My Kaiser doctor suggested that I try a Tongue Restraining Device (TRD) for sleep apnea. So I would like to have a consultation with a local sleep doctor. In fifteen years since my obstructive sleep apnea diagnosis, I've tried almost everything else: the jaw extension device caused too much jaw displacement due to my already pronounced underbite; a uvulectomy failed; CPAP provides minimal relief, but I have to tape my mouth shut for any relief at all with a Mirage Activa mask. The full face masks all leak. I don't have nose obstruction and I understand that Kaiser will not cover the TRD treatment. I would like to have a consultation, preferably to see if TRD might work for me.
Doctors Answers (4)
In this case, the best thing to do is call and schedule a consultation with a qualified sleep specialist in your area. After looking at your history of diagnosis and treatment, they will be able to provide insight and determine the best course of action.
Sounds like you have been through the mill. This should not have been that difficult for you. What I would recommend is to research services in your area to find a physician boarded in sleep medicine and then schedule an evaluation. He/she should be very helpful. You can go on line to the Academy of Sleep Medicine and find someone in your area that can listen to you, your history, evaluate your needs, and help you. There is someone out there who can help you.
In my experience, tongue retention devices have not been very successful. However, with your experiences I understand your physician's recommendation. With a pronounced underbite you may be a candidate for surgery to move the mandible forward. This is major but often effective in treating sleep apnea. Leaks around masks can be reduced with the use of the REM ZZZ.
A tongue retention device works by "suctioning" the tongue and keeping it forward. From my experience, it does help some patients, but the relief may be temporary. Some patient's tongues become very sore and are therefore unable to wear them long term. With regards to oral appliances, we do our best to make sure that the appliance isn't adjust past what your jaws can take. I have seen some appliances come in with very unreasonable adjustments and they do cause a lot of strain on the jaw. I wouldn't completely discount an oral appliance as there are many different types and many more ways to fit them so you can wear them comfortably. When capturing a position to hold your lower jaw with an oral appliance, they need to be adjusted in 3 dimensions, not just "pulling" your lower jaw forward and straining ligaments and muscles in a 2-dimensional fashion. There are also oral appliances that have components to help gently coax your tongue forward so it moves away from the airway. Please call our office for a consultation regarding an oral appliance if you're interested.