Well, did he really lose the weight? He was really motivated because he really wanted to get the insurance. So, he lost 38 pounds and this was really hard since the two hormones that have to do with weight loss are out of control in patients with untreated sleep apnea.
The patient was excited because he could try that mouthpiece he saw at the sleep physician’s office. The official terminology for the oral appliance he saw on the sleep doc’s desk is a mandibular advancement device (MAD) since that is what it does — advances the lower jaw and therefore advances the tongue since the tongue is attached to the lower jaw just behind the lower front teeth.
But at the appointment with the sleep physician, he was told that the MAD still wouldn’t work for him because his sleep apnea (OSA) was too severe. Due to the promise the physician had made, he wrote a prescription for the MAD, although reluctantly. A condition was put on the patient — he had to have a follow-up sleep study in three months after getting the device.
At his consultation appointment with a qualified dentist, the patient found that there are over 110 oral devices (MAD’s) that are FDA approved for use in patients with obstructive sleep apnea (OSA). But only two designs are approved for use by Medicare and Blue Cross — the Herbst and the TAP. They move the mandible (lower jaw) forward and stop the tongue from falling back during sleep.
The patient came to the dental office for the MAD and had a comprehensive exam to verify that he was a good candidate for an oral device for oral appliance therapy (OAT). Prior to constructing his custom device, X-rays were taken to look at the teeth and supporting bone to check for teeth that had to be treated. If periodontal disease is present, a patient may not be a candidate for a MAD. Fortunately for this patient, nothing showed up during the exam that had to be dealt with before having the custom oral appliance made.
Upon completion of the exam showing that he was a good candidate, impressions were taken and a bite registration was recorded for the initial position of the device. All this was sent to a certified lab for fabrication of the MAD; this process generally takes about three weeks. The patient returned in two weeks since the lab was quicker than originally thought. The oral appliance was seated and adjusted. A repositioner was made to help in getting the jaw back to its normal position after being out of place all night with the oral appliance.
The patient returned to the office in three weeks to begin adjustment of the appliance. You see, the appliance cannot be set at the final position without damaging the TMJ. Therefore, adjustments were done gradually by the dental office to avoid any problems with the TMJ. Over three months of adjustments, the lower jaw was moved forward about four millimeters.
At this position of the oral appliance, the patient was not snoring, was not using the bathroom as often, and was not taking any afternoon naps! Finally, he was waking fully rested and ready to go!! Now it was time to see the sleep physician, as promised.
You can read prior episodes of this story online at cdapress.com. Just search on “Snoring Bear.”
Next week we will see if he really had his sleep apnea properly treated and eliminated!
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Dr. Donald Johnson founded Northwest Treatment Center for Snoring & Sleep Apnea in Coeur d’Alene to help patients stop their snoring and live free with no limits! Obstructive sleep apnea is usually able to be treated with a small oral appliance. Dr. Johnson’s office is at 114 W. Neider Ave., near Costco. The website for more information is www.NWSleepDoc.com and the office phone is (208) 667-4551. Schedule a free consultation appointment today!