Note: This post may contain statements that I no longer consider true.
See: The Vivos mRNA Appliance Didn't Improve My Obstructive Sleep Apnea.
After doing a lot of research into palate expansion options to treat my obstructive sleep apnea, I’ve decided to go with the Vivos DNA appliance. Actually, I’m getting the mRNA version which also advances and expands the lower jaw. This should give me more tongue space in my mouth, stop it blocking my airway and get me off my CPAP machine earlier.
Several dentists trained in dental sleep medicine, an othrodontist and a couple of ENTs have told me that I have underdeveloped jaws and a retrognathic maxilla as a result of the orthodontic extractions and retractive braces that I had when I was aged 13. This has left too little space in my mouth for my tongue, which collapses into my airway when I sleep. The condition is compounded by the gradual loss of muscle tone in my airway as I have aged and probably lead to my chronic fatigue developing at age 40, but it’s likely to have been affecting me most of my life.
I’m very risk-averse and was told by an ENT that I wasn’t a good candidate for maxillo-mandibular advancement (MMA) surgery, which at the time was both disappointing and a huge relief. While I can’t go back in time and stop the dentist extracting my teeth and insist that the orthodontist expand my jaws to make room for both my teeth and tongue instead, the next best thing is to expand my adult jaws to the size they should have grown to naturally. This led me to explore the world of maxillary expansion appliances.
In a couple of years I hope to feel like this.
I chose the Vivos system because:
- It claims to be pain-free.
- It gently expands/grows the maxilla and mandible over a long period of time.
- Being removable, it’s less invasive than a fixed appliance.
- It expands sideways and forwards, giving both maxillary expansion and advancement.
- The mRNA does mandibular advancement during the expansion period, which should liberate me from CPAP earlier.
- The lower appliance will help straighten my lower teeth which tip inwards
- It should also fix the crowding in my lower teeth.
- It is likely to improve my daytime breathing and my overall health.
- I found the patient testimonials compelling.
- I have only heard of a few people online who didn’t find it helpful.
- It has improved cases of severe sleep apnea like mine.
- AGGA sounds more painful and appears to have a higher risk of losing teeth.
- MSE only expands sideways, and requires screws in my maxilla and splitting of the maxillary suture.
- ALF seems more suited to children.
- There are no Homeoblock providers in Sydney.
- If it doesn’t work for me 100%, I can always try a more aggressive treatment like surgery later.
- It’s backed by the in-house expertise of a large company.
- There are now Vivos providers in Sydney, so it’s available to me.
On the down side:
- It costs a fortune. (But so does being sick all the time).
I was pretty skeptical of Vivos at first, but what sealed the deal was watching the presentations from their Breathing Wellness Conference on the Vivos Vimeo channel. The patient testimonials are particularly compelling, including those of the dentists who had suffered from obstructive sleep apnea themselves before using the Vivos system. While the marketing material aimed at recruiting dentists has the usual corporate gloss and polish, I get the sense that these people really are passionate about ridding the world of sleep apnea because they’ve been through it themselves and know what it’s like to feel exhausted all the time.
The sleep specialist who diagnosed me had no experience with oral expansion for treating obstructive sleep apnea, seemed rather dismissive of the idea and said my case was “too complicated” for him; which left me feeling like he had been asleep at the wheel professionally. How could you work in a field treating a devastating chronic illness all-day, everyday, and be completely unaware of what causes it or the latest advancements in treatment? He seems to think that CPAP is the best thing since sliced bread, which is interesting when you consider the role our overly soft diet plays in causing the modern epidemic of sleep apnea: Sliced bread isn’t actually all that good after all.
He referred me to The Woolcock Institute, who are leaders in the field of sleep research, for an interdisciplinary approach. I had a consultation with a sleep specialist there to get a second opinion on my oral expansion plans. He discouraged me from getting surgery and also had no experience with oral expansion for treating obstructive sleep apnea; but at least didn’t dismiss the concept outright. In fact, I was really impressed when he asked me:
“How did you feel when you were diagnosed with severe obstructive sleep apnea?”
“I was shocked”, I replied, “I had none of the risk factors and an overnight sleep oximetry test I had done years ago showed no significant oxygen desaturation”. I was also shocked that a doctor actually asked me how I felt; that hasn’t happened very often over the last 12 years. I know now that an oximetry-only test should not be used to exclude a diagnosis of obstructive sleep apnea, and believe that the reason my oxygen desaturation wasn’t significant is because I mainly have hypopneas rather than apneas, as shown by my sleep studies. Lesson learned: get a polysomnograph!
When I asked him if he had noticed any connection between adolescent orthodontic extractions and adult sleep apnea in his patients, he said it was an interesting question but he hadn’t noticed any. I suspect he hasn’t asked. It appears that sleep specialists generally are unaware that orthodontic extractions are a significant risk factor in obstructive sleep apnea.
I expect the treatment to take 18 months to 2 years, and that at some point during that time I’ll find my CPAP machine isn’t required any more because the mRNA’s mandibular advancement function is treating my residual sleep apnea effectively. Then eventually I’m hoping to get enough expansion that the mRNA isn’t required either for my airway to stay open during sleep. I’m also hoping my daytime fatigue improves over this period. If it doesn’t work, I can always try a more aggressive/invasive treatment later.
My appliance should arrive in the next week or two, and then I’ll start e x p a n d i n g.
40 Comments
Jason · September 2, 2021 at 4:39 AM
Hi Graham, Thanks for the great information. I am considering getting VIVOS out here in California. Looks like you wrote this article more than a year ago. Do you have any follow up thoughts since starting use of the appliance?
Graham Stoney · September 2, 2021 at 8:15 AM
Hi Jason. Sure, you might enjoy these articles:
You can also check my monthly progress updates, which have been going for almost a year now.
Cheers,
Graham
Michael · January 12, 2021 at 12:19 PM
Hi Graham! First of all, I really appreciate the amount of effort you’ve put into sharing all of this info and your story with us. I’ve had upper bicuspids removed for orthodontal work as a teenager and have suffered from CFS, brain fog, TMJ, poor posture, nonstop postnasal drip etc. for many years since and it has taken me a while to come across the connection. I will be living in NYC this year and was wondering if you’re familiar with DNA providers there? (Obviously there is Dr. Belfore and Homeoblock, though it seemed as if DNA was a bit more proven and developed)
Also did you have any doubts about DNA/mRNA and claims that it just moves teeth, rather than actually expanding the maxilla? i.e. the discussion about teeth-borne instruments such as DNA, Homeoblock, BIobloc vs. bone-borne instruments such as MSE (which I feel is a bit traumatic and forceful after watching a YouTube video of Ron Ead’s experience of his suture splitting).
(Maxillary expansion this is what I am most interested in as I’ve only had upper bicuspids removed and my mandible actually juts out into an underbite unless I either retract it and jam it into the TMJ causing brain fog and tightness in my head or hunch my back into poor posture so that my teeth can occlude properly and have an open airway)
Graham Stoney · January 12, 2021 at 12:58 PM
Hi Michael,
Thanks for you comment. Your story sounds all too familiar to me I’m afraid. I had an online consultation with Dr Belfor and would have gone with Homeoblock if there had been a provider in Sydney. They really are very similar; they even share a patent on the basic design, although both teams have refined it somewhat since. If I was in New York and had access to him, I would probably have gone and got a Homeoblock instead of choosing Vivos because he co-invented the thing and I believe Dr Singh doesn’t see individual patients any more. Dr Martha Cortes is a leading Vivos provider in New York, and there are others you can find via the Vivos provider locator.
Yes, I had many doubts. Still do to some extent. I’m a skeptical kind of guy, and I want results not hype. I’ve read all Dr Singh’s research papers, watched all Ronald Ead’s videos, and participated in lots of discussions on The Great Work forum, which is teeming with MSE advocates who believe that DNA/Homeblock doesn’t work. However, I’ve also read a lot of scientific papers on bone remodelling and bone biomechanics that they never cite, and come to my own conclusion about how the appliance works. This independent scientific research which put the pieces together for me is cited in my articles Does the Vivos DNA Appliance Really Work via Epigenetics? and The Optimal Daytime Usage Pattern For Adult Oral Expansion Appliances.
I agree with your reservations about trauma with MSE, but I would have considered it more favourably if all I needed was maxillary expansion. It’s just a little too aggressive for me to want to try it first up if there is a chance that a DNA Appliance might do the job for both my jaws over a longer time period, without having to be screwed into my skull and requiring braces to close the diastema. SARPE is another option for you: I have a friend with somewhat narrower jaws than I who is currently doing SARPE with a bone anchored expander prior to MMA surgery, so I’m keen to watch his progress. He’s basically doing what I will have to do if DNA doesn’t cure my obstructive sleep apnea. I’d rather do SMARPE with MSE personally, but I’ll see how my friend goes.
That said, I’m 3 months into treatment, I’ve expanded the appliance 3.5 mm, I’m gradually feeling my energy return and there are no signs of my teeth tipping. It seems to be working as advertised. I suggest subscribing to my newsletter to follow my updates and please let me know what you end up choosing to do.
Cheers,
Graham
Michael · January 12, 2021 at 3:34 PM
Thanks so much for taking the time to respond! I think you make an excellent point about Dr. Belfore seeing patients himself. I will probably shop around a little in NY. I am totally with you in wanting to be patient and first choosing a non-invasive, non-aggressive method, as I’m lucky enough to be in a state of health where these symptoms are not totally debilitating and still being able to go on with my life in the meantime. I think you’re doing us a great service with this blog and I’d be happy to report back with what I choose to do and any updates!
Graham Stoney · January 12, 2021 at 6:41 PM
Thanks Michael. I really appreciate the positive feedback and hope you find an effective solution. Cheers, Graham
Erik · September 25, 2020 at 9:49 AM
How are your fatigue levels Graham, curious how you’re progressing since focusing on your apnea..
Graham · September 25, 2020 at 6:15 PM
It’s still not great, and very up-and-down. I have a pretty low tolerance for exercise for instance, often need a lie down in the afternoon, feel like I’m falling asleep in my afternoon online classes, have a constant headache that varies in intensity, anxiety that comes and goes, dark circles under my eyes and feel really run down all the time. I’m managing my studies by taking lots of breaks and not really doing much else, partly courtesy of COVID. I’ve not managed to have 8 solid hours sleep any night since starting CPAP therapy about 10 months ago though and I suspect this is the culprit.
LAURA · September 26, 2020 at 11:32 AM
have you considered getting a bipap? people with UARS do better on bipap. i don’t think you mentioned uars on your blog but just throwing it out there.
Graham · September 26, 2020 at 2:58 PM
The Resmed Autosense 10 Autoset I have is technically a BIPAP machine. I suspect I have UARS in addition to OSA and I’m hoping the Vivos appliance will resolve it.
Nick · September 21, 2020 at 8:48 AM
Does the MRNA actually move your lower jaw forward overtime or does it just act as a mandibular advancement device ? I have a mandibular advancement device right now and I am looking into the DNA . if you just get the regular DNA does it also push your lower jaw forward ?
Graham · September 21, 2020 at 4:51 PM
Hi Nick,
The mRNA has an expansion screw for expanding the mandible, and tabs that lock in to the upper DNA appliance to do mandibular advancement during sleep; so it does both. The position of the mandible is set by the way the teeth in each jaw intersect, so I expect my mandible will move forward over time as the maxilla expands sideways and forwards. I would imagine that regular DNA would still allow your lower jaw to move forward over time, but it won’t hold it forward to help open your airway at night. I don’t know what MAD you have, but I can’t imagine you could wear both at the same time, and expansion of the jaws and teeth will mean your existing MAD won’t fit any more anyway. If you already have an MAD, are you considering mRNA?
Cheers,
Graham
Lauren · September 8, 2020 at 4:37 AM
I was wondering if you were going to do anything specific to boost dna/mrna??
I hear that you should drink a lot of water, get your vitamin d, vitamin k ( expensive organic eggs), lower inflammation (ie stop eating wheat) in your mouth and body.
I’ve also seen posts in the facebook gropu for expansion about seeing all these people. do you have posture problems? chronic aches and whatnot?? Also some people say their cranial osteopath is a lifesaver during dna treatmen. I saw a cranial osteopath recently. It was strange because the doctor it just felt like the doctor was lightly/gentle massaging me haha. I might keep going if my insurance covers it all (I will find out soon).
this is one of the comments I came across on facebook
https://www.facebook.com/groups/craniofacialactiongroup/?post_id=2959162510826746
I see a rolfer, atlas orthogonal chiropractor, spinal network analysis chiropractor, laryngeal specialist, cranial sacral therapist, and do gyrotonics. I will be incorporating more myofunctional therapy and physical therapy into my routine whenever covid-19 allows for that!! I hope this is helpful!! To anyone considering the DNA you are welcome to DM or write a messa
thanks for all the mega-posts
Graham · September 9, 2020 at 2:20 PM
I’ve ordered some mastic gum and am planning to do a lot of chewing exercise during the day when I’m not wearing the appliance, as I’ve heard this can reduce the risk of teeth tipping. I’ll also continue to eat as healthily as I can, which includes avoiding wheat, and may get some myofunctional therapy. I’ll see what else the dentist recommends when I get the appliance any day now.
I’m not aware of any postural problems but I do have a persistent headache and a feeling of tension in my teeth and neck.
Thanks for the extra link too; I’ve moved it from your comment to my Vivos appliance resource bookmarks post.
Jeanette · August 21, 2020 at 12:08 PM
I saw Dr. Hang yesterday. It was interesting. I can share with you if you want to know. I’d rather share privately, regarding some of his comments. In general for the thread, his way of treating is standard for him. Sagittal appliance opening up spaces for the missing bicuspids, braces, palatal expander, then implants.
Graham · August 21, 2020 at 2:20 PM
That’s really interesting Jeanette. Thanks for the summary!
Aimann Rasheed · August 16, 2020 at 10:24 AM
Excited to see your developments! I hope to start homeoblock soon. One question I have is, did you come across any data related to long term results? You had posted a study in one of your previous articles showing that MADs caused a deterioration of AHI over long period of time. How is DNA different?
Graham · August 16, 2020 at 4:52 PM
Thanks Aimann, me too! Let me know how you get on with the Homeoblock. I haven’t seen any data on long term results with Vivos; that is, beyond a couple of years. If there was any, I think they would have it up on their articles and publications page; unless it was really bad I suppose!
The difference is that DNA (or more specifically mRNA) expands your maxilla and mandible in addition to merely advancing the mandible, which is what an MAD does. At the end of treatment you don’t wear the device any more, whereas you have to wear an MAD for life. I’ve heard Mike Mew say that with an MAD, over time the force of the mandible pulling backwards on the maxilla shrinks the jaws, making the airway worse with long-term use. That may be true of mRNA to some extent, but I assume it’s offset by the forward pressure of the upper device, and you only wear it for 2 years or so rather than the rest of your life so it has much less time to retrude the maxilla. I’m also planning to use a facemask with it, which should help avoid this problem.
Is there a version of Homeoblock that also does mandibular advancement, or would that be of no benefit to you?
Aimann Rasheed · August 16, 2020 at 11:18 PM
Yes Graham, the homeoblock has an upper and lower appliance that’s almost identical to the DNA appliance. That makes a lot of sense. I really appreciate all of your articles as I’ve done almost all the same research and come to the same conclusions as you!
One thing that I’ve discovered that I think is worth your while: More frequent chewing is said to prevent tipping.
Secondly, the addition of vibrations seems to increase bone volume and speed up the process. I don’t plan on rushing, so I want to use it to just “nudge” growth of my mid palate faster than the teeth have time to tip (if that makes sense).
Here are two articles on the effects of vibrations. None are specific to palatal growth specifically but I think we can draw from them anyway!
Effects of vibration forces on maxillary expansion and orthodontic tooth movement
Quantifying the effects of mechanical vibration on the volume of the midpalatal suture
Graham · August 17, 2020 at 1:14 PM
Thanks Aimann, that’s really helpful.
I wasn’t aware that chewing could help prevent teeth tipping during the expansion process. It is one of my fears, so that’s really helpful to know.
Those articles are really interesting too. The first one in particular notes: “Under high loads, bone demonstrates low viscoelasticity and behaves as a brittle object. However at low loads, bone demonstrates a lower modulus of elasticity and behaves as a more viscous material.”
I share the ClaimingPower author’s skepticism about the epigenetic claims that Dr Singh makes. It appears to me that the effect of the appliance can be explained entirely in terms of the material properties of living bone being somewhat fluid under low pressure, and growing in response to intermittent loads due to nightly use and day-time chewing. Perhaps any kind of growth could be described as “epigenetic”, but that would mean broken bones healing naturally is epigenetic too.
All of this also makes me think that, contrary to Ronald Ead’s video, you don’t have to split the suture because that’s not where the growth is occurring in a mature adult: the bone is fluid and it’s expanding everywhere provided the force is lightly applied, intermittently, over a long period of time.
Cheers,
Graham
Krishna · August 10, 2020 at 3:14 AM
Hi Graham
I have a narrow upper arch and cross bite. I recently decided to get my braces and the doctor decided to extract upper two teeth and use a palatal expander to expand upper arch by moving around teeth. Do you thing the dna appliance would work in this case to expand upper arch without extractions?If it works on patients who already had extractions do they need to do orthodontic treatment again because the teeth might change after expansion?.How long is the proposed treatment time for you?
Thank you
Graham · August 10, 2020 at 5:33 PM
Hi Krishna,
I’m not qualified to give orthodontic advice and even if I was, I’d probably need to look at your mouth or at least a scan or something in order to do so. What I can recommend though is getting a second opinion from an dentist or orthodontist who understands the importance of your airway and avoids extractions. Look for someone trained in Forwardontics or Orthotropics if you can find one.
It might be worth including a consultation with a DNA appliance provider since they would be in the best position to answer your question. There are also other appliances like AGGA and MSE which can help expand a narrow upper arch too. I personally regret having extractions tremendously and would do anything to go back in time and not have that happen. Some doctors are blissfully unaware of the damage it can cause and I’d be surprised if there really was no alternative to extractions for you.
I don’t know how many DNA appliance users who have already had extractions end up getting braces after finishing using the appliance. In theory the teeth are supposed to align more or less naturally during the process, but some users get braces and/or implants afterwards for cosmetic and functional reasons like ensuring that the space gained isn’t lost again.
I can’t honestly remember how long my dentist said the proposed treatment time is for me, but I’m assuming 18 months to 2 years. I’ll ask him when I pick up my device.
Cheers,
Graham
Dave · August 10, 2020 at 1:57 AM
Graham, Here are two articles for you:
https://www.newcastleherald.com.au/story/5934752/what-you-didnt-know-about-fatigue/?cs=6173
https://www.psychologytoday.com/us/blog/sleep-newzzz/201301/chronic-fatigue-syndrome-how-does-it-affect-sleep
Graham · August 10, 2020 at 5:40 PM
Thanks Dave. I wish I’d spotted this connection ten years ago…
Dave · August 9, 2020 at 3:14 AM
Hi Graham,
So what are your thoughts now on a diagnosis for your condition? Do you believe that you do not, in fact, have CFS and only OSA as the cause of your symptoms? I’m in the same situation of trying to determine what is the cause of my chronic fatigue. I have sleep apnea/UARS that hasn’t resolved with CPAP treatment. Lately, I’ve been questioning whether I have comorbid CFS, as was previously thought.
Good luck with your treatment.
– Dave
Graham · August 9, 2020 at 4:54 PM
Hey Dave.
Strictly speaking a diagnosis of obstructive sleep apnea should rule out chronic fatigue syndrome, as pointed out in this paper identifying undiagnosed obstructive sleep apnea as a common comorbidity with CFS. However, I’ve not seen the flu-like symptoms I experience, which are typical of many cases of CFS/ME, commonly listed as typical symptoms of OSA. Also, seven months of religious CPAP usage hasn’t completely eliminated either my flu-like symptoms or my daytime fatigue yet either. So I don’t really know!
I do seem to be gradually getting better but it’s taking a frustratingly long time. My first edition of that last sentence used an expletive in place of the word “frustratingly”.
I’m going to give Vivos a good 6 months to see what it does to my airway before visiting a local doctor who specialises in CFS to see what else I can do. I suspect one of the first questions they will ask me is “How’s your sleep?” and at the moment I’d be like: “Well, it’s like this…”
Likewise, good luck to you too.
Cheers, Graham
Jeanette Oki · August 5, 2020 at 5:30 AM
I would love to hear more on how Graham and the others are proceeding. I am considering the DNA vivos. I live in Los Angeles, so I also have an appointment to consult with Bill Hang, the orthotropic guru in this area. He does not use DNA, so I will get his view based on his 35 years of helping children and adults with airway issues, using palette expanders. One 73 yr. old sleep/TMD specialist dentist I met with, who carries both ALF and DNA Vivos, used the DNA on himself and he showed me his before and after airway imaging. Impressive.
Graham · August 5, 2020 at 10:02 AM
Hey Jeanette,
That’s awesome that you have access to Bill Hang! I can understand someone with his experience in this field not wanting to fork out the hefty training fees to Vivos required to become a Vivos Integrated Practice so that he could provide the DNA appliance. If I were Vivos, I’d be paying him to present at their Breathing Wellness conferences and waiving the training fees in order to get him on board, since he already has such a high profile. I’d love to hear what he suggests for you.
I’ll keep posting updates on this blog as I progress, so if you want to track my progress I suggest you subscribe to my newsletter.
Cheers,
Graham
LAUREN · August 1, 2020 at 10:11 AM
so how compliant do you plan on being ? 16 hours a day??
Graham · August 1, 2020 at 1:31 PM
I plan on doing the recommended 16 hours a day, as this is my highest priority. It should work fine with my schedule since I’m a university student, most of my lectures are likely to be online again this semester due to COVID, and I’m still too fatigued to go out at night much; so I’m at home by myself most of the time.
lauren · September 5, 2020 at 12:22 PM
how come you weren’t a good candidate for the surgery? was it your age?? or they thought it may not fix you ??
lauren · September 5, 2020 at 12:24 PM
also i would love it if you wrote a blog post about why you rejected the other options you researched since you’re knowledgable about the topic now. do you have your plan b c etc like doing mse if mrna doesn’t give you full resolution of your sleep apnea?? obviously doing mrna/dna doesn’t preclude you from doin the other treatments while some of the other treatments might preclude you from doing dna/mrna
Graham · September 6, 2020 at 12:57 PM
Hey Lauren. OK, leave it with me. You’re spot on though: I’ve started with the least invasive and can work my way up if it fails. It’s riskier to start with the most invasive and work down, so to speak.
Graham · September 6, 2020 at 12:53 PM
At the time, I had been wearing my Mandibular Advancement Device for 6 months, and my lower jaw had moved a fair way forward to the extent that I could no longer chew on my molars. The ENT I saw said he would have to move my upper jaw so far forward that I would end up looking like a chimpanzee, and it still wouldn’t liberate me from my CPAP machine. His only other suggestion was laser tongue ablation but his general conclusion was that I should just persist with CPAP. He didn’t seem to know anything about dental/orthodontic approaches or maxillary expansion options. I felt a mix of disappointment and relief since on one hand I thought MMA would finally fix my health, but on the other it’s pretty gruesome. I know other surgeons in Sydney who also do MMA but haven’t sought a second opinion yet because I was aware Vivos, Homeoblock, MSE and other options existed and would soon become available here so I wanted to pursue those first.
Shankar · August 1, 2020 at 2:33 AM
Who is the dentist that you are working with for your DNA appliance?? I’m in Sydney as well, and would like to know about this. Just like you, I suffer from sleep apnea due to a narrow maxilla, and a retruded mandible.
Graham · August 1, 2020 at 1:28 PM
Dr Jalal Khan from The Dental Station in North Sydney.
Elizabeth · August 1, 2020 at 12:05 AM
You never give up. and now all your efforts will hopefully change your health for the better!
It amazes me how dental treatment in the past has caused problems for lots of people.
Graham · August 1, 2020 at 1:31 PM
Thanks Elizabeth! I certainly hope so. Cheers, Graham
Daniel · July 31, 2020 at 3:49 PM
Interesting stuff. I’m considering this kind of treatment too. What is the cost?
Also how do you find a dentist to work with in Europe? I checked the Vivos website and got the impression they’re only in the US.
Graham · July 31, 2020 at 5:32 PM
I paid A$9000 (gulp) for mine. You could try contacting the company and asking them. Dr Singh has been touring the world recruiting providers. Cheers, Graham