From CPAP To Oral Appliance

I’ve been rambling this story a bit so it’s time to wrap it up and get to the present. In a nutshell my experience with CPAP didn’t go so well for a variety of reasons. Partly due to my own ignorance on the subject and partly just the general lack of incentive on the healthcare industry to address OSA. For many, CPAP provides long-term manageability of their OSA but few seem to really take to it straight away so stating that CPAP is the most popular or most accepted method for treating OSA is a little misleading.

For myself, there was a lot of anxiety involved over the use of the machine, most likely built up over time from just having issues going to sleep and not knowing why. Now it’s almost habitual, I can be a zombie at 11pm, barely able to keep my eyes open, but when I get in bed I’m wide awake. Adding the CPAP to the mix just made that anxiety worse and therefore decreased the likelihood I could/would be compiant with it. More specifically I developed almost immediately issues with the machine. It makes a weird noise that’s different than the normal aspiration noise it makes so I get focused on that noise and then can’t go to sleep. I’ve also never found a mask that I was completely comfortable with. I’ve tried:

Resmed Mirage Quattro Full Face Mask with Headgear - Mirage Quattro Medium
Resperonics ComfortGel Nasal CPAP Mask with Headgear - Medium
Fisher & Paykel FlexiFit HC431 Full Face Mask with Headgear - All Cushions (S, M, L)
Resmed Mirage Quattro Full Face Mask with Headgear - Mirage Quattro Small
InnoMed Hybrid Universal Full Face CPAP Mask with Nasal Pillows - All Sizes Included
Resmed Mirage Swift II Nasal Pillow System - All Size Pillows (S, M, L) Included

All of these masks have had issues leaking. The Mirage Quattro is probably the best of the lot but it makes a crazy hissing noise that despite repeated attempts to stop, wouldn’t. There are numerous reports of similar issues with this mask online. I tried the small version to see if that fit better but I felt I had to pull the masks too tight in order to maintain a reliable seal. All of these masks were ultimately returned except for the original Quattro which I got from the DME and the Hybrid Full Face & Mirage Swift II. The latter two I do like but still feel they have to be pulled too tight, to the point of being uncomfortable to wear. They are however, not nealy as confining as the full face masks.

After a few months of not having success with the CPAP I gave up. Neither Ambien nor Lunesta helped get to compliance much less maintain it. Not once, aside from the titration study did I ever keep the mask on for more than a couple of hours. Discussing it with my doctor the answer was simply using it some was better than none.

At this point I had done research on the Oral Appliances and was familiar with some of them. My doctor had no experience with them and I didn’t want to go to just any dentist to get one. As luck would have it, my dentist has OSA and uses a TAP3 Oral Appliance himself. After discussin my sleep study results he felt the device would definitely help so I dropped the cash to get one.

It’s a pretty simple device and in hindsight I’d pay for it again. I’ve had some jaw pain but that was expected and usually goes away pretty quick in the morning. The only real problem I’ve had with the device is the upper piece didn’t fit well, it kept slipping so after a week of using it we sent it back and had it remade. I didn’t realize at the time just how much it was helping until I went without it that week. The full force of the Apnea came crashing back and after a couple of days I was feeling like crap again.

When the new device came in it had an immediate effect, I could tell positive results the next day. I’ve also been compliant with the device everyday since (roughly 2.5 months), although that’s with the help of Lunesta. Unfortunately, the upper piece started slipping again but I put up with for several weeks and I probably should have gone right back in when it started. So I’m without it for the next few days, trying to tolerate the CPAP and not having much success. Hopefully, the thrid time will be a charm and this time the device will be cut correctly to fit my teeth as I do believe it’s providing a tremendous benefit.

This essentially brings this story up to date. There’s been issues, both with the various CPAP masks, the TAP3 Oral Appliance and most defintely the drugs (Ambien, Lunesta). I’ll address these in seperate posts because each is unique.