Sleep apnea and mouth guards

[Mr._Graybeard]

I have sleep apnea, according to a couple of sleep studies I underwent this summer. The sleep lab immediately wanted to put me on a CPAP, but the ear-nose-throat guy I later consulted judged my condition to be "mild," and he said I probably could get by with a mouth guard (mandibular advancement device in docktorspeak).

I visited my dentist yesterday, who remarked on the lack of analysis in my sleep lab's report but concurred that the numbers suggest my condition is "mild to moderate." He agreed that a mouthguard could help, and then he quoted me a price: $2800 to $3300! Of course that isn't covered by insurance like the CPAP would be.

I could suck it up and pay, but I'd rather have some clue that the device would be effective before rolling the dice. Which has me looking at the over-the-counter market.

I'm looking at the SleepMD. Apparently you can consult remotely with a physician while fitting the device, and there's a 30-day money-back guarantee. Reviews I've read confirm that the consult and the guarantee are for real. The price is $129. https://www.sleepmd.net/

I tried an over-the-counter mouth device years ago and it triggered my gag reflex -- but it was pretty crude in retrospect. I have used a guard I got from my dentist to protect from teeth grinding with no problem.

I expect to read recommendations to lose weight, and I could drop a few pounds, but I've been a noisy sleeper all my life, even when I was built like a running back. I'm big -- big head, big neck, big shoulders. The ENT said my tongue is big, too, which is part of my problem.

The ENT also noticed I have a slightly deviated septum, and recommended these nose cones as an alternative to breath-rite strips. https://www.amazon.com/Breathing-Snoring-Different-Relief-Dilator/dp/B086YL8LSQ/ref=asc_df_B086YL8LSQ/?tag=hyprod-20&linkCode=df0&hvadid=507467652717&hvpos=&hvnetw=g&hvrand=6765679186659078765&hvpone=&hvptwo=&hvqmt=&hvdev=c&hvdvcmdl=&hvlocint=&hvlocphy=9018899&hvtargid=pla-1252944783999&psc=1
They look weird but they actually work pretty well

Soooo ... has anyone actually used a mouth device to deal with sleep apnea, and has anyone gone the over-the-counter route? Either way, I'll update this thread with my SleepMD experience.

 

[Masquernom]

This probably won't apply to you. I grind my teeth in my sleep. I've worn a bite guard for many years. I ordered one of the cheap devices to move your jaw forward. It triggered my grind reflex and I chewed it up the first night. That was the end of that experiment for me.

 

[tfudtuckerpucker]

I've been on a cpap for ~20 years, and I never sleep without it. So I'm pretty familiar with them. For sleep apnea, I would not rely on a dentist for treatment. Correct treatment of sleep apnea involves a sleep study for diagnosis, and testing whether a cpap helps. Maybe a mouth guard would work, but that would need to validated by testing. If you suspect sleep apnea (I felt like I was suffocating when asleep), you should see a sleep doctor. Sleep apnea can cause major health problems, like high blood pressure, heart disease, etc, so it's not something to take lightly.

On a side note, I've had some bad experiences with profit-driven dentistry, with various dentists wanting to do costly unneeded procedures. So now if a dentist wants to do anything involving significant expense, I'll usually go for a second opinion.

 

[Winemaker]

A fellow winemaker friend of mine had a "chip" installed to control his apnea, he didn't deal well with the CPAP. IIR, it's controlled with cell phone. I've used a CPAP for about 20 years and it doesn't bother me.

 

[omni550]

A fellow winemaker friend of mine had a "chip" installed to control his apnea, he didn't deal well with the CPAP. IIR, it's controlled with cell phone. I've used a CPAP for about 20 years and it doesn't bother me.

Can you please elaborate on this "chip"?


omni

 

[Act2]

Hello! I used a CPAP for several years, and now I use a professionally fitted dental device. And nose inserts called “Mute”, similar to but not exactly like your nose cones (from Amazon).

First off, being on CPAP allowed me to sleep better, which in turn made it easier for me to lose a considerable amount of weight. (I regained some during Covid and am working my way back down…) But eventually I just found the CPAP was hard to lug everywhere when I travelled and it also started to annoy me to the point I could no longer tolerate it, so I went to a team that includes an orthodontist and physician and works a lot with dental sleep devices. I am very happy with the dental device. My sleep is wonderful.

I understand that my insurance would in fact pay for the dental device but only once I could no longer tolerate the CPAP, and only so long as I did the sleep study. But since I had a high deductible health plan, insurance didn’t help me a lot.

The price you quote is higher than what I believe I paid. But it’s not a cheap fix.

When I managed to break my first dental device after a few years of use (a fluke, this is not something they had seen before), I used an over-the-counter type dental device (which I had to melt to fit) as a bridge until I got the new one. My CPAP machine was recalled due to the foam/cancer issue you’ve heard about, so it is not a back-up option for me. The over-the-counter thing was better than nothing but not at all as wonderful as my dental device.

 

[JDARNELL]

I think its effectiveness is a function of the type of sleep apnea you are experiencing. For example, Structural it will probably work. Central to where the brain isn't telling you to breath probably not.

 

[Act2]

Excellent point.

 

[BH58]

I have a somnomed device I got from my dentist. It helps quite a bit except if I am really really tired or drank a lot of red wine. I don't like to be without it anymore. I sleep better with it. I tried an over the counter Snore RX and it seemed to work also but was much less comfortable than the one from the dentist.

 

[MRG]

I used to have sleep apnea but it went away from losing 70 pounds. I'm a grinder and wore devices most of my life they didn't work for me.

You mention not having a lot of room for breathing. A mentor had that issue and had a bob performed on his pie hole, I'm sure theres a better name for it. In another case he thought it was beneficial. Having my severely deviated septum surgically repaired was amazing. Good luck.

 

[Winemaker]

https://www.inspiresleep.com/

This is one style. I guess it's a little bigger than a chip.

 

[Freedom56]

I would not spend $2800 on a device from a dentist. They should not cost any more than a retainer that prevents grinding teeth which are about $440.
My FIL has sleep apnea. He was in denial at first but we recorded him snoring and it was loud and it woke up the cat, dog, and my MIL. His device pumps air through his nasal passage. The device is made by ResMed (model S9). I don't know if they sell those in the U.S. After the CPAP, all was quiet. The dog and cat even jump on the bed and fall asleep with him.

 

[bizlady]

DH does not have sleep apnea but used an over the counter for heavy snoring. Worked well, BUT after 5 months or so, we noticed it started to move his bottom teeth, pushing the front ones out. Discontinued after that for that reason.

 

[Act2]

On the teeth moving and jaw position: my orthodontist/sleep doctor team has me use a little bite corrector for about ten minutes in the morning after I take out the sleep dental device. Just pop it on my teeth while I shower and get ready. It’s more to get my jaw back in its daytime natural location after the jaw was gently held forward during sleep by the dental device so I could breathe in my sleep. I think the dental device actually keeps my teeth inline - it’s basically a plastic retainer, after all - so it’s really for the jaw position.

 

[Markola]

https://www.inspiresleep.com/

This is one style. I guess it's a little bigger than a chip.

That’s a Minnesota company and I happened to have met the founder at an event. An implanted medical device is probably my last resort choice.

Personally, I have really bad sleep apnea, so I use a BIPAP every night, which varies the pressure on each breath and allows me to exhale comfortably. It’s been profoundly helpful to my rest. I couldn’t handle the CPAP with its constant pressure.

If I had a mild case, like the OP, I’d definitely start with a mouth guard.

 

[Exchme]

What prompted you to have a sleep studies done? If it was because you are sleepy during the day, then I would take the apnea seriously and get the CPAP. My doctor said my case was mild too, but I got the CPAP anyway and while it took me time to get used to, I sleep much better.

 

[Romer]

I used a Mouth guard for several years and it worked well. Except it moved my teeth which then started sitting cooked making me look like a hillbilly ( nothing wrong with that The Dentist said it weakened my Jaw and the teeth would keep moving and so we pulled them, strengthened my tissue there and put in implants for the 4 front teeth

Since then have been using a CPAP for about 3 years now with no issues. Resmed Airsense 10

Now that I am retired I am losing weight, so hopefully can get back down to a weight were I won't need anything.

 

[Piper20]

I’ve been using a CPAP for 5 1/2 years. Sleep study was at my home. A tech came and showed me how to wire up. He picked up the machine the next day. I’m also on the recall but was lucky Medicare will pay for a replacement machine every 5 years so I got an AirSense 11.

 

[Bamaman]

Most people don't realize how many people there are out there that really need CPAP or even BIPAP--both men and women.

My doctor says if you have weigh 200 lbs. or more, wear a size 17 inch shirt or larger, snore a lot and/or have down periods especially in the afternoons--you need CPAP/BIPAP. He went on to say that he has 53 local physicians on CPAP in our town of 50,000 people.

I've been on CPAP for 20 years periodically--but all the time recently. I now realize how I am so much more energetic mornings when I'm on air at night. And I don't have to take naps at 2:00 p.m. But what's the best thing is that I'm more agreeable and easy to live with when I'm on the CPAP. And after so long, it doesn't bother me a bit to have the mask on at nights.

Back in April, my wife woke up one morning talking gibberish, and she had a terrible cough. She'd had a BIPAP for 3 years but refused to use it due to the mask "choking her." I thought she was in congestive heart failure, and I hauled her to the emergency room. She slipped into a 13 hour coma, and the ER didn't know if she was even going to recover. They put a BIPAP on her, and she woke that night--with too much CO2 in her system. She had pneumonia. The next day, she was released and quickly recovered. You bet she's a believer in BIPAP now.

You can read online about BIPAP/CPAP. But those receiving air live maybe 2 years longer, and they have a much lesser chance of having to go through open heart surgery.
And they act better too. It's all a plus to me.

 

[pacergal]

I will be interested to hear about your experience with the Oral device.

DH has used a CPAP for several years, none now as it was the phillips recall one and he can no longer use it comfortably due to back issues (he has to be able to move frequently and lay on his stomach--has not been able to find any mask that works.)
He has a referral from our PCP to talk with the dental specialist who does the dental apnea device. Hoping it will work for him. We have Kaiser, so since it was a referral from his PCP, we are also hoping our insurance will pay for it. Have Kaiser Advantage medicare with extra dental coverage.

 

[swakyaby]

I have moderate obstructive sleep apnea and use a nasal CPAP. It works really well, although sometimes I find myself taking it off in the early morning so I can curl up in more natural sleeping positions. But I have also used the over-the-counter mandibular advancement devices that you make a moldable impression of your jaw first. It was because sometimes I had to spend the night in various places where I didn’t want to bring a CPAP machine, but didn’t want people to hear my loud snoring. Or dry camping where plugging in a machine is a problem, but didn’t want to bother DH with my snores. It works enough to lessen the snores, but I’m pretty certain the CPAP machine does a better job keeping my oxygen levels up and carbon dioxide level normal.

For mild to moderate sleep apnea such as the OP, it would be reasonable to try the over-the-counter mandible device, I think. An actual CPAP would be the next choice. The overpriced dental device from the dentist would be last choice.

 

[FlaGator]

I have sleep apnea, according to a couple of sleep studies I underwent this summer. The sleep lab immediately wanted to put me on a CPAP, but the ear-nose-throat guy I later consulted judged my condition to be "mild," and he said I probably could get by with a mouth guard (mandibular advancement device in docktorspeak).

I visited my dentist yesterday, who remarked on the lack of analysis in my sleep lab's report but concurred that the numbers suggest my condition is "mild to moderate." He agreed that a mouthguard could help, and then he quoted me a price: $2800 to $3300! Of course that isn't covered by insurance like the CPAP would be.

I could suck it up and pay, but I'd rather have some clue that the device would be effective before rolling the dice. Which has me looking at the over-the-counter market.

I'm looking at the SleepMD. Apparently you can consult remotely with a physician while fitting the device, and there's a 30-day money-back guarantee. Reviews I've read confirm that the consult and the guarantee are for real. The price is $129. https://www.sleepmd.net/

I tried an over-the-counter mouth device years ago and it triggered my gag reflex -- but it was pretty crude in retrospect. I have used a guard I got from my dentist to protect from teeth grinding with no problem.

I expect to read recommendations to lose weight, and I could drop a few pounds, but I've been a noisy sleeper all my life, even when I was built like a running back. I'm big -- big head, big neck, big shoulders. The ENT said my tongue is big, too, which is part of my problem.

The ENT also noticed I have a slightly deviated septum, and recommended these nose cones as an alternative to breath-rite strips. https://www.amazon.com/Breathing-Snoring-Different-Relief-Dilator/dp/B086YL8LSQ/ref=asc_df_B086YL8LSQ/?tag=hyprod-20&linkCode=df0&hvadid=507467652717&hvpos=&hvnetw=g&hvrand=6765679186659078765&hvpone=&hvptwo=&hvqmt=&hvdev=c&hvdvcmdl=&hvlocint=&hvlocphy=9018899&hvtargid=pla-1252944783999&psc=1
They look weird but they actually work pretty well

Soooo ... has anyone actually used a mouth device to deal with sleep apnea, and has anyone gone the over-the-counter route? Either way, I'll update this thread with my SleepMD experience.

After the fiance' sent me to the hotel suite couch for snoring, I started looking for options. First was using the Snore Lab app on my phone. It records overnight, and I could tell I was gasping for air at points during the night (as well as just "loudly breathing ). Next was the ZQuiet mouthpiece. It advances the lower jaw, opening up the airway (in theory). That worked fairly well, but was a bit uncomfortable. It was effective-the tenderness in my feet in the morning disappeared.

Did that for a few months, then my dentist, who had just opened a TMJ/Sleep clinic, recommended a sleep study. As expected, sleep apnea was diagnosed. No surprise, a custom mouthpiece was prescribed, and I spent the $3,000 based on the results of the OTC device. The custom piece fits perfectly, and has substantially reduced the gasping for air I had experienced (I record with Snore Lap every night). I've been using it every night, as well as afteroon naps for a couple of years.

As stated above, if you're dealing with central apnea (brain wiring), none of this will help. Mine is mechanical, and I've not needed a CPAP machine to have an active life.

A little more background info:
1. I'm "normal" proportions, but sleep better at 155# than 165#
2. Sleeping on my side helps with the apnea/airway blockage, but I can still be noisy.
3. Wouldn't have naturally accepted a "dentist" recommendation on a sleep device, but this one properly diagnosed vertigo with one of my kids (jaw pressure on inner ear due to orthodontics) and quickly rectified it.


Recommendations if you're situation is similar to mine.
1. Start recording overnight using Snore Lab or similar before you do anything. Will give you good info on apnea, time during the night it occurs and disruptive volume (if you share a bed). Look for the spikes on the graph and listen just before and after them.
2. Try an OTC mouthpiece that advances your lower jaw before committing to a custom piece for $$ thousands. Record while using it. Should also be able to tell if it's working via reduction of things like foot tenderness, tiredness/yawning during the day.
3. If the OTC mouthpiece works, and is comfortable, you may be able to stop there . If it works kinda, and is uncomfortable, seriously consider the custom-fitted. Huge difference for me.
4. Less alcohol is better, and cut off whatever you have earlier in the night.
5. The Breathe Right strips are worth trying if there's a problem with your nostrils. My results are mixed per Snore Lab.
6. Do your best to be on your side when you fall asleep.
7. If you're a light(er) sleeper, remember to breathe through your nose and position yourself so that's easier. If on my back, tilting my head to the side helps keep my airway open.
8. Pay attention to your pillow. Some elevation is good for me.

This is a vexing problem. Sometimes CPAP is the best solution. I'm lucky to have found alternatives. Maybe you will too.

 

[Teacher Terry]

11 years ago I was diagnosed with severe sleep apnea having 78 episodes a hour. 2 years ago I lost 50lbs and thought I could get rid of the machine. Although now I only have 4-6 episodes my oxygen level drops too low so I need the air. I wear it about 4-5 hours a night. If I don’t wear it I feel awful the next day.

 

[Mr._Graybeard]

I have a somnomed device I got from my dentist. It helps quite a bit except if I am really really tired or drank a lot of red wine. I don't like to be without it anymore. I sleep better with it. I tried an over the counter Snore RX and it seemed to work also but was much less comfortable than the one from the dentist.

Also my concern. Plus inducing my gag reflex. I've used a mouth guard for teeth grinding but that only covered the lower teeth. DW said that alone helps reduce my snoring.

I'd like to find a device that is relatively short at the upper jaw. I think that would cut the potential for gagging.

I'm also looking at devices that control the position of the tongue. Still shopping around, though.

 

[Mr._Graybeard]

After the fiance' sent me to the hotel suite couch for snoring, I started looking for options. First was using the Snore Lab app on my phone. It records overnight, and I could tell I was gasping for air at points during the night (as well as just "loudly breathing ). Next was the ZQuiet mouthpiece. It advances the lower jaw, opening up the airway (in theory). That worked fairly well, but was a bit uncomfortable. It was effective-the tenderness in my feet in the morning disappeared.

Did that for a few months, then my dentist, who had just opened a TMJ/Sleep clinic, recommended a sleep study. As expected, sleep apnea was diagnosed. No surprise, a custom mouthpiece was prescribed, and I spent the $3,000 based on the results of the OTC device. The custom piece fits perfectly, and has substantially reduced the gasping for air I had experienced (I record with Snore Lap every night). I've been using it every night, as well as afteroon naps for a couple of years.

As stated above, if you're dealing with central apnea (brain wiring), none of this will help. Mine is mechanical, and I've not needed a CPAP machine to have an active life.

A little more background info:
1. I'm "normal" proportions, but sleep better at 155# than 165#
2. Sleeping on my side helps with the apnea/airway blockage, but I can still be noisy.
3. Wouldn't have naturally accepted a "dentist" recommendation on a sleep device, but this one properly diagnosed vertigo with one of my kids (jaw pressure on inner ear due to orthodontics) and quickly rectified it.


Recommendations if you're situation is similar to mine.
1. Start recording overnight using Snore Lab or similar before you do anything. Will give you good info on apnea, time during the night it occurs and disruptive volume (if you share a bed). Look for the spikes on the graph and listen just before and after them.
2. Try an OTC mouthpiece that advances your lower jaw before committing to a custom piece for $$ thousands. Record while using it. Should also be able to tell if it's working via reduction of things like foot tenderness, tiredness/yawning during the day.
3. If the OTC mouthpiece works, and is comfortable, you may be able to stop there . If it works kinda, and is uncomfortable, seriously consider the custom-fitted. Huge difference for me.
4. Less alcohol is better, and cut off whatever you have earlier in the night.
5. The Breathe Right strips are worth trying if there's a problem with your nostrils. My results are mixed per Snore Lab.
6. Do your best to be on your side when you fall asleep.
7. If you're a light(er) sleeper, remember to breathe through your nose and position yourself so that's easier. If on my back, tilting my head to the side helps keep my airway open.
8. Pay attention to your pillow. Some elevation is good for me.

This is a vexing problem. Sometimes CPAP is the best solution. I'm lucky to have found alternatives. Maybe you will too.

Thanks -- good tips.