CPAP & MAD Anyone?

[DevonBound]

Hi All,

It's been a while since I posted in this forum but always look in most weeks!

I have a question, My AHI Reading will not go down below 5.5 and my tech @ the Sleep Lab advises that my problem is physiological and that my Jaw is dropping back and aiding in narrowing my throat.

I have tried a chin strap, but this only holds my mouth closed but does not stop my jaw from dropping back.....my techie recommends a Mandibular device and I would like to give this ago.

I am not a man of endless means and have therefore been eye'ing up the 'Tomed Somnoguard' @ circa £130'ish....
Can anyone advise whether they suffer the same problem and also whether they have tried both the 'MAD' and the CPAP at the same time?

I ask becuase although my AHI reads 5.5, and has been steadily for the past few months, I still feel very tired in the day and will fall asleep if I sit down for long enough - so I really want to rid myself of this feeling.

I have a RESPIRONICS APAP for your info.

Looking forward to hearing any words of advice.
Thanks

[James @ Intus]

Hi,

I've seen a chin strap once somewhere which claims to pull the jaw forward. How that works, I don't know, I only vaguely remember seeing it. It could be rubbish but perhaps worth hunting around for.

Not many people will go for both options, MAD and CPAP.

Can you tell me...

Which mask do you use?

What has been tried and tested with the CPAP to try and drop the AHI further?

What type of sleep study did you originally do?

What was your AHI pre-CPAP?

[DevonBound]

Hi and thanks for the response James.

I use a Resmed Quattro (Full Face) and is very comfortable - leakage is not an issue and sleep very comfortably with this.

The lab tech was not concerned by my AHI level and commented that they would not investigate further as the acceptable limit of AHI is between 7 & 15 - therefore I was considered to be getting good sleep despite my concerns of continued tiredness!

I had a full sleep study previously with Oxometer and breathing recorder strapped to me carried out at Leicester, my pre CPAP reading was AHI 45+.....so in this regard I am getting far better quality sleep.

I do only sleep for about 6.15hrs per evening which used to be adequate pre-CPAP, but perhaps now that I am getting better quality sleep I should try getting more sleep. This does come down to ill discipline I am afraid as I have always been a night owl and tend not to creep off to bed until wee hours.

All the Lab tech would say was that my issue is more physiological than weight related, as I have a small jaw which is slightly receeeded and will naturally drop back on relaxation, which is absolutely correct and apparently the only way to help this is a Mandibular device which she recommended as well as CPAP....Hence the original question really.

I have tried 2 chin straps and they were both terrible and neither hel my jaw in place once I relaxed and one I couldn't tighten enough to keep my mouth closed?

Any Thoughts?

[James @ Intus]

They really reckon between 7 and 15 is OK? That's rather liberal. 10 Events per hour is one in every 6 minutes.

From 45+ down to 5.5 is a good result, and despite the continued sleepiness, I'm sure your body is thankful for it already.

Sleep hygiene / habits is in deed an important factor and it was actually at a recent sleep disorder conference where someone highlighted exactly what you describe. Compliant with CPAP, but still sleepy. They found indeed that the CPAP user was chronically sleep deprived because he/she never slept more than 6 hours a night.

So if your AHI is stable around 5.5, there's probably more to gain from increasing the time slept than trying to lower than further, with yet another contraption.

Also, did you ever try a nasal mask? Perhaps the full face mask is putting pressure on your lower jaw, the wrong way. If you have a short lower jaw already, perhaps this is even more the case in you, that the full face mask is pulling it back even further, in an attempt to get a seal.

You can also look into those funny PJs which force you on your side. Or crank up the lower pressure of the Auto to increase its preventative abilities. That often lowers AHI further, at the expense of increase average airflow and possible leaks/noise etc.

But crank up the 6.5 hrs I'd say. See if a week of 8hrs sleep makes a difference before continuing the hunt for a solution. My money is on that one.

I asked for thoughts on this on Twitter:

http://twitter.com/intus_sdb/status/27345649578

Some sleep doctors follow us, hopefully they'll chip in.

[Grumpy]

MAD

I tried a MAD (Therasnore) a few years ago but couldn't get on with it.
Took several weeks of training in front of the telly with a towel on my chest (I could dribble for England) before I could even think of trying to sleep with it in.
Then I just used to wake up and a have to try and find it as I would have spit it out. Not always easy to find if the cat had decided to play with it!
It finally went in the dustbin and I was left wiser and £200 poorer (it was custom made via my dentist).