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Chin straps to treat OSA


#1

Hi,

I am new to the forum.

I just saw an ad for “My snoring solution”.

Has anyone on the forum used one of these? Was it useful, or not?

BTW: I looked for a search box on the site, and didn’t find it. If there is a search function, please direct me to that.

TIA,

Rog S


#2

Hi Rog,
It is the icon that looks like a magnifying glass in the upper right hand of the page.


#3

With CPAP therapy in the treatment of sleep apnea, patients wear a mask over the nose (nasal mask) or a full face mask which covers the nose and the mouth. A full face mask is used when the patient is a mouth breather. Full face masks can be challenging due to their larger size which means a greater surface area and potential for mask leak. So sometimes a mouth breathing patient will prefer and choose to wear a smaller nasal mask WITH a chin strap to help keep the mouth closed.

A chin strap MIGHT keep the lower jaw pulled up, but it does not keep the lips together. So for some, a chin strap might work, but for many they do not. You would have to try one to see if it works for you.

Primary snoring is snoring without the presence of sleep apnea. While products are available for primary snorers, those with sleep apnea need oral appliance therapy or the gold standard which is CPAP. Remember that snoring is just one of the symptoms of sleep apnea, If you have sleep apnea and simply eliminate the snoring, it does not mean you are resolving your apnea.

Have you been diagnosed with sleep apnea?


#4

Yes, I have sleep apnea. I have been using CPAP for 10+ years with no problems.

I am always looking for alternatives that would make traveling easier.

Thanks for the response.

Rog


#5

Ah OK. Chin straps are not a treatment for sleep apnea, just an accessory to enhance use of the mask in some patients.
Nice to hear that you have been successfully treated for 10 plus years! Bravo!
I do know SOME patients with MILD sleep apnea who use oral appliance therapy when they travel and don’t want to lug the cpap machine. One friend enjoys sailing and uses cpap religiously at home, but on his boat for long trips, he can use the oral appliance. Also people who camp and do not have easy access to electricity, benefit from oral appliances away from home. If you are interested in exploring this option, ask your local sleep doctor for a referral to a dentist who is trained in treating sleep apnea.


#6

I am a dentist working in dental sleep medicine. The best oral sleep apnea appliances, such as the TAP 3, are quite successful in treating both MILD and MODERATE obstructive sleep apnea. Peer reviewed studies have shown that the TAP 3 can give successful treatment(defined as reduction of AHI below 5 and all symptoms eliminated) in about 84% of the cases. The inclusion of moderate cases is important because the vast majority of OSA patients are mild to moderate(about 90% if my memory serves). This means that, as a practical matter, most patients have oral appliance therapy as an option. a.b.luisi,d.m.d.


#7

Yes, great points. I really wish our field did a better job of actually measuring how well therapy is working for patients. Right now, what is relied upon is asking the patient how therapy is working (which is definitely important), but supplementing that with objective data would be great. For example, the CPAP machine does provide a measure of the AHI when the mask is being worn, but what we don’t know is sleep quality on the machine, as well as full amount of sleep . . . in other words if CPAP is worn 3 hours and total sleep time is 7 hours, you have have normalized AHI when on CPAP, but 10 or 15 events per hour during those next 4 hours, so your effective rate is worse. IMHO, this is a responsibility of the clinic, but the way our reimbursement system works, it is the patient’s job to come back to clinic and say, this therapy is not working very well for me.


#8

84% reduction to below 5 is way overstated, and using extremely mild AHI case studies. I know from real world experience that oral appliances reduce AHI, but by no means does it effectively reduce 84% of patients to within normal limits below 5 times per hour. In fact plenty of times I’ve actually seen patients AHI increase from pre-treatment study to post oral appliance study. In oneither example I had 2 weeks ago, patient had overall AHI of 14.3/HR on original diagnosis study without treatment. They had their second study after getting oral appliance 2 weeks ago and their AHI with appliance was 15.4/hr. This a an abnormal instance in that their AHI was increased rather than lowered, and in general oral mandibular devices do decrease apnea index. However, people need to understand Sleep apnea is no where near effectively treated as well as traditional positive airway pressure therapy. Oral appliances should only really be viable option for those that have primary snore, extremely mild case of OSA, or who have failed tolerating PAP therapy and are unwilling to attempt it. The final instance they should be made aware that they will still have OSA with oral appliance, it will just be reduced along with audible snore. Health risks are still viable over time.


#9

I am a dentist working in dental sleep medicine. Sorry, munkybeatz, but you are way off the mark with this one. A very reputable four year study done by a physician in a university hospital setting did indeed show that the TAP 3 oral sleep apnea appliance reduced the AHI to below 5 in 84% per cent of the patients with mild to moderate OSA. The study cited is: Hoekema. A, et al, Oral Appliance Therapy In Obstructive Sleep Apnea-Hypopnea Syndrome. a clinical study on therapeutic outcomes. AADSM, 2007. This study is available for purchase at www.aadsm.org. Now, I grant you this, ONLY the TAP 3, which is the most effective OSA appliance in existence, can generate these numbers. The vast majority of oral OSA appliances DO have results way worse than that. But who cares if even one can be this good, because you can use that one. Also review:Clinical Practice Guideline for the Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy: An Update for 2015. Journal of Clinical Sleep Medicine. Vol.11, No.7, 2015, Joint report by AASM and AADSM. The upshot of it is that, for mild to moderate OSA, oral appliances and CPAP have roughly the same effectiveness with a slight over-all edge going to the CPAP. Even though CPAP does lower AHI modestly better than OAs, in terms of various medical outcomes there are statistically insignificant differences. CPAP continues to have significantly better outcomes for severe sleep apnea. But please do not take my word for it. Study the report and draw your own conclusions.a.b.luisi,d.m.d.


#10

CPAP only reimbursed by some third party payors if used above certain threshold. I am not aware of another medical therapy for which reimbursement is based on BEHAVIOR (i.e., treatment adherence)? Oral appliances have higher adherence rates, but lower efficacy than CPAP. Very well established the PAP therapy is efficacious is majority of patients, particularly for obstructive events. To help generate discussion, let me throw this out there to the group: Patients and third-party payers want to pay for a therapy that is known to work. Given the variability in the efficacy of oral appliances, perhaps oral appliances should only be reimbursed (or on some sliding scale) if they are shown to be efficacious for an individual?


#11

I travel a lot and having to take your CPAP is very important. Your body is used the enhanced sleep and there is no shortcut to a good night’s sleep. I have a smaller older machine without humidifier. I keep it in a bag with all the goodies so I don’t have the breakdown my home machine. That way I don’t forget anything,i.e. extension cords,multi outlet adapters. Plus for air travel it is always with you and fits under the seat, it good for holding snacks or a book, etc.


#12

I am a dentist working in dental sleep medicine. I do want to make the group aware that the thinking about oral appliances vs. CPAP has changed rather dramatically recently. I am specifically talking about mild to moderate OSA patients here, I am not talking about severe patients. There are now many more studies directly comparing oral appliances to CPAP in terms of actual medical outcomes, such as improvement in daytime sleepiness, quality of life, lowering of nocturnal blood pressure, driving alertness, etc. Very surprisingly, in most of these medical outcomes the difference between OAs and CPAP has proven to be statistically insignificant in mild to moderate patients. What this means is that, although the CPAP does have better efficacy in lowering the actual AHI than OAs, this does not actually translate into significantly better medical outcomes. This is a stunning revelation and will take some time to get used to, but time moves on and attitudes have to be adjusted as new scientific information is accumulated. a.b.luisi,d.m.d.


#13

I would like to see one of our Dental experts reference the following:

  1. What are the markers (in pressure settings) for mild, moderate and
    severe Sleep Apnea?
  2. What are the Names and URL’s for the studies that support their
    arguments?

Until then…this all reminds me of our marginal Presidential
candidates…

Rog


#14

I am a dentist working in dental sleep medicine. As to your question number one. Everyone agrees that an AHI less than five is to be considered “normal” and that would be the ideal goal for any therapy for OSA. For CPAP, technicians in a sleep lab or now, in some instances, the machine will autotitrate to a pressure to get the AHI down below five or as close to it as possible. Each person has different biology and the pressure to achieve that will vary from patient to patient, so there can be no standard. For oral appliances, there is less agreement as to where the AHI needs to be for effective treatment. The dental sleep medicine community is still hashing that one out, although we are beginning to suspect that, maybe, OAs don’t have to get the AHI down quite as far as CPAP for a comparable medical outcome, but we are continuing to work on that one. As to question number two. In 2015 the AADSM and the AASM had a joint conference to review all existing studies to establish how good the efficacy of oral appliances is relative to CPAP in treating OSA. There is much more data now than there was in the past. I have referenced the results of the conference in my post which is in this thread four posts up. Just google the article and it will come up in the entirety. It will answer all your questions and support my assertions(In my opinion).a.b.luisi,d.m.d.


#15

How is a patient measured as to determine if they have “mild,” “moderate,” or “severe” OSA?


#16

Patients are diagnosed for OSA severity either by a laboratory sleep study or a home sleep test. Each one measures breathing during one night of sleep. There are rigid guidelines as to what level of breathing interruption is considered to be significant. Each breathing interruption that meets the criteria is scored as one on the hourly breathing interruption index or AHI. An AHI of four or less is considered to be "normal, " an AHI of 5-l4 is considered “mild”, an AHI of 15-29 is considered “moderate”, and an AHI above 29 is considered to be “severe”. The breathing interruptions are recorded by sleep technicians in the lab test and by an electronic computer in the home test. Data is feed to the technician or the computer through sensors placed on that patient’s body. a.b.luisi,d.m.d.


#17

SleepDent:
THANK YOU so much for responding to my question. I had a sleep study done last year, and my results were:
AHI 24.6 and REM AHI was 41.9. I am using a BiPap machine every night since I got it. It does make me feel better and surprisingly of all, it has greatly reduced my migraine episodes. So it is worth using just for that! I wasn’t sure if I was considered “moderate” or “severe”, so I’m in the “moderate” category for OSA. Again, thanks so much for the info.


#18

ScootersMom speaks to AHI and Rem AHI. This is the first time I have heard or seen the AHI broken down like this. So which one is used when setting CPAP pressure and/or considered for an oral appliance?


#19

The over-all AHI is basically the measurement used when making the setting. During the REM or dream stage of sleep it is not uncommon to have a higher number of breathing interruptions than in the other sleep stages. This is actually not inconsequential. If you get into the severe category during REM, that can cause more damage to you body than you are getting on average. a.b.luisi,d.m.d.


#20

Does anyone here know of any good brands/models of CPAP masks that are nasal masks WITH a chinstrap? Also, I read about chin straps and/or full-face masks (with the numerous straps) actually making people’s teeth and mandibles (etc.) move over time; as a matter of fact, a friend of mine who also has OSA told me she stopped using her CPAP mask altogether for that very reason. Would anyone know if ALL masks with either chin straps or multiple straps would basically make your teeth (etc.) move, even if you are at first unaware of it even happening?