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Re: mathematics of sleep apnea

Posted by Mark Biegert on March 03, 1998 at 19:08:49:

In Reply to: Re: mathematics of sleep apnea posted by Sue on March 03, 1998 at 17:48:19:

Hi Sue,

Dental appliances are a mouthguard-like device, primarily made of plastic, that either pull the jaw forward (sometimes called mandibular protrusion devices)or pull the tongue forward (sometimes called tongue retainers), thereby opening the airway. I use the jaw variety - it has worked well for me. Some, like my TAP device ( - web site gives almost no information), are adjustable by the patient. Others can only be adjusted by the attending dentist. For appliances that thrust the jaw forward, it usually is required to move the jaw out about 75% of its maximum outward movement. This can result in some jaw discomfort until you get used to it. The discomfort reminds me of the feeling I used to get as a kid when I chewed a lot of gum. I must admit that I find the dental appliance convenient and effective. However, some people have to stop using their appliances because they develop TMJ.

Other side-effects reported include tongue soreness (the tongue can rub on pieces of the appliance - feels similar to a burn from drinking liquid that is a bit too hot) and excessive salivation. I have had both side-effects and consider them minor (all OSA treatment options have problems). I have used CPAP and consider the appliance a better fit for my particular case.

I had an "at-home" sleep study while using the appliance and it showed that my OSA was successfully treated. So it does work - however, I have had numerous people express doubt.

I have been told (by my dentist) that dental appliances are considered useful only in cases of mild or moderate apnea (RDIs < 30). In general, they have a 65% success rate at relieving sleep apnea and an 80% rate of relieving snoring. I hear tales of people who use both CPAP and a dental appliance. They use CPAP at home (because it is effective) and a dental appliance on the road (because it is convenient, but not quite as effective). Using the appliance, they get sufficiently good sleep for short road trips and the appliances are much more convenient to use when traveling.

There also are devices called equalizers, which are designed to lie on the soft palate or reposition the uvula and thus reduce the snoring sounds caused by its vibrations. This is similar in concept to the common surgical procedure uvulopalatopharnygoplasty (UPPP). I have found no data on the success of equalizers.

As far as maintenance, dental appliances are easier to deal with than CPAP. They are small and require no power. They do need to be cleaned daily (I brush mine along with my teeth in the morning) and occasionally soaked for a few minutes in mouthwash (otherwise they develop a "morning mouth" sort of taste). They do wear out, lasting from 2 to 5 years. Mine cost $1000, which insurance covered 80% (my "out of pocket" cost was $200).

Some people with difficult cases end up using both CPAP and a dental appliance. The dental appliance generally reduces their pressure requirements. It sounds uncomfortable, but it is better than extremely poor sleep.

When getting the dental appliance, I noticed a little competition between the dentists and the sleep docs. When I mentioned to my dentist that I had tried CPAP and had problems, he mentioned with a wry smile that far too many CPAP machines end
up in the closet after being used for only a short period of time. His feeling seemed to be that CPAP is just too much hassle for people with mild apnea.

There are a number of web sites that discuss dental devices in greater detail:

These two are a good start. For some excellent reviews of the professional literature (some refer to appliances), see

This is maintained by Kerrin White, an MD with OSA. It is a GREAT site.

I have a web site of my own where I discuss the information gathering I did while I sought effective treatment. Take a look at:

Do not hesitate to contact me if you have further questions. Good luck!

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