Mandibular Advancement Devices

[snoreslikeatrain]

I realise this forum is mainly aimed at CPAP users but have any of you had success with Mandibular Advancement Devices?

Did any of you:
- Try them and find you then did need CPAP?
- Try them, not see much improvement, then go onto CPAP?

I'm just interested in their relative worth.

Colin

[threewheelweave]

Good Question - JAMES PLS LOOK

Hi Colin & welcome

Try looking at the alternative treatments section of the forum - also send a PM to James at Intus - he may be able to tell you how many mandibular devices Intus have supplied over CPAP equipment and also if people who purchashed the mandibular devices went on to purchase CPAP gear

JAMES can you reply to this thread? Thanks

Hope this is of some help - cheers

TWW
UK

[James @ Intus]

Welcome to the forums!

When looking at MAD's, or as they are more commonly called these days, Mandibular Repositioning Devices (MRD's because it's more than advancement alone) you have to realize that sadly, there's an enormous quality range. Where CPAPs are almost universally quality, MRDs range from the downright crap to the super well made "Rolls Royces". There's about 100 different makes and models ranging form £15 to £1500. You get all sorts!

You then have to realise the obvious. They're not all going to work that well. In terms of clinical research, custom made, proven designs have been found to have reliable efficacy for mild to moderate OSA. Low-end MRD/MAD's are only found to treat snoring. They do very little, if anything, for reducing ODI/AHI.

So you have to start off knowing, do you just snore, have mild, moderate or severe apnoea?

If you have severe, you just have to get on CPAP.

For moderate, CPAP probably still is your best bet, unless you have the budget for a custom engineered precision MRD like our SomnoDent MAS. (S for splint, yet another abbreviation).

For mild OSA, any custom splint like the SomnoDent and perhaps one or two others may be suitable. The problem is, they'll quickly tackle snoring, so pepole assume it's going swimmingly. But without a follow-up sleep study, you wouldn't know whether it'salso taken care of the apnoea and hypopnoea events. In other words, whether the AHI or in case of monitoring with finger pulse oximetry, the ODI has been lowered to well below 5. If snoring goes but apnoea stays, you have a "silent apnoeic" and a very dangerous situation. Many dentists who haven't had dental sleep medicine training make this mistake when fitting inferior splints.

If you "just snore" and have confirmed this with a sleep study, you can try a "DIY splint" first. We cater to this category with the best we could find in this category, the Somnofit. It's also used by mild-moderate apnoea sufferers on CPAP, who need a short term alternatives for example on a weekend away. It beats dragging your machine on a plane. For every-night use, it's only for snorers as the relative bulk of it, compared to a custom device, and the fact it's not precision molded to your teeth by a lab, means it's efficiency in treating OSA can't be assured across the board.

In summary, a true, high quality, custom made splint with a reputation and plenty of clinical data behind it (SomnoDent is our preferred unit in this category) is a great CPAP alternative for mild-moderate sleep apnoeics. Follow-up sleep studies to confirm the treatment is going well is always recommended, if not required.

All the others, especially the ones you can fit yourself, are only for snoring, or for very short term (weekends, long-haul flights) CPAP replacement.

You very much get what you pay for in this case.

[snoreslikeatrain]

Thanks James

...for your comprehensive reply.

In brief, I know know I suffer from a degree of Apnoea becuase my wife has commented on me stopping breathing during the night and I have several of the symptoms during the daytime.

I'm booked in for an assessment at a sleep centre in Bristol, to find out the degree I'm affected.

The thought of the CPAP machine isn't particularly attractive (though I accept it may be the best course of action). Whilst I'm waiting I thought I'd look at the mandibular devices. I'm afraid that whilst a Dentist fitted device sounds the most effective, I'm reluctant to pay £1,000-1,500 until I know a lot more. In addition, there seem to be a very limited nuumber of dentists who can fit the Intus one (2 in the South of England?!).

In the meantime, I looked at the Intus Somnofit and also the "Tomed SomnoGuard SP Soft" and have plumped for the latter. Sorry...

I'm looking forward to getting the assessment

Colin

[James @ Intus]

There's a limited number of dentists who are qualified enough to fit the SomnoDent. That's to ensure the quality. It's the only ISO certified device and those high standards can't be risked with dentists fitting them without any training on dental sleep medicine. Quality over quantity so to speak.

You are right in saying you need to know the full extent before investing considerable amounts, whether it's a CPAp or MRD. A sleep study is the only way to find out so I'm glad to hear you're booked in for one. In the meanwhile, the Tomed you got will be alright for reducing the snoring. Hopefully, it won't move your teeth like some do.

Let us know how you get on.

[sticky59]

Results.

Just to add my 2 cents worth. I have been a OSA sufferer for many years. My wife brought it to my attention back in 2003. I had the sleep study done by a guy in Winpole St London, and went on to have a custom splint made.
For the first 2 years I would say (or rather my wife would say) that it was 85% effective. I am now in the market to have another one commissioned. They are expensive but if you look after it and clean it often, and keep it in water it will serve you well and last a few years. The quality of my sleep when wearing it is 100% better than it is without. The custom made splints are pretty streamline and fit like a glove....hence nothing big and bulky to deal with. I highly recommend a custom build that is adjustable.

[snoreslikeatrain]

Got my results

Ok, here's an update.

I had an assessment using oximeter readings. As an experiement I used it for one night using the SomnoGuard MAD and one night without.

Well my wife had told me that the MAD definitely reduced my snoring. However the oximeter readings showed I had mild-moderate OSA and that there was very little difference in the readings on the two nights. The report said my average 4% dip rate was between 7-5 dips per hour (however there were periods especially later in the night when the frequency appeared higher).

I'm quite happy to accept that a better made MAD would give me better results.

In the meantime, the consultant suggest I try a ResMed CPAP machine for a month and I have been using it. I'll report separately on how this has gone but in summary my wife says she now can't hear any snoring (sometime mildly more noisy breathing, but that's about it).

It's only been a couple of weeks so I'm waiting to see what other benefits I notice in my "waking life".

[Tricia]

So you have to start off knowing, do you just snore, have mild, moderate or severe apnoea?

Does anyone know what the stats are for catagorising mild, moderate and severe?
On average I stopped breathing 20 times an hour. I know someone who stopped 90 times an hour. I've read on here that someone has stopped breathing 100+ times an hour.

[cheryl4andy]

stats

I was told anything 30 and over is severe! im at 38 an hour well before cpap anyway x

[Pracha]

Has anyone tried SomnoGuard SP / AP

I'm thinking to buy either SomnoGuard SP Soft or AP. Does anyone know which one is the best to go? Someone told me that the SP Soft is more comfortable but its plastic straps are difficult to put on/off. The AP is more bulky. Thank you.

[snoreslikeatrain]

Someone told me that the SP Soft is more comfortable but its plastic straps are difficult to put on/off

I bought the SomnoGuard SP Soft. I haven't found the plastic straps difficult to put on.

I have no experience of other MDA's, but what I liked about the design of this model is that you can open your mouth slightly (useful if you need to sneeze or cough whilst you've got it in). However whilst this feels more comfortable, I don't know if this makes it as good at keeping the lower jaw advanced as some of the other models where your upper & lower jaws are effectively clamped in a fixed position.

I'm sure James can advise further on this.

[Needsleep]

I've just subscribed to this forum. I tried CPAP and BIPAP, but both didn't work for me. I'm considering a ``Mandibular advancement device" but it seems very expensive and not certain it will work. Can anyone who has tried such a device let me know whether it worked, and the pros and cons of using it? Thank you!

[Needsleep]

To anyone who is on this forum and following this "mandibular advancement device" thread:

I've just subscribed to this forum. I tried CPAP and BIPAP, but both didn't work for me. I'm considering a ``Mandibular advancement device" but it seems very expensive and not certain it will work. Can anyone who has tried such a device let me know whether it worked, and the pros and cons of using it? Thank you!

[Kelly @ Intus]

Hi Needsleep,

Thank you for your post.

Can I possible ask why you did not get on with your CPAP therapy, and ask if you have mild, moderate or severe OSA? The reason I ask is that mandibular advancement devices are recommended for people with mild to moderate OSA. We have 2 of the mandibular advancement devices, and they are both worth having a look at.

1. Somnolis Mandibular Advancement Device - This product provides a low-cost method of evaluating the effectiveness of mandibular advancement for your snoring or OSA. It is effectively a trial, which if effective allows you to purchase a longer-term MAD with confidence.
2. Somnofit Mandibular Advancement Device - The simple boil-and-bite method gives a customised fit that brings the lower jaw forward, creating better airflow and reducing the pressure that causes snoring and apnoeas.

The advantage of a mandibular advancement devices is that it is a cheaper method of treatment then a CPAP machine and mask.

The disadvantage of a mandibular advancement devices is that you have not way of seeing if the product is effective, apart from whether you are feeling better, and sleeping better.

If you have any questions, or would like any further assistance, then please just let us know.

Kelly

[yassine]

If you have moderate or mild obstructive sleep apnea you can use the alternative cpap mask like Mandibular Advancing Appliances ,wix and Somnoplasty.....