[throwawayokzzz]

I am thin and not the typical profile for sleep apnea. I started waking up in the middle of the night with severe hand pain, needing to urinate (nocturia) and had a headache in the morning despite getting 8 plus hours. Doctor sent me to the sleep lab. Unrelated, I thought to myself, but submitted. The lab said the hand pain was a red herring, thought it was neck related, and gave me a home test. Results came back, mild sleep apnea (10 AHI, under 5 is considered normal). I was given not a lot of guidance, said to get a CPAP, which is the gold standard.

I was in a ton of pain, so I dutifully bought one and started monitoring my data using SleepyHead. Getting the right pressure was key, as was finding the right nasal pillow fit and making sure no mouth leaks. The first month was brutal, but my body started adjusting. The first night I slept well I woke up with a refreshing feeling I hadn't felt since grade school. That motivating me to keep going. I read sometime later that when you have an apnea, your vascular system constricts in the extremities and dilates going to the head to prioritize getting oxygen to the brain. Sure enough, that was what had been happening. My hand pain was the feeling of lack of oxygen or lactic acid build-up, I'm guessing. The headaches were from too much blood pressure going to the head (I've since found that a cold compress on the neck or a naproxen can help that if it occurs). The nocturia came from the fight or flight response when the adrenaline of apnea kicks in. All three symptoms went away when I started getting down to <2 AHI.

However. Though I grew to be used to the CPAP, I never liked it. It made a good night better but a bad night worse. I started having unrelated back pain which made it hard to sleep in certain positions with the headgear on. And during the summer my allergies made it near-impossible to get enough air (I found fluticasone to help though). On a whim I bought a snore-aid mouth appliance. It didn't work initially because it made my jaw hurt so much, so I stuck with CPAP and began using the mouth appliance with less mandibular advancement during only the last 3 or so hours of the night. Finally a work trip came up and I decided to rip off the band-aid. I took only the mouth appliance, and found I could tolerate the further advancement. It worked, no more apnea events, mind still clear in the morning, no hand pain etc. I waited a couple weeks, then packed away the CPAP. I had been on it for 3 1/2 years. I wish the sleep lab had mentioned that option for my condition.

[throwawayosa]

Do you mind sharing what mouth appliance you are using?

[throwawayokzzz]

I use PureSleep, a boil and bite style device, and not the best for adjustment, since it only has three settings (each about 3 mm apart, from 0 to 9 mm). I had to cut it apart to adjust it after the first fitting.

Better options may be SnoreRx Plus (1 mm adjustment, from 1 to 6 mm) or VitalSleep (1 mm, from 1 to 8 mm) which allow for easy adjustment, no cutting required.

Note that none of these devices are rated for sleep apnea. However, the cost is $60-100, whereas a fully FDA-approved device runs about $2000. And not everyone who has sleep apnea can benefit from an oral appliance. You don't know until you experiment with one, and it can be money wasted. So I felt justified in trying a cheaper one out off-label to see if it helped alleviate my problem before investing a lot of money. I'm still considering paying for the more expensive one since they are FDA approved, seem less bulky, and may be less likely to cause tooth movement in the long run.