. I did miss eating what I wanted and lost significant weight. (What I would do to have that happen now!!!) I missed yawning the most, though!

     It did fix my sleep apnea completely. I have never even snored since. It was well worth it for me.

     My 5 year old had tonsils and adenoids removed for the same reason (sleep apnea) with good results as well. I had previously had that surgery, and it was much more painful than the mandibular advancement.

     I hope this helps! Best of luck to you!

10. QUESTION:
    Does anyone have any information regarding tongue retaining devices for use with sleep apnea?
    Although my sleep study showed that the AHI was reduced to around 10 an hour, the dental appliance is causing TMJ pain and my bite is totally off. Since my problem is that my tongue slides back closing the airway, I wonder if a device such as the Aveo might work. Any ideas??

    • ANSWER:
      Thats a tough one. Three people in my family have sleep apnea but I haven't heard any of them talking about there tongue assisting in causing the problem. I would talk to your dentist and your physician about what you can get. You could probably even go to Walgreens for advice. You could try getting a mouth guard to sleep in. Helps to prevent grinding and such. Hope you find something to help you!

11. QUESTION:
    Question about sleep apnea.?
    I have moderate obstructive and central sleep apnea. My blood oxygen levels according to sleep study dropped down to 60. I tried the CPAP machine for a couple of months and finally gave up. And I can't sleep with that dental appliance either. BTW I am tall and very thin, medically I would be considerated underweight.

    I am looking to buy a pulse oxyimeter with alarm that would wake me when my oxygen gets too low, like below 80. Do you think this would work? Where is a good place to buy one?
    Thanks.

    • ANSWER:
      I would think that would wake you up just as much as sleep apnea.

      Go to the place that supplied you with your machine and ask them to be fitted for a new mask. They have ton's of choices and there is bound to be one that will work for you. If you find a nice respiratory therapist who is willing to spend extra time with you, you can find a mask or nose mask that will work right for you.

      Good Luck!

      I've had sleep apnea for years and it took a while to find a working mask.

12. QUESTION:
    Can I get treatment for sleep apnea in Thailand?
    I have sleep apnea. I have a c-pap machine which I have stopped using because I can't tolerate it. My doc says that ignoring sleep apnea is very dangerous to my health. So, I made an appointment with a specialist about having an oral appliance made for my mouth. The catch is that he must see me every two weeks for 8 months. That does not fit in with my plans to retire in Thailand. Plus, his service costs an arm and a leg and my insurance coverage would be 50%. The question is: are there doctors in Thailand who can treat people with sleep apnea?

    • ANSWER:
      Skipper, you can go to the website of any of the International hospitals over here and e-mail them for the cost of the oral appliance for your mouth. They will be happy to give you an estimate of the cost. You should check in the area you plan to stay, I know you asked a lot of questions about going to Chiang Mai so maybe a hospital there could help you. Also, you should check and see if your health insurance will cover the cost over here. If you are retired military you could use Tricare over here also.

      Here is just one example. The sleep clinic at Bumrungard Hospital website: http://www.bumrungrad.com/thailand-expat/medical-services/clinics-and-centers/sleep-disorders-center.aspx

13. QUESTION:
    How important is it to correct a change in my bite?
    I recently began treatment for sleep apnea with a custom-fitted oral appliance - a mouth piece that I wear at night to pull my jaw forward. This has done an excellent job in preventing snoring, but has altered my bite. My dentist was very concerned by this, but the doctor that fitted the device (also a dentist) indicated that a change in bite is not serious - nothing more than an annoyance. The change in bite does not bother me, but I am afraid it will cause damage to my teeth down the road. Is this something that I should be concerened about? Do I need to get the bite corrected? I'm kind of in a bad situation where I have to choose between the effective treatment for sleep apnea, and the bite problem.

    • ANSWER:
      1stly, since the appliance was to protract your jaw, a change in bite shud`ve been predicted. u need to consult an orthodontist as well, regarding the new bite and whether is it leading to a malocclusion. in this case, all your teeth will be affected over time and change in their positions may occur.

      also, a change in bite could lead to temporomandibular joint dysfunction, though the manifestation is not immediate which might cause ur dentist to overlook the bite change.

      so confirm with an orthodontist.

14. QUESTION:
    My husband is snoring so loud I can't sleep..?
    I am open for suggestions. My husband has sleep apnea and the doctor gave him a CPAP machine. He says it is uncomfortable so he won't wear it. He won't try the breathing strips or the mouth appliance. The doctor wanted to do surgery...tonsilectomy and rhinoplasty, but he refused. She said it is really serious because the sleep study showed he was not getting enough oxygen and having almost 20 apnea episodes per night. I have tried ear plugs but they really don't help. We have a couch but it is the kind with a recliner at each end so it is uncomfortable to lay across. We do not have a spare bedroom. I have a 22 month old baby as well as a 17 year old son that I am homeschooling. I need some sleep. I am so tired and grumpy. I feel so tired..from lack of sleep and my doctor says I am severly anemic. I am worried that if something doesn't get better soon, my kids are going to be without one of their parents. This isn't healthy for either of us.

    • ANSWER:
      Have you sat him down and told him everything you just told us? Especially the second last sentence... something or someone needs to slap him upside the head to wake him up (no pun intended).

      If he won't listen, tell him he MUST keep his life insurance paid up to date... and keep checking to make sure it is... maybe he'll get the hint then.
      .

15. QUESTION:
    Question about functional orthodontics? Expander?
    I have begun functional orthodontic treatment (I'm 26, F) my problem is v. narrow upper jaw (both wisdom teeth and bicuspids extracted years ago, and lower wisdom teeth also gone). I have tmj, sleep apnea, and a recessed upper jaw as a result. My question: My orthodontist proposes replacing the missing teeth, and to this end he has given me an expander for my upper jaw, which is made of acrylic, has one midline screw, and just wires which attach to one molar on each side. Looks like a Schwartz expander, I think. Form what I've read, it seems that these are only used for children when trying to expand the jaw, and that after childhood, these appliances will only tip the teeth. I am spending alot of money, and the success of this treatment is very important to my health and airway. Will this appliance just tip my teeth outwards, or can I expect my jaw to expand? I'm to turn it once every two days.

    Can anyone shed some light?

    • ANSWER:
      You have a Schwartz plates and it WILL expand the jaws in adults. I have successfully expanded palates in patients over 50 years of age without teeth tipping. Slow expansion is much more stable than rapid expansion. 1 turn every 2 days is too fast, IMHO, for an adult and that could result in tipping. That regiment is fine for a teenager or younger but not for someone your age. The normal schedule for adults is 1 turn every 5 to 7 days or once a week. I'm wondering why you were not given a sagittal appliance to wear so that the palate can be widened and the premaxilla developed simultaneously. Perhaps the cephalometric analysis showed that the maxilla is properly positioned anteroposteriorly (a ceph analysis was done, right?). Also, palatal expansion appliances like Schwartz plates are usually made with 2 screws when treating adults. As the upper jaw expands, the palatal vault usually drops so make sure that the tissue side of the roof of your appliance gets ground away, if necessary, to compensate for this. A drop in the vault will increase your airway and improve nasal breathing. Expansion is not stable in adults so be prepared to wear a retainer at bedtime for the rest of your life, a small price to pay to get back to normal.

16. QUESTION:
    Functional orthodontic treatment plan?
    I'd like to ask Tooth 975's opinion about a proposed treatment plan I 'm to undergo, if you're around, and willing!!

    My situation: 2 upper biscuspids extracted years ago, 4 wisdom teeth also extracted. Sleep apnea, neck pain. Flat facial profile

    Proposed treatment: Bring upper teeth outside lowers using 1 screw upper schwartz, 2 months, turn once every 2 days. Bring front teeth forward with a schwarz 3d- like appliance, to allow lower jaw to come forward. Braces, implants to replace teeth. There may be things missing, but this is what I gathered. Probably an expander somewhere. Is this ok, to just tip teeth initially and start proper expansion later?

    Does this seem sound to you?

    1. Can the lower jaw actually come forward at my age?
    2. In fact, I thought it odd he wants to move my lower jaw forward, as it always looked more prominent (or at least larger) than my upper. I know that narrow upper jaws can cause retruded lower jaws, so I understand its likely in my case, but does it look bigger only as my upper jaw is slightly back, and narrow?
    3. I've heard extractions can cause the upper jaw to move backwards, which is likely in my case- is it possible to move it forward, and if so, should this be done?

    Sorry for the questions, but I feel uncomfortable questioning my ortho directly, in case he would take it the wrong way.

    Thanks!!
    forgot to mention, i'm 26.

    • ANSWER:
      The treatment plan you described is an excellent one. The only things I would do different is use an upper Schwartz with 2 screws instead of one because it would be more effective. One turn every 2 days is too fast for an adult and I would suggest one turn a week but at 26 years of age you can probably squeak by at one turn every 5-6 days. Slow expansion is more stable than rapid expansion. FYI, expansion with a Schwartz plate will not tip teeth if done correctly, it will actually expand the jaw. At the rate you described tipping will likely occur so go slow because you do not want to tip teeth. The bone needs time to remodel also so one turn every 7 days would be ideal. Almost always when bicuspids are extracted and the front teeth are retracted to close excess space during traditional orthodontic treatment, the mandible becomes trapped posteriorly. When the front teeth are moved forward again, the mandible sometimes moves forward on its own because that is where it wants to be. If the mandible does not move forward on its own, a functional appliance (i.e. Twin Blocks) will need to be worn to reposition it properly to a Class I relationship. When a mandible is translated, it does not change in size, only in position so your jaw will not look bigger; your facial profile will improve and you will look better. And YES, a narrow maxilla can make the mandible look too large. Whether the premaxilla needs to be moved forward will depend on what the cephalometric analysis shows (you must have one done because that will be your road map and it will tell you what needs to be done). Yes, it is possible to move the premaxilla forward if necessary with a sagittal appliance with or without the help of a Reverse Face Mask. The Face mask is worn only at night, BTW. Congratulations on finding someone who knows what he/she is doing.