Sleep Apnea Oral Appliance & Embouchure

[hschneck]

Does any trombonist in the dental field have any experience with what sleep apnea oral devices can do to one’s embouchure. I’m worried that forcing my bottom jaw forward at night using this device (about 11 mm by my estimate) will adversely affect my playing. I do muscles tighten exercises each morning 15 minutes after removing the device, but dentist wants to move it even further because it does not yet have positive results based on biometric measuring Ring results. Just curious if anyone else has faced this issue?
Thanks, Howard

[ghmerrill]

I'm not "in the dental field" -- so I know this isn't exactly what you're looking for, and hopefully there's an experienced dentist on the forum who can answer, but just to provide some insight that might be worthwhile ...

I've been using one of the apnea dental appliances for almost a year now and have NO intention of going back to CPAP. It works wonderfully for me. And I expect that different "versions" of the dental devices might have some different effects, although -- since they all do basically the same thing, I'm not sure there would be a difference in any embouchure effect. With those caveats ...

I don't notice any effect on my embouchure. I started out doing something like the "exercises" you do -- except in my case it was using a silicone "realignment" insert to chew on for a few minutes (produced and provided to me by my dentist). But now I don't bother with that and do no exercises after I remove my device except for just moving my jaw around a bit after I remove it. My son takes the same approach, as does my wife.

According to my documentation, (with the #5 strap on my SomnoDent AVANT device) I'm getting 5 mm of "advancement". 11 mm strikes me as a LOT of advancement -- and in fact the AVANT provides (via different "straps") a maximum of 8 mm advancement. I'm not sure how you did your "estimate", but it may not be accurate. I'm not sure anything close to 11 mm would be possible in my case, but I suppose it depends a lot on the alignment/size of your own jaws.

It definitely took me some time (a couple of months or so) to settle on the degree of advancement that was both tolerable and the totally eliminated snoring. I'd advise you to stick with it over some time -- because the benefits are so positive -- and just see if it really has any effect on your embouchure over time as you give it a real trial.

[CalgaryTbone]

I stopped using mine for that exact reason - it was changing my jaw position, and playing the trombone was being compromised.

Jim Scott

[2bobone]

I've definitely noticed a huge embouchure change from the use of a standard sleep apnea full face mask. I was a pretty much straight forward kind of player and now am definitely a downstream player. Surprisingly, there are some benefits to acquiring the change. Who knew ?

[Doug Elliott]

I have been on a full face CPAP for probably 15 years or more, and I am extremely happy with it.
Playing has moved my jaw forward from its previous resting position, and that happened long before I started using a CPAP.
I have no real interest in trying a dental appliance. I feel like the CPAP itself benefits my breathing and chronic congestion in good ways that I wouldn't expect something else to help.

[ghmerrill]

This situation and condition (sleep apnea) is severely individualistic since it depends on a number of individual features of the patient. And for many apnea patients, CPAP (better, APAP) is still the best choice. CPAP changed my life dramatically for the better, and I used it religiously for close to 20 years. But it was never ideal for me and it also has definite drawbacks for many users.

I was originally very skeptical of the dental appliance approach (as was my primary care doctor), but over time (based both on published materials/studies and the results of others I knew who had converted to it) I thought it was worth a try -- to free me from what I found to be quite unpleasant aspects of CPAP. For me, there is a definite improvement in effectiveness over CPAP, and there are other genuine benefits. I sleep better now than I ever did with CPAP -- not to mention other benefits to being freed from the machine, the mask, and the whole CPAP supply chain.

But ... My diagnosis of sleep apnea has been -- from the beginning -- what I'd call "marginal". In fact, if it weren't for a couple of "comorbidities" (mild Type 2 diabetes, moderate hypertension, and a history of some vascular issues stemming from treatment for Hodgkin's Disease decades ago), the diagnosis of sleep apnea couldn't have been made in my case because it wouldn't satisfy the diagnostic criteria.

Other people have moderate sleep apnea, and yet others have severe apnea. Different strokes for different folks -- and in this case it's really important to take the right approach in you own specific case.

[Bassbonesso]

I've been using an oral appliance for just about 2 years now. I'm only advancing by 1mm (have mild OSA) and use the reset device (small appliance over the lower front teeth) for about 20-30 minutes in the morning. No adverse effects so far.

It strikes me that 11mm advancement is a lot and I can completely see that having all sorts of effects on your "normal" jaw position. IF it were me, I'd look for another solution....

Good luck!

[Doug Elliott]

I have a friend who is going to get the Inspire surgery, the implanted device to stimulate opening the airway during sleep.
Any trombone (or other brass) players here with specific experience with Inspire?

[baBposaune]

Not me, personally but the list of potential side effects make it seem like a risky option for brass players. "Temporary or permanent weakness of the tongue" jumped right out, plus nerve damage and neurological symptoms. I've also been on CPAP for maybe a couple of years longer than DE and I have pretty up to date technology with nasal pillows. I sleep on my side and I'm so used to CPAP I can't see switching to something else, unless it stopped working as well as it has.

On a side note, has anyone who uses CPAP ever had problems with their eustachian tubes narrowing?

[ghmerrill]

... the list of potential side effects make it seem like a risky option for brass players. "Temporary or permanent weakness of the tongue" jumped right out, plus nerve damage and neurological symptoms.

I'm glad to see someone else point this out since I didn't want to be alarmist about it. But I've done some serious investigation of the various studies involving the Inspire technology and patient response to it. And it's not just the "potential side effects" that are the issue, but the incidence of these side effects (including the incidence of post-surgery infection and the incidence of "removal or relocation" of the device).

There are, of course, a number of (sometimes complex) factors at work here, and each patient is different. So you're own individual risk may be much less (or may be much higher) than what the study statistics suggest. And your own situation may make a heightened risk tolerable.

But I would not move forward with this particular solution before I got at least one reliable second opinion from a physician intimately knowledgeable about this technology (but doesn't perform the surgery him/her-self) and its history of success, problems, and failure -- and how that might work out in my own specific case, with my own specific comorbidities.

[ghmerrill]

On a side note, has anyone who uses CPAP ever had problems with their eustachian tubes narrowing?

There are so many potential causes of this that -- in the context of CPAP -- it's very difficult to pin it on the CPAP without some careful investigation. However, it's also pretty easy to "imagine" how long-term use of CPAP might be related to developing this condition. There are apparently no know relations of CPAP and eustachian tube narrowing, but there are "associated effects" of CPAP that would be "related to" eustachan tube narrowing.

I think the situation is that no one has done any studies on the relationship. Unfortunately, collecting anecdotal evidence from self-reporting subjects is unlikely to be helpful. Have you said to your ENT guy "Hey, what's up with this? Is it maybe caused by my CPAP?" (To which I'd expect him to reply "Maybe." )

[baBposaune]

Waiting for my ENT referral to do just that, Gary!

[ghmerrill]

Good luck. Last year my (new -- the old one retired) ENT guy totally rebuilt my sinuses and also did "turbinate reduction" at the same time while removing a giant polyp on one side that he feared might become cancerous. The result has been miraculous. I haven't had a sinus infection or even the hint of a cold since then, no sinus congestion, and I'm sure it has made my use of the dental apnea appliance possible (since I can breath fully through my nose!!). The ENT tools and techniques have REALLY improved over the past 30 years (what a shock, eh?)! One big advance is in the endoscopes and imaging -- they can now SEE what's going on in there a lot better than previously.