Sleep apnea: Mouthguards less invasive, just as effective as CPAP | Hacker News Reader

Sleep apnea: Mouthguards less invasive, just as effective as CPAP

newatlas.com

219 pointspeutetre171 comments

The title doesn't really reflect what's accurately explained in the article: the study was solely about comparing blood pressure reduction rates in the mouthguard vs. CPAP groups, as opposed to the more common metric of whether breathing actually stopped. There was greater reduction in BP in the mouthguard group, and the hypothesis is just that participants simply wore them more when sleeping.

But the article also explicitly stated "MADs are less intrusive, but studies have shown they’re outperformed by CPAP when it comes to the apnea-hypopnea index (AHI), the number of times airflow fully (apnea) or partially (hypopnea) stops per hour during sleep."

About “the hypothesis is just that participants simply wore them more when sleeping” - we know that was the case:

> Over half (56.5%) assigned to the MAD used it for six or more hours each night on average over the study period, while 23.2% of CPAP users did the same.

> “The MAD patients simply used the device longer,” Chi-Hang said.

The takeaway is that if you can handle wearing the CPAP mask all night, then that's your best option. If you can't, then you may be able to obtain better results with the the MAD.

I know some people struggle to get used to CPAP but I found I had fully adjusted to sleeping with the mask on all night after about 2 weeks. Huge difference in energy levels and blood pressure.

Yep, to clarify I didn't word my statement well. We know it's the case that participants wore the MAD more. The hypothesis is that the reason for the greater reduction in BP for MAD users is solely due to this difference in adherence.

Doesn't airflow fully stop twice per breath?

AHI only measures stops of 10 seconds or more

Only on Hacker News would someone picture an oscillating waveform with a derivative of 0 twice per cycle! (I'm just poking fun)

Remind me never to ask HN to check if my indicators are working.

Yes, no, yes, no, yes, no…

There seems to be an intermittent fault.

Define "working"?

it's not a bug; it's a feature!

"A breath is a breath, you can't say it's only a half"

Okay there, TA "89" 03... ;)

Not for the AHI's purposes, no. It has to stop for a certain length of time to be counted.

In the US at least I think this time is usually 10 seconds.

https://www.cms.gov/medicare/coverage/evidence/cpap

Yep, mine is ~79 (at least, ten years ago it was)

I think my dad used one of these for a while. He talked about trying something that effectively made him dislocate his jaw at night, then pop it back into place in the morning. I thought it sounded like a terrible idea, but he seemed excited for the possibility of traveling without his CPAP, so I didn’t say anything negative, having not done any research on it, while he had.

Fast forward several months later, he ended up with TMJ issues and tinnitus. I didn’t find that all too surprising, but when talking to him it was like he didn’t see it coming and the risks of messing with the jaw every night were not made clear.

He discontinued use. Last I heard, I think his jaw is feeling better, but the tinnitus remains, to some degree.

The literature is replete those kinds of issues. The most common side effect of prolonged use is a change in the bite alignment. I used one for over a year before I had surgical intervention to increase the size of my airway via jaw surgery (both jaws advanced). By the end of that year, I couldn’t get my lower jaw back into place during the day and bite no longer aligned.

Thanks the braces and surgery corrected my bite and expanded my airway to the point that I no longer need anything to help me breathe at night or during the day

I had the same issue with bite alignment after sleeping with a mouthguard for a few nights only!

I'm glad that worked out for you and you're finally cured. Did you have a painful recovery was post surgery?

I think my recovery was pretty normal. I spent two nights in hospital, which is normal where I’m from. When I woke up after surgery, I remember being in pain and asking for the strong stuff, which worked just fine. After that it was quite manageable. It’s a difficult long recovery, but I wouldn’t describe it as painful. I

TMJ = Temporomandibular joint (probably clear for anyone who has issues with it, but not so much to the rest of us)

I’ve had it my entire life, if you have ever met someone whose jaw clicks they probably have this. It doesn’t necessarily have to click, but that’s the most noticeable external symptom.

It doesn’t really affect my life that much outside of getting the occasional strange look/question when dining with strangers and being unable to chew gum because it makes my jaw ache.

These are quite uncomfortable, actually. They can have a negative impact on your teeth and jaws (says my dentist friend who wears one every night). So less invasive => yes, but still far from perfect.

I bought a couple of them off Amazon several years ago. The first one I stopped using after a few nights as the kibble felt like it was cutting the insides of my mouth. The next one, I've used for 2 years. Immediately felt the benefits of having a good sleep at night. Friends that I often travel and bunk with tell me my snoring is much more reduced. I could sleep on my back without choking!

I stopped after 2 years because I noticed my front lower teeth no longer align with my upper teeth. I can't use my front teeth to 'saw' off food anymore. I always woke up with a really sore jaw and lots of pain around my teeth. The lower teeth always felt like it was bent forward when I woke up.

Lately, I've been considering getting another pair, because I think the one I used was meant to be swapped out every 6 months, which I obviously didn't do.

I was fitted for one, and was told that the lower jaw is held forward by using the upper teeth as an anchor. Over time they can cause upper and lower teeth to move.

For those who want to simulate the feeling, touch your tongue to the front of your top teeth and jut your jaw forward so you can close your jaw with your tongue staying in place, sandwiched between the front of your top teeth and back of your bottom teeth.

It was wildly uncomfortable and I gave up after three nights. Also didn't notice better sleep.

Wow, I can (just barely) slide my bottom teeth in front of my top teeth, but not with the tongue in between, and it still feels extremely weird and uncomfortable...

Does anyone have a photo of these? I can only find the boxing ones, and don't understand how they might help with snoring.

To see a photo, image search "apnea sleep guard." By jutting your lower jaw forward, it is supposed to move your whole lower jaw assembly including tongue forward. It is the tongue drooping back towards your throat that causes the snoring for most. This, in turn, should reduce episodes of reduced oxygen then leading to less wakeful events since your body is not having to jerk itself awake to keep air flowing.

Ahh, I see, thank you, so this is by design. Yeah, this much tension on your front teeth really can't be good :(

I have one, and it works well. It's the default treatment here, where CPAP is reserved for the morbidly obese.

But the effect of jaw displacement is real. Every morning it takes a few hours to move the lower jaw slowly back. And I've visited a dentist in another country, who advised against it (and had apparently rarely seen it).

It's all local.

My dentist wanted me to get one to use as a retainer to stop my bottom middle teeth from sliding or something. I never once fell asleep with it in and after about two weeks of trying (and each night giving up after a few hours) I put it in a drawer and forgot about it. More effective at keeping me awake than caffeine lol

That sounds like the mouth guard I use because I grind my teeth at night but the mouth guards the article is talking about are different. These mouth guards for snoring move your lower jaw forward while a mouth guard for grinding doesn't.

Here's a case of choosing the lesser of two evils

I just learned to sleep with my mouth closed and I watch my breathing during the day too, and avoid breathing through my mouth. This was difficult at first. Idk why, but I’ve read the musculature responsible for breathing gets weakened if you breathe through your mouth, because there’s a lot less resistance. But now it’s fine, and I don’t even snore anymore. Obviously this is down to individual physiology, so I’m not saying this works for everyone, but it did work for me. Costs $0.

Did you learn this in a temple or what discipline helped you master it?

I did the same 25y ago, as prescribed by my allergy doctor. It was called (translation from French) "breathing reeducation", and it was roughly interval training: breathe fully in through your nose, then blow into a pipe (connected to a spirometer) at various speeds.

Before that, I was mostly breathing through my mouth. It was challenging even to eat a sandwich while walking :). Since this reeducation, I only breathe through my nose with no effort. I'm willing to believe it indeed has to do with muscle.

A breathing specialist (on a podcast, so take that with a grain of salt) said that breathing through your nose uses less overall muscles than through your mouth. This was focused on athletics training. By nose-breathing, the athletes were getting enough oxygen without heaving their chests so much, which uses more energy. The idea was that when you suck in air through your mouth, it works your chest more than is required, so you are wasting effort doing that. I tried it, nose breathing while working out, and it is incredibly difficult. Another guy on the podcast, the presenter, is an ex-rugby player and said he had to tape his mouth shut to be able to try it, and his nose was pouring with snot while jogging because he was not used to it.

I'm not saying it isn't to do with muscles, perhaps a sort of "muscle memory" due to years of breathing through your mouth, but my feeling is there's also a large psychological aspect to it. I nose breath when I remember, but it has to be a conscious effort to sort of clamp my mouth shut. Otherwise I'm :-O like that breathing. I feel like I'm going to suffocate if I nose breathe, but that's not the case of course when I actually force myself to do it.

Yep, I was not excluding muscle memory when I said it had to do with muscle. It is true that breathing through the nose seems effortless (at least when resting).

The "reeducation" consisted in a few 30 minutes sessions (probably around 5, not sure) and I don't remember having done any conscious effort to breathe through my nose after that. It just seemed easy.

That said, I still have to breathe through my mouth when running.

It’s actually because your oxygen absorption increases when you breathe nasally. Your nasal passages change the temperature and humidity of the air.

Breathing nasally does have positive effects on respiratory systems in general though.

You can tape your mouth shut when you sleep, and after a few days/weeks of this, you don’t need the tape anymore.

I see ads for these devices and the possibility of suffocating in your sleep just terrifies me. Sure most of the time you might wake up but still :/

Fortunately CPAP therapy works fantastically for me, and the CPAP masks have anti asphyxia valves to prevent you rebreathing your CO2 in the event the machine stops working (I wondered about that for a bit).

>the possibility of suffocating in your sleep just terrifies me

If you're to suffocate, in your sleep is the best time to do it!

I guess it's kinda funny

Can you refute this?

https://www.health.harvard.edu/staying-healthy/can-mouth-tap....

They say "could" a lot, and then say that there's no research/evidence to support it - but that's probably just because no one has done and yet. If there was any evidence against it, presumably they'd cite it?

Not a refutation, but then the article doesn't really offer any evidence to be refuted.

Afaik, "mouth taping" is just putting a little strip of fairly low tack surgical tape across your mouth, vertically, to encourage your body to keep it closed and breathe through your nose while you sleep. I've tried this just to see and it seems to work - but if you open your mouth or move your jaw even a little, it just peels off.

As long as you're sensible, it doesn't seem like it's going to do any harm?

Refute what? It's just a random doctor giving some general caveats about side effects. Anything we currently use to great effect, from aspirin to chemo, and from leg casts to band aids will have such generic caveats.

"Skin irritation" from some allergic reaction to the adhesive or fastening the mouth tap too hard? Sure.

"hampered breathing" sure, if you tie it wrongly, or have other issues.

It's more like a random physician's advice for caution than some voice of science. Also, they write:

"There's no research to support the measure"

Well, there's some:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9498537/

"Our study provided a simple and effective treatment modality using 3M mouth tape for mild OSA patients with open-mouth-breathing. The AHI and SI were reduced by nearly half after mouth-taping during sleep; the more severe the baseline AHI and SI, the greater the improvement after mouth-taping. For mild OSA mouth-breathers, mouth-taping could be an alternative treatment before CPAP therapy or surgical intervention are tried."

https://pubmed.ncbi.nlm.nih.gov/25450408/

Novel porous oral patches for patients with mild obstructive sleep apnea and mouth breathing: a pilot study. Conclusion: The POP is a useful device to treat patients with mild OSA and habitual OMB.

https://www.atsjournals.org/doi/10.1513/AnnalsATS.202109-105...

Mouth Closing to Improve the Efficacy of Mandibular Advancement Devices in Sleep Apnea. A combination of an adhesive mouthpiece and MAD is a more effective therapy than MAD alone. These findings may help improve clinical decision making in sleep apnea.

That's irrefutable by design. It _could_ lead to all those things. But it could also _not_ lead to them. Depends on the person. Besides, it's not like people with obstructive sleep apnea are having great sleep to begin with. FWIW I have facial hair so I did not use the tape. For me merely breathing through my nose during the day turned out to be sufficient to be able to comfortably do so at night.

Two books helped convince me this effect was "real" enough to try it: The Oxygen Advantage and Breathe.

A ~year later, anecdotal evidence: it works.

Start breathing exclusively through your nose during the day, and you will be able to do it at night too.

Yeah, no. That's about as useful as saying "just don't snore".

I've never been a mouth breather and yet I'm a heavy snorer with my mouth slacking open at night.

Hence "it won't work for everyone", in the original post. People differ anatomically.

Just to clarify:

You were diagnosed with OSA. You learned this technique, did another sleep study and were told you were all clear. Is that right?

What was your AHI before "curing" yourself? Afterward, was it 0 or just below the diagnostic criteria of 5?

You can wear an oxymeter to bed nowadays, which I do. I don’t need a “sleep study” to confirm my oxygenation is adequate though the night and I no longer wake up gasping for breath like I used to.

So that would be a "no".

Or a “yes” seeing that I do a “sleep study” every night and check the results at least once a week. I don’t see why I need to pay a doctor to tell me if I’m asleep or to monitor my blood oxygen in 2024, much for the same reason why “computer” now means a tiny device you own, and not a room full of people.

A sleep study is more than just monitoring your blood oxygen.

Ok "yes" if you're willing to ignore actual diagnostic criteria in favor of "whatever I decide the criteria is". Oxygen saturation isn't what they use, and lack of oxygen is not the issue with apnea.

Id normally let your comment go unresponded, but you are giving dangerous advice.

Totally right. Also helps with snoring. I'm using a small piece of masking tape to make sure my mouth is closed during sleep. Quite a common recommendation for when learning buteyko method.

>I just learned to sleep with my mouth closed and I watch my breathing during the day too, and avoid breathing through my mouth

It's not something you "learn" if you have apnea.

And if you don't, you don't normally have to learn it, it's natural, though some people might be accustomed otherwise.

It's amazing how many anecdotal folk remedies we're presented with on this forum, which I had assumed would have a more scientific bent.

Science begins from experience, and develops from there.

It's not like religion, which starts from holy scriptures.

Though many think science should just be something we take in as a holy scripture, unconnected to our personal experience, and even when it doesn't match it.

You seem to believe that one can only rigidly do “science” or “religion”.

Much of what people are suggesting in these comments are not just “personal anecdotes”. They’ve proven to be wrong for most people. They’re outright dangerous.

For example, the comment about just taping your mouth shut is awful without even doing anything for the vast majority of people with sleep apnea.

>You seem to believe that one can only rigidly do “science” or “religion”.

No, in fact I wrote explicly the opposite about science: that it starts with experience, and should not be about accepting some rigid dogma.

And I wrote that it's bad that "many think" that science is something we should "take in as a holy scripture".

>For example, the comment about just taping your mouth shut is awful without even doing anything for the vast majority of people with sleep apnea.

That manages to be both wrong and unscientific.

- It's not true it's not "doing anything for the vast majority of people with sleep apnea"

- Mouth taping has been shown to be efficient in preliminary research (not to mention in many people's personal results).

- "Awful" is just a sentimental meaningless term standing for "I dislike it" in this context

- Saying it does not do "anything for the vast majority of people with sleep apnea" is just some personal opinion, since you haven't measured anything or pointed to any research. So the very thing you claim to condemn, pulling stuff out of one's ass.

There's big science and little science.

You can use the scientific method to see what works for you. Those results may or may not be applicable to others.

You can use the scientific method on a representative group. Those results may or may not have anything to do with a specific case.

Both are scientific and have their limits.

If you're trying to address an issue related to your own health, you only need a sample size of 1.

We give lithium to folks with depression.

Modern day medicine is at times the same as folk remedy.

Why's lithium a 'folk remedy? We have scientific evidence of the efficacy of lithium as adjunct in depression treatment and anti-suicidal.

“here ya go, eat this magical rock. we have no idea how it works, or why it works, but it’ll make you feel better”

Not understanding the mechanisms of psychiatric medications is the norm, from what I understand with my limited knowledge of psychiatry. The brain very poorly understood compared to the rest of the body. Not knowing how exactly something works doesn't make it any less effective anyways, it's a small miracle there are so many effective drugs for so many disorders with how little knowledge researchers have to work with.

We don’t really understand why anesthesia works, but I’m still going to opt for it if I have surgery.

https://en.m.wikipedia.org/wiki/Theories_of_general_anaesthe...

did you feel you didn't have enough debit at all?

What the?! Who's sleeping with their mouth open?

I specifically hate going to sleep with my mouth open, which only happens when I have a cold or something and my nose is stuffed, which means I HAVE to breathe through the mouth. Which is fine at first but my throat will dry very fast and starts to hurt. During the day I can moisturize it by drinking liquids but at night it's horror time if I can't close my mouth and divert respiration through where God intended: the nose.

some of us have very "stuffy noses". I frequently get blocked nasal passages, and only by religiously using a steroidal nasal spray can I breath through my nose. I've had to travel to another city just to get my nasal spray on two occasions, when there is literally zero stock in my city (just prior to hay fever season), so access to this is not a given.

Obviously yes, mouth breathing sucks for a variety of reasons, but if you can't breath through your nose it is significantly preferable to the alternative.

It's a self reinforcing cycle, the more you breath through your mouth the harder it is to go back to normal breathing.

It's like saying being fat makes it hard to exercise so you don't exercise, which makes you more prone to stay fat, which makes it harder to exercise, &c.

I highly recommend https://www.barnesandnoble.com/w/breath-james-nestor/1134986...

It's unlikely you wouldn't have noticed this if it were the case but my nose tends to block too by some reason if I lay on my back. What I observed though is that if I lay on a side, there's some mysterious movement about where the sinuses are and one nostril gets unblocked, I think the one facing up (not touching the pillow). If I switch sides, the blocked and unblocked nostrils switch places. So oftentimes I breathe though just one nostril but still beats breathing through the mouth.

Not a medicine doctor, but your overuse of steroidal nasal spray is the probable cause of your stuffy nose.

That is entirely dependent on the type of steroidal nosespray. There are types that don't cause dependence or stuffy nose when not used.

Probably not. Steroid sprays are not the same as the OTC nasal congestion sprays that often lead to stuffy nose as soon as you stop taking them.

"Stuffy nose" tends to go away too once you start breathing through it all the time. This, of course, doesn't apply if you have allergies or are sick with a cold or something - those are legit reasons to have a "stuffy nose".

No, not true. I exclusively breathe through my nose all day (unless panting from a workout). The moment I lay down, something changes and my nose stuffs up. This has only gotten worse over time. If I were to, say, tape my mouth shut, I would absolutely suffocate in short order.

You might want to really clean your bed (pillow, sheets etc) and surroundings from potential allergens like dust mites, mold, pollen etc. Ideally with one of these mattress vacuum cleaners. Window sills (even outside, if the window doesn’t seal hermetically) might leak mold spores or other particles into your bedroom. A really good air filter next to the bed might also help.

>>"something changes" When you lay down, blood shifts to your head which can cause your nasal passages to become engorged with blood, causing a stuffy sensation.

>What the?! Who's sleeping with their mouth open?

People with apnea. Ever heard people snoring? Think they do it because they like the sound?

>I specifically hate going to sleep with my mouth open

Which is irrelevent, as once asleep you don't control it. And if you have sleep apnea issues, you can't just will it.

I assume you are not aware of it, because of being asleep. Maybe it happens in deeper sleep?

Could be but I'm only talking of what I can consciously control. I do know I snore if I sleep on my back, that's probably sleeping with the mouth open.

The tongue and jaw muscles slack and relax when you fall asleep, like much of the rest of your body. For many, this causes apnea and heavy snoring.

> Of the participants, 44.5% were overweight, and 49.5% were obese

That was a hard one to figure out. I guess the "overweight" classification here probably means "overweight but not obese" and nearly the entire cohort was overweight in the conventional sense?

Yep looks like they're non-overlapping. From the article -

> 44.5% (98/220) of the participants were overweight (BMI 23.0-27.5 kg/m2) and 49.5% (109/220) were obese (BMI > 27.5 kg/m2)

25-29.9 is the usual range for “overweight, but not obese” in the US and Germany (so probably the rest of Europe, too); I remember my hotel room scale in Korea showing 23 as the start of overweight, so I guess the ranges in that study are more commonly used across Asia - the study was done on Singaporeans.

Yes, obesity is on a scale for the medical profession. I can’t name all the steps but it’s basically severely underweight, underweight, normal weight, overweight, obese, severely obese. As far as the cohort, sleep apnea is often a side effect of obesity, though not always caused by it (see central apneas which is a nervous system disorder).

Sleep apnea compounds obesity because it makes it difficult to get restful sleep, which is one of the necessary tools for losing weight.

The BMI (Body Mass Index), while far from perfect - mainly because it can't tell the difference between relatively heavy muscle and relatively light (density wise) fat, so a very fit and very strong person can wrongly be classified (and in the opposite direction too) - is still the standard recognised by the WHO, by the NHS in the UK, etc. It's just calculated by body mass divided by the square of the body height, using kg and m.

And then there are specific names for ranges of BMI, which include "Normal range" for 18.5 to 24.9, "Overweight (Pre-obese)" for 25-29.9, and then three classes of "Obese" above 30 as well as three "Underweight" types below 18.5.

Generally this is simplified down to "Underweight", "Normal", "Overweight", and "Obese", with the following words after "Normal" and "Overweight" being implied, and with the multiple levels of underweight and obesity ignored unless discussing someone light or heavy enough that it's worth considering the differences between "Obese (Class I)" and "Obese (Class III)", or between "Underweight (Mild thinness)" and "Underweight (Severe thinness)" - all still based purely on the BMI number.

Sorry for the long winded answer, but even more here: https://en.m.wikipedia.org/wiki/Body_mass_index

Weirdly it seems like this study used the same logic but set non-standard boundaries (27.5 rather than 30 as the point between Overweight and Obese).

> a very fit and very strong person can wrongly be classified (and in the opposite direction too)

Unfortunately, it usually goes in the bad direction, by quite a bit. BMI under-predicts obesity. You only have to hit 25% body fat as a male to be obese, or 32% as a female.

https://academic.oup.com/jes/article/7/Supplement_1/bvad114....

> The BMI (Body Mass Index), while far from perfect - mainly because it can't tell the difference between relatively heavy muscle and relatively light (density wise) fat, so a very fit and very strong person can wrongly be classified

Let's be honest a second here, for every "too muscular bmi obese" there are a thousand "good ol obese"

Interestingly that horseshoe effect of people with large muscle mass having a high bmi might be appropriate for sleep apnea. Strong-men who move in to very high weights (120kg+) will almost always need CPAP due to muscle mass around their necks

The boundaries are different for South Asian and East Asians. NUS's participation probably influenced using the Asian cutoff rather than the Caucasian cutoff.

> and nearly the entire cohort was overweight in the conventional sense?

In this sense, in the US, over 70% of adults are overweight ("overweight or obese"). So the numbers seem reasonable splitting that population in half.

Sleep apnea also affects people with thick necks, such as people who used to play sports or lift heavy things. So you can be a slim, thick necked person and still be affected by it.

This comedian's mom taped him in the middle of sleep apnea - https://www.youtube.com/watch?v=iP1rMGlUCck

Yeah that's probably based on the BMI definition. Overweight is a BMI > 25, and obese is > 30. So yes, nearly the entire cohort was overweight by definition. BMI is a population measure and normal, healthy people can definitely fall into the overweight category. But it's still useful, including when summarizing the participants of a study like this.

Are there non-plastic nighttime mouthguards out there? In light of all the new awareness about the health hazards of micro and nano plastics (and plasticizers), I'm a bit reluctant about sleeping with a soft plastic block in my mouth every day.

It's not actually made from a single soft plastic, the inner lining is soft, and the outer parts are quite hard. I don't think there's a non-plastic mouthguard in the market.

This whole push for mouthguards is being driven by something devious, I'm convinced. There's tons of money to be made. To get a mouthguard is very expensive and requires a lot of custom work from several different providers. The mouthguard you end up with is only for you and if it doesn't work, you're going to end up in a CPAP anyway.

If you think you have sleep apnea, just go rent a CPAP and see if it helps. If it does, great! If not, then you can look into other solutions.

Source: My wife suffered with sleep apnea for a few years and was talked into an ineffective mouthguard. We paid out of pocket and wasted a lot of time and money when we could've just rented a CPAP. When we finally did, it was a miracle for her. The whole experience was frustrating as hell.

Have done a couple of sleep studies, no apnea, but snored terribly. (Have snored my whole life)

During the studies they had me try a CPAP, none chance I would ever be able to wear one. I have a strong gag reflex.

I've worn a number of mouth guards, all fitted by my dentist. I wore them for about 25 years. Absolutely noticed the change in my bite, but was will to put up with it to allow my wife to sleep at night.

I've now changed out to device that holds my tongue. Much less stress on my jaw and works just as well as any of the mouth guards.

Which device do you use? I'm also a heavy snorer, but tested for apnea and came back negative. I've used a mouth guard that was supposed to be fitted but the drooling and the jaw pain makes it impossible for me to use consistently.

I'm using the Aveo, https://na.aveotsd.com/

I'm a pretty big drooler when getting dental work, and I'm ok wearing this device.

does it hurt your gums much?

Not at all.

It only contacts my tongue and then my lips.

It took a couple of nights finding the correct position, how far in to stick my tongue, from there it's been no issue.

Less complicated than any of the mouth pieces.

Thank you! I'll give it a try :)

This is super interesting. I did a sleep test a while back and they were on the fence with recommending a CPAP machine. My experience isn't like what is described by most people with sleep apnoea. I don't wake up tired or groggy. I do snore from time to time.

The doctor suggested, cutting out alcohol, and sleeping on my side rather than back. I've paired that with a smart watch to keep a track of my O2 stats and feel fine. I'm hoping to avoid all machines as long as possible.

I really feel like there's no great way to win here.

- I've tried the side sleeping thing as well as I snore less with it, but the only way to stay on my side is to force something behind me so I can't roll over. But then I get shoulder and hip pain from lying on only one side for most of the night.

- CPAP side effects sounded enough that it'd just be a 50/50 on if it'd help me sleep better

- MADs can cause jaw pain and other issues

The closest improvement I've had so far is by accident: a higher-end chain store in my area started selling S-shaped "back sleeper anti snoring pillows" so I tried one out. Like CPAP my mouth is suuuuper dry when I wake up, but I've felt more alert waking up and my sleep quality has improved.

There are many causes of sleep apnoe, the most common one being obesity. Some people, however have an underbite which causes sleep apnoe, this can be measured and corrected by an orthodontist. I didn't have either, but I did suffer mild sleep apnoe for years. What solved it for me was rinsing my nose with salt water every evening and using Nasonex spray.

There is also Central Apnea which is 'fun'. Your brain just 'forgets' to breath.

Note that correcting an underbite by extracting/retracting teeth will likely make sleep apnea worse. Make sure you consult an airway focused orthodontist, not just any orthodontist, as many are unaware of these issues.

Now I'm not sure if its an underbite or an overbite that causes the issue, but I do know it's something that can be objectively measured and fixed. You're right though that I went to a specialist in apnoe to have my teeth/jaw measured.

i had a CPAP for years, now I've had a (custom-made, prescription) mouthguard for years. For me, the mouthguard is about as effective as CPAP but much, much more convenient.

Without treatment, I have severe Sleep Apnea and awaken 30 times per hour during sleep. Using a snore-detecting app while sleeping with the mouthguard, I can see that I snore very little with it and I feel rested and ready after 8 hours.

It works by locking into your teeth and very slightly advancing your lower jaw, thereby opening up your airway. After a couple nights adjustment, I hardly notice it.

Note that I had this prescribed by a sleep doctor, fitted by a specialist using a high-tech imaging device, made to fit my teeth, etc. The cost was in the range of $3000 and insurance covered it.

I see people saying the ordered something off amazon and that is definitely a different thing, not a "Mandibular Advancement Device" as these clever, utterly simple devices are called.

I hate those mouthguards. I tried to use them before I got my CPAP but I kept waking up with hellish tooth pain in the middle of the night. Also, it was moving my teeth out of wack like braces do, for a few weeks after using it my teeth kept colliding when eating.

Maybe for some people they work but for me it was terrible. And they were custom-formed.

But without a CPAP machine, would my cat have a button to press to instantly wake me up when he wants breakfast? Seriously, once he figured out the off button, even if I pretend to keep sleeping, he just keeps pressing the button in frustration, like, why isn't this working.

Lately, I've covered the button with double sided tape so it's uncomfortable for his paw. So, he found the off switch on the power strip...

Have you tried feeding your cat when you come back from work, rather than first thing in the morning? The incentive to wake you up would go away.

Cat's got your tongue

Last summer, I (33m) was diagnosed with mild sleep apnea and began treatment with a mouthguard. It took me almost no time to get used to sleeping with one. And it had a great effect on my sleep quality, but lately, I've been experiencing more and more trouble with my jaw. Considering switching to a CPAP soon.

Diet is another thing to try. A family member went on a low histamine diet (carnivore) and no longer has any of these issues. It's not a very fun diet, but they also were able to get off of their blood pressure medicine and had a bunch of other conditions clear up.

Are mouth guards likely to cause jaw issues by keeping the mandible extended for long periods of time?

some crappier mouth guards and "tongue retaining devices" can cause severe dental issues like open bite but these custom made ones are less likely to cause such issues I think...

Your bite can get misaligned, though the solution is a moulded piece of plastic that realigns your bite that you use when you wake up.

I used the morning moulded piece of plastic that you’re talking about but still, after a year my teeth no longer aligned. I just couldn’t move my lower jaw back into its prior aligned position

I'm sure the custom fitted MADs work well, but the price on those is on par with a CPAP. The cheaper self fit (moulded after being warmed up in boiling water) are absolutely not a replacement for CPAPs.

I got a quote from my dentist for a MAD. Half the price of CPAP machine where I am and that's not including sleep study costs.

IIRC my cpap machine was close to $1k, but the quote for a MAD was around $3600.

In-home sleep studies are cheap now, but in-office ones are even more expensive than the MAD sometimes.

I don't doubt you are correct, but have you tried any of those mouthguards? Do they have any benefits at all?

The self fit kind are a replacement for a sports mouth guard (hockey, rugby, football) - protect your upper teeth only. They also help with teeth grinding (bruxism). A dentist will sell a custom fit version for several hundred dollars. (Both are useful for their need, the custom fit are more comfortable, but at a 10-20x price hardly worth it).

This article is about a guard that connects to your upper and lower teeth, and draws your jaw forward (it has to to help with obstructive apnea). You basically can't talk while wearing, it takes getting used to. They're not always comfortable, but they definitely help. Less invasive than a CPAP, and you don't need a machine/constant power source.

But there's multiple types of apnea, which the paper[0] makes clear (it's only talking about obstructive apnea) - this headline suggests guards are better for all. That's far from true. Obstructive is more common, but; for the other kind (where you forget to breath at night) this does nothing, and a CPAP is the only solution.

[0]: https://www.sciencedirect.com/science/article/pii/S073510972...

As someone with combined OSA and CSA (central sleep apnea), CPAP actually doesn’t do much for the later. Most people suffering from CSA need a BiPAP which basically acts as a ventilator when it detects breathing has stopped.

> A dentist will sell a custom fit version for several hundred dollars. (Both are useful for their need, the custom fit are more comfortable, but at a 10-20x price hardly worth it).

I have one of these, my dentist wants me to wear it because apparently I grind my teeth, but turns out I can't wear it. A whole bunch of stuff goes wrong: The thickness means I have nowhere to put my tongue and between that and how it adds volume to my molars my jaw can't close all the way, saliva builds up in front of and below the guard (between the teeth/gums and lips) where I can't do anything to swallow it, and the plastic taste is terrible - the longest I've lasted is about 10 minutes before I have to run to the bathroom and take it out.

I used a self fit one for a camping trip. Following the directions gave me a sore jaw and painful teeth. Not fun. I find my CPAP with a Nuance Pro mask (the opposite of what's shown in the article) to be much less intrusive.

A 16" (female) or 17" (male) or greater neck circumference is the primary indicator of OSA.

I know you all will probably tar and feather me for suggesting correlation equates with causation, but I imagine reducing one's neck size below that threshold is also an effective method of treating sleep apnea.

NOTE: I am not a doctor and this is not medical advice.

Something in my mouth is _way_ more invasive than something mounted across my nose, especially something like the Philips Dreamwear.

The sleep doc made this point prior to writing my Rx for an oral appliance—basically it may not work and/or may be not tolerable.

Given I wear a mouthguard while training, I felt that I would be able to tolerate an oral sleep apnea device (the cpap I tried was very difficult for me to use)

I've been using one of these for the last two years and definitely feel more rested on the nights I wear it. Never tried a CPAP so I can't speak to the comparative effectiveness. The brand I've been using is called Silent Nite.

Had a sleep study done years ago that showed mild sleep apnea, but at the time wasn't severe enough to warrant a CPAP.

Silent Nite mouthguards work great for snoring, best thing out there that I've tried for it. However, I've been cursed with the propensity to grind my teeth, hard. I've snapped every single one I've used after a few months. Mouth guards have been a very expensive outlet of my money.

I can't find whether it's effective against snoring or not. Can someone help?

Anecdotal, but I have CPAP and MAD. MAD never worked for me, although I wish it did. I still snore with it and don’t get good sleep.

On the flip side, I can no longer sleep without CPAP. I wish it wasn’t so expensive, invasive, and power hungry.

I’ve been thinking about designing my own 3D printable nasal mask. The consumables are the expensive part for me and they are relatively simple devices. I pay around $100 for the mask that you thrown away every few months.

Mine consumes a lot of power because it uses a heated humidifier—I’m in a dry state. Seems like a cool mist would be better for me but they don’t really exist. The power isn’t a problem at home but can be when away from home, such as camping.

Have you tried not using the heated humidifier or using an inline humidifier filter? I started out using the heated humidifier on mine, but quickly decided I hated having to fill it up and removed the chamber using a bypass plate. I travel to Denver, CO area frequently and never have issues with humidity.

The woodckucks' guide says:

> “The splint treats snoring and sleep apnea by moving the lower jaw forward slightly, which tightens the soft tissue and muscles of the upper airway to prevent obstruction of the airway during sleep.”

And there are some references to snoring among the links at the end of the article.

https://en.wikipedia.org/wiki/Mandibular_advancement_splint

I have no personal experience, but I am also interested. I found one data point in the below article. Snoring was reduced, and seemingly dependent on the level of adjustment.

https://www.linkedin.com/pulse/i-tried-silentnite-sl-my-osa-...

How is a mouthguard "less invasive" than a CPAP mask? A CPAP mask is 100% outside of your body--it doesn't "intrude" at all.

Sounds like marketing b.s. to me.

P.S. I love my CPAP.

I would say intrusive (to the ability to sleep), rather than invasive.

I tried CPAP. I am a frequent tosser-turner and the pull from the hose was enough to awaken me dozens of times per night, which obviously defeats (part of) the purpose.

My mouthpiece (custom fitted and gradually adjusted with progressively tighter bands by the doctor) doesn't have that problem. It isn't quite as effective as CPAP per the sleep studies, but together with side sleeping it's close.

I've been using silicone vents in my nostrils for several months, and they've made a huge impact on quality of sleep. It is a much cheaper alternative to cpaps.

Only if your snoring is caused by a deviated septum or other nasal cause.

Sleep apnea and heavy snoring more commonly is due to the tongue and jaw slacking during sleep, causing the tongue to kind of slide into the throat and obstruct your airway.

This is even worse for overweight and obese people with visceral fat making their airways physically smaller too. Then it becomes a self-reinforcing cycle as bad sleep quality and low oxygen during sleep has a host of side effects, including making weight loss and digestion a bit more difficult.

That’ll work for someone whose only or primary breathing obstruction is nasal valve collapse.

I had enough nasal valve collapse that I tried these vents but found them uncomfortable. I got the desired impact on my nasal airway from nasal strips that keep the nasal valve open, but that didn’t solved my nighttime sleep/breathing issues because I also had a very narrow airway into the back of my nose and throat due to my recessed upper and lower jaws, which I had surgery to correct about bit over a year ago

Do you have a link to what you use? I don't think I've heard of them before, but sounds interesting.

If this were true it would be great. My mom uses a CPAP and it’s very loud at night and a pain to travel with since it requires distilled water and is an extra bag.

I was able to come off a CPAP by using a nasal steroid (fluticasone propionate) before bed each night, and my quality of life has improved dramatically

I’m curious, have you tried nose strips? [1]

I recently realized that my nostrils slightly collapse inwards when I breath through my nose. The nose strips seem to help me enough to make nose breathing comfortable.

[1] https://thefeed.com/products/intake-breathing?variant=401458...

Is that prescribed by a doctor? I'd be concerned about using steroids repeatedly on membranous tissue.

My doctor prescribed exactly this for me.

After CPAP fail, I tried one of these and it worked GREAT. N=1.

Can you buy them over the counter or does it require a visit to a provider for a prescription?

It needs a fitting. IIRC they took a gel impression.

I’m glad there are alternatives to CPAPs for treating sleep apnea.

Given the link between some CPAP machines and certain types of cancer, the entire category makes me nervous.

Are you referring to Philips Respironics devices and their sound-dampening foam? You can get a CPAP from ResMed (a different company) instead, which was not affected.

This is frankly pretty interesting.

My wife has a CPAP, and after several months of absolutely dreading sleep she decided that she hated it so badly she’d rather suffer the consequences than live with the machine.

I've used a CPAP for years, and I tolerated it pretty well. I was convinced it was dramatically improving the quality of my sleep - that I was waking up more well-rested and energetic.

However, I failed to notice any real improvement in my life. In time I became convinced it was basically just a placebo effect, and when I started developing some brain fog and waking up feeling light-headed I finally ditched the machine. And never felt the need for it again.

IMHO, some of this obsession with CPAPs is exactly this: a product of over-medicalisation, of companies that have found a new huge market to tap into (see Philips), and of placebo effect. In my case, learning to sleep on the side was enough.

FWIW, I don’t know that I disagree based on our experience as described in reply to another comment

I have a machine, took a few weeks to dial in the settings right for me. Tried a few different masks & machines from a sleep study clinic. In a few years I have gone less than 7 nights without using it.

Using the machine has been life changing for me.

I used to struggle to get up before 10am. Now I wake up naturally around 6:30am-7am most mornings.

Learning new things isn't a mountain to climb to retain just a bit of information. I feel like if I had done a sleep study 10 years earlier I would be a much better technologist than I am now.

I would recommend you suggest to your wife that she tries a few different mask styles. I initially found I wasn't fitting the mask well or had a slightly wrong size and I would get some leaking that would keep me awake at night.

The consequences of untreated sleep apnoea are very serious. I would urge you both to revisit this issue.

For what it is worth, which is probably not much, I don’t know that I actually believe she has sleep apnea at all. She does not snore, nor wake, nor generally have any trouble sleeping beyond initially getting to sleep - for which she is already on medication.

The only reason she even got checked in the first place was she paralyzed one of her diaphragms after a very bad bout of pneumonia, and her pulmonologist made a suggestion based on nothing other than an abundance of caution that we might want to make an appointment to see.

I remain largely unconvinced of the methodology by which she was diagnosed. It was an at-home single-night sleep study. She had to strap a box to her chest, place a handful of electrodes around and wear a breathing monitor. She only managed around three hours of sleep, largely because she could not sleep in her preferred position (stomach) and found the hoses in her nose anxiety inducing. It was, in my unprofessional opinion, completely unrepresentative of a normal restful night of sleep, and thus largely irrelevant data.

On top of that, the day we returned the device the doctor opened the appointment by checking what CPAP machines our insurance would cover - BEFORE the results came back from the lab.

It felt very … salesperson-y

I think you are the best person to judge your parnter's sleep health.

CPAP has been a gamechanger for me, and my partner. It took two years to get it through the health system, (having a box duct-taped to me at the hospital for home sleep analysis was completly useless), duriing which time I developed some chronic health issues. I was so grateful to to finally recieve my machine (the Nose Hose we call it) that the aquwardness and sillyness issues were tiny in comparison to the benifit of getting a good night's sleep.

Be on the lookout for these symptoms:

https://www.nhs.uk/conditions/sleep-apnoea/

And if being overweight is an issue that's probably where most people should start, which of course is easier said than done.

It takes active effort to dial in the machine settings. If you just trust the APAP algorithm most people will never get used to it. Took me a year of tinkering. There's a great piece of software called OSCAR that helps.

i tried one to hold my jaw forward. cpap is way, way less painful.

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