For sleep apnea, a mouth guard may be a good alternative to CPAP | Hacker News Reader

For sleep apnea, a mouth guard may be a good alternative to CPAP

nytimes.com

74 pointsbookofjoe72 comments

CPAP isn't anywhere near as awful as people make it out to be. I suspect many of these "CPAP sucks" stories come from people who (for whatever reason) are given a cheap, shitty mask and a cheap, shitty & loud machine. Masks used to be really bulky and unpleasant. Machines used to be pretty loud. These days, machines are nearly whisper quiet and masks come in more varieties than I care to list. I mean sure, there is an adjustment period. And sure, given a choice, I'd rather not have to wear one. But as far as annoyances go, it's pretty minimal.

If you're ever put on CPAP, take your time (and dime) looking for a mask that feels right for you. If your doctor/insurer/whatever only covers shitty ones, then pay for it out of pocket (or try to work out a deal). There's a ~100% chance the first mask you try won't be right for you.

Edit/addendum: the article talks about loud snoring. That's true for many, but definitely not all. You can have sleep apnea without snoring.

Truth.

My CPAP machine is the best thing that ever happened to me!

The problem starts with the doctors. Regardless of who paying, if your doctor says "here's a thing, use it" you assume (because they are a knowledgeable specialist) that it's the "right thing". Most people don't/won't know if they've actually been prescribed the best option.

Not too long ago I went through this adventure and my experience with the ENT was terrible. Fortunately I was in a position where I could do an end run around the system and get something better, both machine and mask.

I still had a not-great experience, even with better gear. The adjustment period just never went away. Maybe a better doctor would have solved it, but I'm sure that for some people, the CPAP's just aren't a great experience at the best of times. Options are always good.

The biggest up-side to this mouth guard option is that it can be available to a lot more people for a lot lower cost.

I agree. You pretty much have to be your own doctor. With sleep apnea at least, it's pretty easy. There are tons of great resources out there. The CPAP machine captures a lot of useful data which you can use to tailor your experience (insert big fat disclaimer here).

When my allergies act up, I increase my pressure. When the air is dry, I decrease my pressure. When I've got a cold, I use a full face mask. When I'm feeling fine, I use a nasal mask. These are super simple things for me now, but these are non-obvious for someone who just got sent home with a CPAP machine -- and who is often told to never touch the pressure settings.

Also, a lot of people may not just need a CPAP machine but a more advanced bipap machine that also pulls instead of just pushes.

It's been 10+ years since I tried CPAP, but I could never get to a place where I'd sleep through the night with it on. I'd always take the mask off in my sleep. I tried more than a half dozen different masks and I could never get one comfortable enough to sleep with. It always felt like it made the situation worse.

Over the years I think I've been to 4 different doctors for sleep apnea. Had 3 in lab sleep studies and a few take home ones. I always came away somewhat skeptical of any data obtained from the sleep studies, especially the in lab ones. The situation was just so different from how I'd normally sleep.

I only have mild sleep apnea and I'm not overweight. So I ended up going in for surgery twice, with different doctors. Got a turbinate reduction, so I could breath through my nose better and they somewhat straightened a deviated septum. Had the pillar procedure, and got a mouth guard made.

The mouth guard has changed my bite, but overall it does improve my subjective sleep quality, and objectively, the stake home sleep study showed substantially improved numbers. Though I'm told I'll still stop breathing and gasp for air in my sleep. So It's improved on the issue but not eliminated it.

> I only have mild sleep apnea

Disclaimer: I don't want to rain on your parade, and I'm happy that you feel better. But for everyone who isn't you: the way I understand it, there's no such thing as mild sleep apnea. I mean sure, everyone gets a couple of apneas every night, that's fine. But "mild" apnea is defined by 5-15 apnea/hypopnea events per hour. That's an average over the whole night. Usually apnea is worse during REM sleep. And each event comes with a (micro-)arousal. If you're waking up 5-15 times (or more) during REM sleep, you're not getting much actual REM sleep, and your sleep quality is destroyed anyway. Reglardless of the "mild" diagnosis. REM seems to be an important part of sleep.

As an aside: I wish it were easier to get a deviated septum fixed. Seems like the Russians have a laser treatment which can (non-invasively) increase the plasticity of the cartilage so it can be straightened, but AFAIK it's only available in Russia.

It took me a month to get used to CPAP. But my apnea was so severe I knew I'd die without it, so I stuck it out. On day 31 something in my brain clicked and from that point on I couldn't sleep without my CPAP.

That was 20 years ago. My latest CPAP is the size of my hand and doesn't need a water tank. Its only problem is that it uses 20VDC so I need to build a boost converter that will run it from RV power when I camp.

Getting my sleep apnea treated was probably one of the best choices I've ever made, but there's no denying the fact that it comes with downsides. I have to bring a machine to wherever I sleep, I have to maintain it decently, I will suffer worse sleep whenever I have no possibility of connecting the machine to electricity (i.e hiking). I will gladly use it, but I would prefer a cure over constant ongoing treatment.

Just so we are clear: this paper does not show that mouth guards have similar efficacy to cpap. It shows that mouth guards have a significant, non-zero efficacy that is worth pursuing for patients that don’t tolerate cpap. It’s still way less effective than cpap.

It's the path I took over ten years ago here in oz, and I've never regretted it. The device gets pretty janky because it's a soft liner moulded into the rigid carrier and biofilms just love that kind of interface to grow on.

I got a medical fund rebate on a GP diagnosis and referral to the dentist.

My partner continues to tell me it works. Ymmv.

I've had a mouth guard before, for bruxism, but that thing 100% prevented me from falling and staying asleep, it was effectively a torture device in my experience.

How is falling asleep with this device? Is it easy to adjust to? How heavy is it on maintenance?

So I have one also. It took me a good 7-10 days for it to feel comfortable enough to easily fall asleep with.

My jaw alignment takes around 20-30 minutes to go back to normal.

I'm around 5 years in using it and i can put it in and fall right to sleep. That said I'm told results really vary for people.

> My jaw alignment takes around 20-30 minutes to go back to normal.

Can you say more about this? I.e. you wake, and what is the experience? Any fear that it may be causing other issues?

First month? Hell. Got used to it. Mine has a hex key adjustable chin distance setting, helps to avoid really tiresome jaw ache if you can get this set right.

Sure, have heard both that it does nothing for some snorers, and some people can't get used to it, which sucks at the price.

My dentist told me to get a "mold-it-yourself" bite guard for bruxism that only covered the upper jaw.

This stopped the damage right away and helped my sleep right away. I still have some TMD symptoms that may improve further. (I make my own "meal replacements" by grinding up a bag of frozen vegetables, maybe some fruit or nuts or a piece of pork into a soup and don't feel bad getting a shake at Burger King.)

That was the type of thing I had. I was essentially forced to choose between taking care of my teeth and to be able to sleep at all. The choice was very easy, at the end of the day.

Fun fact: You can buy cpap parts in some truck stops. Because that's a legally monitored condition for truckers.

Fatigued driving is a killer.

I think this this article leaves out the consequences of the device, which I believe include permanently changing your bite and tooth damage.

It's weird because I'm seeing this page [1] say the exact opposite of what I'm reading here:

"Prescribing a night guard to a person with sleep apnea will stop the teeth from becoming damaged, but will not address the much more serious issue of keeping the person breathing at night. [...] The scientific evidence that bruxism can be a symptom of sleep apnea has come from studies that were relatively recent, and not all dentists are aware of this information yet. This is why many dentists are still prescribing night guards for bruxism without screening for sleep apnea."

[1] https://millcreekdentistry.com/why-a-night-guard-for-teeth-g...

FWIW, some mouth guards are actually beneficial for your bite, though I can't comment on tooth damage. I bought Invisalign from my dentist which is a specially-made acrylic mouth guard that is designed to realign your teeth/jaw, and probably also serves this purpose... unfortunately, I'm allergic to acrylics so I had to stop using it.

I've yet to successfully fall asleep while using a CPAP, so I wish this was an alternative for me. Alas.

It's true, my SO had to switch from a mouth guard to a CPAP machine because the guard was changing their bite "pattern" to worse.

Anecdote warning: I've already been wearing a mouth guard when sleeping for years due to bruxism. It's perfect for that. A couple months ago though when I was ~15 pounds heavier than I am now, I started to wake up struggling to breathe a couple times per week. Now that I lost the weight, it stopped completely. Mouth guard didn't help me there (or maybe it did and that it could have been much worse). It's probably better wearing that machine though.

Unlike mouthguards for bruxism, those for apnea are designed to hold one's jaw in a particular position.

Got it, shows how much I read the article!

The danger in this article is that less people might be willing to get a proper sleeep study after reading it and having a false sense that CPAP is terrible.

For sleep apnea CPAP WORKS and everything else is a hack.

We need more articles encouraging people to try CPAP instead of: here, take this nose clip on Ali Express it might work; or here put this ointment or use this mouthguard.

If you snore loud or people say your breath stops at night or you feel continuously tired or have headaches in the morning: - talk to your doctor and demand a sleep study - try CPAP for several weeks/months and try to get used to it - once in a while you can test your blood oxygen / heartbeat overnight with a pulsoxymeter that has memory; also this can be helpful for people who can't convince e.g. a family member to do a sleep study - please don't believe that a nose clip or mouthguard is a full solution; your life quality will suffer greatly

I use a CPAP; I hate it. I can’t wear appliances because of orthodontics, and I am very wary of costs & long recovery times for surgery. However, neither of those two things are ‘a hack’ in any negative sense. They both can offer significant life improvement.

I love my auto tritating cpap resmed airsense 10. I assume you've tried a number of different masks?

Tried 3, no success so far.

Nostril masks too?

Everyone's different, but I love mine, and hate the full mask I have to use when my nose is occasionally blocked.

I think sleep studies are over rated and expensive compared to just giving them a CPAP and seeing if symptoms improve. For many, the sleep study takes a long time to schedule, doesn't always work, and as I mentioned terribly expensive.

CPAPs themselves are expensive.

The CPAP machine that I was prescribed would cost me $700 over three months to _rent_, which I would have to pay in advance, with reimbursement from my insurance plan only after I uploaded weekly compliance data dumps. Or, for an additional $200, the machine could upload those data dumps for me.

That's the real barrier for entry for most - cost.

But how much does a sleep study cost? Specialize doctors, specialized lab, specialized equipment: $700-$3000.

I got a better deal with my work's insurance plan: it would bill me for it if I didn't use it, and auto logged the data for me. That sounds ridiculous. Also my sleep study was just a unit I wore at home in my own bed. Seems cheaper than an in erson sleep study

I'll get my medical advice from a board-certified MD who specializes in sleep medicine, thank you very much.

If you're putting blind trust into an institution that's open to lots of manipulation and bias then you might want to wake up a little more to understand outside the GIN (gated institutional narrative; a term coined by Eric Weinstein) there may be very valuable if not critical information to be learned.

I get what you're saying, but gaining the required level of expertise for something like this is very time-consuming.

In my case (not the OP), my sleep has improved completely since getting on a CPAP, and I don't consider sleep a problem in my life any more. What value is there for me to question what you call the GIN? None, as far as I can tell. For me, they've done exactly what they needed.

It's true that there are other who's situation is different. But I wouldn't be so quick to write off what is currently accepted knowledge.

This article is not an NYTimes writer telling you to go get a mouth guard from a sporting goods shop. It’s about experts in otolaryngology studying the effectiveness of appliances that are colloquially called mouth guards. Otolaryngology is a significant component of sleep medicine, and the primary one of the mechanics of sleep apnea. None of this article is advice to circumvent that expertise.

I sometimes wake up in the middle of the night noticing that it's trouble breathing that wakes me up, it happened the last weeks and months more often than before. However, I also feel this has a lot to do with how much I weigh. Due to corona I did a lot less sports (because I like team sports much more than running etc.) etc. and gained a few pounds. It feels like weighing a few pounds too much (maybe 10 or so) have a really big impact on my [!] sleeping habits. That's why losing weight is the thing I will do now before trying these solutions. Hope it suffices.

It's not a "however," overweight can be a contributing factor for sleep apnea. More soft tissue, more restriction. Weight loss sounds like an excellent first action.

It is much easier to lose weight if you can get restful sleep. My manager lost 20 pounds after he got the CPAP machine with no other lifestyle changes. He had more energy and improved metabolism when he wasn't constantly tired and subjecting his body to low blood oxygen for 1/3 of the day.

So this isn't an either/or situation. Sleep apnea can also be a contributing factor in being overweight. So do everything: take steps to eat better, sleep better, and exercise more. Small steps in a number of areas are often better than a big step in just a single area.

I don’t see any reason why you wouldn’t get a cpap machine now and try to lose weight. Lack of sleep makes losing weight harder.

I see no reason why they should get a CPAP machine. What they should do if they have reasons to suspect that they suffer from sleep apnoea is to schedule a sleep study with their doctor.

Yes, don't try to treat yourself. But if they have sleep apnea the doctor will almost certainly prescribe one.

> schedule a sleep study with their doctor

I have what is considered good insurance, and it cost me $750 out of pocket for a sleep study. So hope you've got the cash.

This happened to me, I've probably always had mild sleep apnea (always snored, always been overweight, and always slept on my wide) but I went up about 10KG and it got super bad to the point my wife was concerned and often heard me stop, got tested and I had a pretty bad result as far as the rest goes (stopped breathing like 40 times per minute or something).

The good news is I got a CPAP machine and couldn't be happier, now about a year in. My only advise is don't cheap out just get the top model with the features, e.g. you want autoset pressure, not static, the heated hose, and play around to find a comfortable mask. Now I stop breathing something like 0.3 times per hour which is apparently "amazing" you can still have up to 5 times per hour and be considered "OK". Also shop around as the place that tested me, kept trying to convince me to go with a static pressure model to "save money" even after making it clear I wasn't interested in that.. but I purchased my machine from perthcpap.com.au instead and the autoset model cost less than they wanted to sell me the static for. Go figure.

I had a few people I know who didn't tolerate it so well and most of them got non-autoset and non-heated and it makes a huge difference. The mask you use also matters a lot.

The difference to my alertness, how I feel after sleeping, and not getting super tired and needing a nap in afternoons is incredible.

TL;DR: Get a sleepstudy. At least here it's a home test where you just where a machine and a few sensors and takes 1 night.

Be very careful with this. It can be dangerous for you. I had the same thing and also minimized it. Turns out that a sleep study showed I had serious sleep apnea. The lack of sleep was causing all sorts of health problems. I strongly recommend you do a sleep study to find out the extent of your problem.

Spoken like everybody who never treated their apnea.

My dad has had 30+ years since he was diagnosed and his apnea symptoms are terrible and really noticeable.

For some types of 'positional' sleep apnea (i.e. apnea only when supine) you also have non-CPAP alternatives with a positional therapy device.

It's basically a vibrating device that conditions you (while you sleep) for you to turn on your side and avoid sleeping supine.

Disclaimer: worked as a consultant for a wearable in this field.

Technology Connections has an interesting video about pulse oxymeters: https://www.youtube.com/watch?v=4pZZ5AEEmek

Really happy to hear that this exists, because when I told the sleep doctor that I'd rather learn to sleep on my side he LAUGHED at me and said it wasn't possible. Jerk.

I sleep pretty well with a CPAP, but I feel like I'm very sensitive to pressure inside my mouth or teeth. I keep adjusting my CPAP nose mask so it puts no pressure on my teeth, and rests on my cheeks instead.

Not sure how I'd take to something like this, but nice to know there are more options for fellow sufferers.

Try nose masks. I have been using them and find them very comfortable. I am amazed how our noses don't feel bothered at all with the additional pressure.

I've tried the nose masks. Every night, my mouth would open, and the air being pumped into my nose would go out my mouth. It feels like my carburetor gets stuck in vapour-lock, and I wake-up in a panic unable to breathe. It would take a few seconds even after the mask is off for things to function correctly.

So I prefer the full face mask.

I have no idea if it will work for your case or not but if you can try it out at a store (many will fit you with things) there are nose models that both go underneath ("pillows") as well as that go over the nose kindof like a full face mask. But then the one I'm currently using is the ResMed F30i whic his a full face mask but doesn't go up over my nose so it's not as.. face enclosing.. which is why I like it. But the entire thing is like a bouncy silicon which seems to put less pressure on my face than some of the other full face ones I tried so may be worth a try.

Anecdote: tried this years ago and found the bite guard intolerable. The one I had, which looked just like the picture, was big and bulky and uncomfortable. CPAP in my experience was much less annoying. Obviously YMMV.

I’ve been wearing one for a couple of years now. One of the best decision I’ve made for my health and quality of life. Waking up from actual restful sleep is like coming out of a fog.

After having sleep study done and bought an airsense 10 with the latest nasal pillow (very very comfortable, i slept like a log the first day I used it). Initially, I felt somewhat different/better but it was not totally obvious until i slept over at cousin's house without the machine and felt wrecked the next day. I then realised my coffee intake was half of what i usually have and I don't yawn during the day as much!

I am surprised that no one mentioned that mouth, tongue and throat muscle exercise have been proven to significantly improve snoring and apnoe.

Started 2 years ago with an OTC boil and bute, sleep quality is night and day (no pun intended),l.

In fact it annoys me greatly if for whatever reason I don't sleep with it because I know I'll be yawning, nodding off, and generally low energy all day.

Highly recommend it at least as a low cost experiment (mine was $70), no issues so far with bite or jaw soreness.

Can you show us how does it look like? Is it similar to the ones for fighting bruxism?

It covers bruxism, of course, because it literally goes over your teeth, but it's bulkier and has a lower jaw adjustment since it's designed more around your jaw and airway than just your teeth

Mine is from VitalSleep.com (promise I'm not astroturfing, you can find 50 similar products)

$70 for a mouth guard??? A Benlee Bite only costs $6 where I live.

Not the same thing at all, here's mine

Vitalsleep.com

Boil=and-bite only provides cushion between teeth. Sleep apnea mouth guards are designed to thrust the jaw forward, so as to mechanically assist in keeping the airway open. They're so very different in effect and structure that if you feel you're benefiting from a boil-and-bite, you've almost certainly mis-attributed something somewhere.

Not necessarily. Boil & bite mouthguards can help you keep your mouth closed while you sleep, which might be enough to fix your breathing in some cases.

My boil and bite has a hex key lower jaw adjustment same as OSA nightguards, many (but not all) of them do

I've never seen that, but I guess TIL. Can you please provide a link to one?

Yep, this is the one I have

https://www.vitalsleep.com/products/vitalsleep-snoring-mouth...

My father has been using a mouth guard for years now, and the sleep apnea is simply gone! The whole machine setup he had at the beginning was so loud, he's really happy he's gone with the mouth guard instead

It was very challenging to sleep with CPAP. I took an extended break from the CPAP machine around 12 years ago, and then I tried the oral appliance - it worked wonders, and I haven't looked back.

https://archive.is/mTZpa

CPAP: $600, Mask: $150. Oral appliance: $1,800. How is that less expensive?

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