An Instant Oral Appliance for Sleep Apnea

July 7, 2010

Besides CPAP, oral appliances are another good option for most people with mild to moderate obstructive sleep apnea. Two of the biggest barriers for people to try oral appliances is the unpredictability of insurance overage, and the time that's involved with custom fitting and frequent adjustments. Formal devices can cost anywhere from $1500 to $4000.

A recent study addressed this issue by proposing that patients be fitted in the ENT office with one of the easily available boil-and-bite anti-snoring devices. Rather than having the patient order it and mold it themselves, he had a supply of these products in the office and helped patients mold the devices at the time of their visit, rather than having to come back for the procedure. He compared three types of devices: The Snoreguard, Somnoguard 2.0, and the Somnoguard AP. The first two are not adjustable after the first molding, where the Somnoguard AP is adjustable using a small screw.

Using subjective questionnaires and pre and post-device sleep studies, he reported a 62% objective response rate (> 50% drop in the AHI and the final AHI is less than 20). Overall success was 39% (objective response achieved, and the patient was adherent – using the device more than 5 nights a week). At 2 months, about 58% were still using their devices.

Interestingly, there was no significant difference in the objective response and adherence between the three different devices. However, the AHI and oxygen desaturation level was significantly more improved with the adjustable Somnoguard AP model.

I've had a number of patients that come in for me to help me mold their Somnoguard devices. Perhaps it's time to try the Somnoguard AP model.

Have you tried any of the boil-and-bite models? Was it helpful?

Written by Steven Park · Filed Under Blog | 3 Comments

Tongue Retaining Device for Obstructive Sleep Apnea: Does It Work?

October 19, 2009

There are many variations of oral appliances to treat snoring and obstructive sleep apnea, but one variation that you may not have heard of is the tongue retaining device (TRD). There are also different variations of TRDs, from suction bulbs to hybrid mandibular advancement device-TRDs. Here’s one example and here’s another. Here’s a good review of the science behind tongue retaining devices.

In this month’s issue to Journal of Clinical Sleep Medicine, French researchers reported complete or partial responses in 71% of cases, with the mean AHI dropping from 38 to 14. Snoring dropped by 68%, and subjective sleepiness dropped significantly as well.

What I had in mind when I saw the paper’s title was the suction cup-like device that sits between your teeth and lips, with a bulb protruding out your mouth. Your tongue sits inside the suction cup, keeping it from falling back. A simple and novel idea. However, when I looked more closely at the study it turns out that what they call a tongue retaining device is actually a hybrid mandibular advancement device and TRD. We know that mandibular advancement devices, by pushing your jaw forward can significantly push your tongue base forward, improves the space behind your tongue. The researchers set the mandibular protrusion at 50 to 75% of maximal protrusion, which can definitely improve your sleep quality.

Although my experience is limited, I’ve had mixed results in people who have tried tongue retaining devices. In general, they’re not as expensive as the formal mandibular advancement devices, so there’s less of a barrier for people to try it out.

Just out of curiosity, I have patients stick out their tongue whenever I examine the space behind the tongue while they’re lying flat on their backs. This is a rough estimate, but only in about one out of 4 times, do I see any significant improvement in the posterior airway space. This may explain why many patients don’t see any benefits. Drooling, discomfort and an inability to swallow are some of the more common complaints.

Have you tried tongue retaining devices and if so, what’s been your experience? Please enter your responses below.

Written by Steven Park · Filed Under Blog | 3 Comments