TAP II adjustment? How far?

[SleepyDee]

I have now been using the TAP II for four nights. I started out a -3 half-turns from the minimum mark my dentist made. My first night was not so good - just trying to adapt.

The next three nights, however, have been pretty good. It takes me a while to fall asleep, but once I do, I am sleeping longer than I typically do on CPAP. With CPAP it was rare that I would sleep through the night (and I was only a pressure of 6). I have now slept to 5AM three nights in a row.

I compared the jaw position of my Silent Nite with the TAP II and found that I could move the hook back out to the minimum mark with less jaw strain than my SN. So I have been at 0 turns for the past three nights.

So, now that I am "sleeping" with the TAP II, how do I know when I have advanced the hook "far enough" - without going in for a sleep study? I want to fine tune it as best I can and then use it for several weeks before having a sleep study done. But since my apnea is fairly mild, I am not sure how to tell when I have advanced it far enough.

Any suggestions or clues for me? What would be a good test procedure to follow as I slowly move the hook forward?

[Sleepy Stoboy]

Hey Sleepy Dee,

For me, the slow advancement was the key. Then, I tried to log sleep results for a few weeks once I hit what I thought was the ideal position. For me, I actually turned it back two turns from the point I thought I needed. The key was to give it more than a few days at the position you find relief at. Too many other things can disrupt sleep (for me I'm a light sleeper anyway), such as noises, illness, kids getting up in the night, etc. Feeling good and maintaining that will get you the answer.

And then, you have to have the sleep study to confirm or fine tune the rest.

[PaulY]

SleepyDee,

Believe me, you will know when you've hit your optimum setting. You will wake up one morning very refreshed, noticibly refreshed. And then it gets better as you begin to pay off years of sleep deprivation. The experience is the same as CPAP - you feel great the first night you sleep all the way through, then it gets progressively better for a few weeks....then it levels off to "normal."

As a rule of thumb, try Stoboy's suggestion of 1 night advance, next 2 nights leave it at that mark. Then advance again. Do this until you feel noticibly better or unti your jaw begins to hurt (you'll know), then set it back one or two turns.

Then, the all-important titration PSG for which there is no substitute to tell you for sure what setting is needed.

-PaulY

[SleepyDee]

Your statement:

"You will wake up one morning very refreshed, noticeably refreshed."

is what I have been longing for for 3 years now. I never achieved that with CPAP, yet my oxygen level stayed high while on CPAP. I think I may never be one to feel refreshed in the morning. I think that is why I have a hard time knowing if my therapy is working. I feel better than without therapy, but never great.

[PaulY]

Hey Dee,

During my early 20's thru early 30s, my wife would be annoyed every morning when I would hop out of bed, whistle a couple of tunes in the shower and pretty much act like a 12 year old on a pot of expresso. Then, when the apnea hit bad, for a couple of years I would wake up with severe body fatigue - the kind of muscle ache that you feel after an intense workout or climbing a mountain. The fatigue stayed with me all day.

The biggest clue to me was waking up one morning with noticeably less body fatigue and a feeling of being mentally refreshed more so than usual. It wasn't "great", per se, but it was aweful nice compared to the previous couple of years.

It does get great over time. The worst part is the wait.

Like interest on a credit card, the effects of this malady accumulate and become greater over time. The basic crummy feeling I know all too well didn't happen overnight, it took time. The normalizing of your sleeping, the subsequent payoff of this enormous debt won't happen overnight either. There won't be a sudden "great", But there will be a turning point that is recognizable, very noticible.

I'm at the point now where there's no noticible continued improvement. I've gotten to the point now where I just feel "normal", like I did before the apnea began to take its toll. I'm starting to annoy my wife again in the mornings, and I stay up until midnight every day without so much as a yawn during daylight hours. But it's taken the better part of 7 months of complete, normalized, 8-hours of sleep to get here. You will, too - as long as you don't give up and you find the treatment, or more likely the combination of treatments, that work for *your* specific obstruction(s).

-PaulY

[Humalien]

I'm still on the bubble, but my faith is strong.

Last night, my fatigue on my upper half started to feel more normalized. On my bottom half, still not refreshing during sleep time.

I finally am getting off the sleep meds but still not entirely. I seem to get 5.5 hours to 6.5 hours of sleep, and I'm having to take a minor sleep med like benedryl 50mg to toss out for another 2 to get fully rested. But this strategy didn't work the last two nights. My brain is wanting to normalize, but it's still not my time. I'm slowly reaching further out on the Tap.

Also did a oximeter in home sleep study for o2 sat SUNDAY. So I'll know if this is still dropping.

Well here's to more sustained confidence with sleep this week. I can't wait to be normal like you PAUL. What inspiration. I too am a ex programmer. I enjoy hearing your confidence. I too will follow... teacher...

RICK.

[PaulY]

Keep that faith up brother, I know exactly where you're at. It sucks, the waiting just sucks. It's the worst part. This is a painstakingly slow process.

Funny, when I finally found what worked for me I vowed not to rest until I helped as many people as possible to get the same result. But deep down inside, realistically, despite my enthusiasm, I know it can't possibly be the magic bullet for everyone.

I still get nervous hearing about the experience as people go along, fearing that it might not work for them and I'll feel terrible. I took a big sigh of relief when Stoboy got his results in....man did I jump for joy. RickRed gave me ulcers over his Pillar ulcers....I was really pulling for him, but despite all the problems he should never have gone through he, too, is nearing the finish line.

You're a programmer, eh? I spent the first 10 years coding in S370/390 Assembler on the Mainframe....but for the last 5 years I've joined the client-server world coding in Java and Perl on a Unix platform. Fun stuff.

-PaulY

[Sleepy Stoboy]

Hey all,

I agree with what Paul's saying about the timeline. It's getting better, but it is slow. I didn't have that magical wake up and bounce around day right after using the TAP. It's gradual and you have to compare notes over time. If you're the analyzer type, keeping a sleep log might help...

What has changed:
1. I wake up (that I notice) only 1 or 2 times a night for a quick rollover. I don't sleep through the night, but I'm a very light sleeper, so not sure this will ever be realistic. Might come in time though.

2. I don't bounce out of bed, but neither do I crawl out of bed with what I would almost call an "angry feeling". Can't really describe this- most of you will know what I mean. I would feel tired physically all over, my mood was poor to start the day. Ever play the "Sims"? It's like when those little sims have the solid red bar for not sleeping, and they just walk around and grumble. Best way I can describe it. I don't bounce out of bed, but now I feel level, reasonably well rested and ready to go. Before, I didn't even start to feel that way without a continuous stream of caffeine.

3. I can sleep in again. My body is only letting me sleep about 6 hours a night, even if I try for more. But occasionally now, if I try and roll back over to get another hour or two, I sometimes can. Never used to be this way. When I did finally stop the apneic sleep, I could never put myself back to sleep.

I'm a retail exec with about 750 employees who look to me every day to see if I have energy and to see if I'll be role modeling what I'm asking them to do. It used to be a daily struggle to get up to do that. Not anymore- I'm running around like a complete nutjob.

I owe Paul a whole lot. You've helped at least one person, my friend. If you could see how much life has changed for me, I think you'd probably quit your day job and work on this full time. Thanks for helping me get my life back. Not all the way back yet, but very close.

[Leahcim]

My jaw is now about 7/16 to ½ inch advanced from its normal bite position but it took about 5 weeks to get to that position and I have now settled there for the last 2 months. I now no longer make adjustments - just bung the old Somnomed in and go to sleep. I rarely breathe through my mouth so never suffer from a dry mouth; on the other hand I do salivate when the MAS is first inserted but that does not last long. I do find that if I drink some water after I have had the MAS in for a few minutes before I get into bed the saliva is much reduced.

How do you know when you are far enough advanced without a sleep study?

As most have said you just start feeling better but my dentist took great pains to quiz me about my dreaming. I now dream very well and I quess what he was trying to say is that dreaming is associated with REM and that if I am dreaming and not waking up from OSA from REM then all is well.

Seems to work for me. Good luck, hang in there, make SMALL adjustments and then allow a day or so before the next one. BTW - I have now had my MAS since 22 Jan 05 - 3+ months.

Mike.

[SleepyDee]

You give me hope for a better day! Thanks.

But I fear that day may not come - it didn't after 3 years of CPAP. I am definitely "better" when I use some form of treatment than when I do not, but never "great".

But I have never gone back for a sleep study since my initial tests which told me my pressure setting. Perhaps I should have done that. I have periodically retested my O2 level, and it stayed up in the 90+% range (it dropped to about 80% before treatment) - so I have assumed the apnea is being adequately treated.

And now that I am using the TAP II I need to establish a new baseline and then get tested again.

Leahcim mention that he is about 1/2 inch forward of a normal bite. Where do you start? It would take a long time to go 1/2 inch at 1/2 turn every few days. Do you start with a normal bite? Or do you start somewhat forward?

I am now forward approximately 1/8" (by my own crude measurements) - which is where my lower front teeth align with my upper front teeth. The jaw strain at this position is very tolerable. Should I move forward at a faster pace until I start to "feel" it?

At this current position, which isn't very far forward, I sleep better than when on CPAP but I don't wake quite as refreshed. Not bad, but not good either.

[Guest]

SleepyDee,

I too just started using a TAP II. On the underside of the top plate by the hook are six notches. The distance between the first and sixth notch is 10MM. With the first notch being treated as zero, then each notch will represent 2 MM of advancement.

My dentist had me start the TAP at the lowest setting where I could easily hook the lower plate to the upper plate with the device in my mouth. For me, that was at the second mark, 2 MM. I slept with it in that position the first night and it felt fine. The second night I advanced it two 180 degree turns. It still feels fine. I'll keep advancing ever couple of nights. At this point, I'm still using my CPAP machine along with the TAP. When I get the TAP dialed in a little more, I'll stop the CPAP and see how I do thru the night.

To the group,
My bite does seem a little off in the mornings. My lower front teeth are hitting the bottom of my upper front teeth before my back teeth. I use the bite tabs and everything starts to feel normal by later that morning. How will I know If I've over advanced or have occlusions?

Thanks,
SunnyTime

[Guest]

[Leahcim]

That last "Guest" was me - forgot to log on

[Guest]

Dee,
Next week I'm going for the last possible adjustment on the Silent Nite which is to 3mm.
I'm not optimistic this setting will make a difference for me, and if it doesn't my dentist will let me return it to him at cost.

So my question is this, now that you have more than a few days with the TAPII, was it a difficult transition?

I don't want to shell out another $500.00 or so for a dental appliance I don't like, won't use, causes me to drool, or I find that a setting of 4-5mm causes just too much pain.

So, would you mind sharing how the transition from Silent Nite to TAP is going?
Rick

[SleepyDee]

I see four advantages to the Silent Night:
1) It is easier to insert and remove.
2) You can partially open your mouth, which makes it easier to swallow or talk.
3) It "feels" lighter weight.
4) You can close your mouth easier because it doesn't separate your teeth as much.

But I think the TAP II is a far superior device:
1) It is built with much stronger materials, so it should last much longer.
2) The adjustability is extremely helpful at fine tuning your treatment.

I would go for the TAP II.