Note: This post may contain statements that I no longer consider true.
See: The Vivos mRNA Appliance Didn't Improve My Obstructive Sleep Apnea.
Time for another monthly update. As usual, my compliance is excellent thanks to my appliance usage tracking spreadsheet. My provider says I’m “super-compliant”, and here’s the graph to prove it:
Four Month Vivos mRNA Appliance Usage
I screwed up something royal last month though and forgot to unlock the CF card when replacing it in my CPAP machine, meaning that I lost about two weeks worth of data. So there’s no pressure trend analysis this month.
The good news however is that I have a new toy to play with, in the form of a Contec CMS50H pulse oximeter so that I can tell whether I’m getting oxygen desaturations during sleep. Here’s an example of a typical night with SPO2 and heart rate data:
Typical Night With Oximetry. No significant desaturations, but I did get up to swat a mosquito about 11pm.
So far so good, but the real test will come when I stop using the CPAP machine. At the moment I still wake up buzzing if I fall asleep on my back in the afternoons with my Vivos mRNA Appliance & Facemask in place, but not my CPAP machine.
The other interesting development is that small gaps have appeared between some of my front teeth, which you can see here:
A gap between teeth that didn’t used to be there
Gaps between teeth that didn’t used to be there
There have been a few cases in the adult non-surgical palate expansion Facebook group recently of unhappy people who have abandoned their DNA Appliance treatment after a few months due to either pain or a lack of results. I feel anxious when I hear of people with similar appliances to mine saying that their treatment has failed, and even talking about suing their provider; so I was curious to find out what, if anything, they were doing differently to me. In each case it appears that one of more elements of my treatment regimen was missing:
- Consistently wearing the appliance an average of 16 hours/day
- Cycling the appliance in and out hourly during the day
- Chewing mastic gum whenever the appliance isn’t in place
- Adopting a chewy diet, such as The Dental Diet.
- Doing myofunctional therapy exercises twice daily
- Using a forward-pulling facemask
- Waiting at least 6 months before expecting any noticeable changes
I’m hoping this accounts for the difference, and means I’ll get a better outcome. It’s too early to say the nRNA Appliance has changed my life yet, but so far everything seems to be on track and it is working as expected.
35 Comments
HANNAH · February 17, 2021 at 6:41 AM
Hey there, I see about your gaps. I am currently in the appliance now. Did you get any more gaps in other places? Is the gaps very noticeable to you?
Graham Stoney · February 17, 2021 at 6:59 AM
Hi Hannah,
That’s it so far. They’re noticeable to me, but they’re signs of progress so that’s a good thing. I was talking to my provider on Monday about it and he said gaps towards the front are good, whereas gaps between the molars aren’t so good. I’ll probably need Invisalign at the end of my treatment if I want to close the gaps and reopen my extraction spaces. I could really use some gaps between my lower front teeth which are crowded (despite the #&@$^@#* painful orthodontic treatment I had as a kid), but that hasn’t happened yet.
Cheers,
Graham
David · February 19, 2021 at 8:15 AM
Hi Graham, I would think that gaps toward the back are good, indicating expansion. Did your provider clarify why he thought this was a bad thing? I only have gaps around my pre-molars with Homeoblock at 3.5mm – so, a bit jealous of your gaps in the front!
Graham Stoney · February 19, 2021 at 8:43 AM
Well yes, gaps indicating expansion anywhere are a good thing; I think the idea was that moving front teeth later to open my extraction spaces is going to be easier than moving molars. I’m a bit jealous of your gaps around your pre-molars!
Greg · February 12, 2021 at 10:18 PM
Hi Graham, I had wanted to comment sooner, but had sprained my back (better now). That’s a bummer about the data not getting recorded.
That was a great list you indicated of best practices for Vivos treatment but I hope it’s not that temperamental. You will be the perfect test case with pulling out all the stops to make it work. Hope the Oximeter is being useful.
I had my intro session and my dentist feels I would be a candidate so far (havent done the full tests yet). She feels it probably happened because I was wearing braces as a child.
I wanted to specifically ask you about what you think about NightLase? Did you try/consider/reject it? Do you think it’s effective?
Graham Stoney · February 13, 2021 at 8:58 AM
Hi Greg,
Yes I certainly plan to get the absolute maximum result from my appliance. Damn those braces as a child! It makes me so angry. I hope you find an effective solution, whatever it is.
I hadn’t heard of NightLase before but it looks like laser ablation of the soft palate. I have no idea whether it’s effective but their research seems to suggest it’s helpful as an adjunct treatment for some people and it certainly looks less invasive than
Uvulopalatopharyngoplasty, which has a poor success rate. The ENTs I saw suggested the soft tissue in my mouth isn’t my problem. The trick is knowing which treatment is best for each person, based on where the obstruction is.
Cheers,
Graham
Greg · February 13, 2021 at 9:42 AM
Hey, yeah my dentist said she suspects that I have an elongated soft palate (I didnt do further tests yet besides in person exam.) I guess maybe I will do the next tests then to get better clarity on whether NightLase could also help. My dentist already told me it would help me so I guess she got enough info from the in person exams (without the scans) to make a determination. Also forgot to tell you… I just found out that Vivos has submitted a next version of their MRNA device which is called MMRNA for FDA approval. I have asked my provider to ask Vivos what the difference is (how it’s improved). Will let you know. I would suspect people might be able to to transfer over to the new device when it’s approved assuming it’s the same kind of device (just improved.)
Graham Stoney · February 13, 2021 at 10:32 AM
OK, cool. I noticed the press release about the mmRNA submission but couldn’t find any details about what’s different about it. It’s a 510(k) submission so the appliance can’t be radically different and the existing mRNA is heavily customised to the patient anyway, so I wondered why they were bothering; but perhaps they just wanted to look like they had a new product to announce. I’d be interested in any information you find on it and what your provider says. Cheers, Graham
Greg · February 16, 2021 at 2:37 AM
Hey Graham, also wanted to ask you… Do you happen to know…Is a physical exam possibly sufficient for a sleep dentist or ENT to simply determine whether or not the soft palate is a culprit problem area for apnea? Or must a scan be performed?
Graham Stoney · February 16, 2021 at 6:44 AM
It probably depends how experienced the person you’re talking to is in diagnosing and treating obstructive sleep apnea, but my guess is that a Drug Induced Sleep Endoscopy by an ENT would be the most accurate, followed by a regular endoscopy by an ENT, an oral examination by an ENT, a CBCT scan by a sleep dentist, and an oral examination by a sleep dentist. If it’s really bad, they should be able to tell just by looking in your mouth.
Greg · February 25, 2021 at 1:02 AM
Ok some news: the new mmrna according to my provider only adjusts a hinge but she says it doesn’t affect treatment or comfort. So maybe just a technical thing, and they need to update with FDA any change.
I go for my CBCT today. I was told by one provider (maybe from Australia coincidentally) that elongated palate might require 6 to 12 treatments of Nightlase.
Since CPAP data was unavailable for the month 4 report… eagerly awaiting the month 5 report! 🙂
Inf0C0llect0r · February 12, 2021 at 2:38 PM
How has your nasal breathing improved? Thanks Graham!
Graham Stoney · February 12, 2021 at 6:18 PM
I noticed when I went for a 1km run along the beach yesterday (in 250 m increments) I could do it without mouth breathing, whereas I used to mouth breath all the time when running back before I got ill.
Peter · February 6, 2021 at 4:34 PM
Can you explain what you mean by fail? Flaring? Pain? Gum recession? No change in airway size despite maxing out on the appliance?? Curious!
Graham Stoney · February 6, 2021 at 6:47 PM
One guy gave up on his DNA Appliance because it was causing him pain and his provider wasn’t able to resolve it; but it sounded like the provider hadn’t given him good advice about how to use his appliance, particularly the things I listed above. A fail for me would mean my obstructive sleep apnea wasn’t cured and I still had to use my CPAP machine and proceed to the next stage of my treatment plan.
Roger · February 7, 2021 at 8:35 AM
I’d be very surprised if you will be able to completely stop using your CPAP after using DNA appliance, especially anytime soon. It’s unlikely that your jaw will move forward enough to resolve obstructions that are keeping your AHI so high. But I’m also surprised that the majority of your apneas appear to be centrals, which has nothing to do with anatomical deficiencies that you’re aiming to correct. I can’t really tell from the small scale image of your OSCAR data, but it looks like your pressure is quite low as well (8 cmH2O). It seems your CPAP therapy isn’t properly optimize which is probably not helping you accurately gauge your progress.
Graham Stoney · February 7, 2021 at 10:31 AM
Hi Roger,
I didn’t have central apneas on my sleep studies, so I believe they are being induced by the CPAP machine; which is another reason I ultimately want to dispense with it. The fact that my pressure is low is a good thing because the lower the pressure, the less hard the machine is working to keep my airway open. It’s set on automatic and I’ve consulted with two sleep specialists and the provider, and they all tell me the current settings are optimal for me. I’d rather focus on treating the underlying cause than waste time tweaking settings on a machine I eventually plan to get rid of. I hear your skepticism about whether a DNA appliance will do that for me, but I’ll see what happens over the next 20 or so months.
Cheers,
Graham
peterr · February 7, 2021 at 11:05 AM
you should experiment with the cpap settings (higher settings esp if you can tolerate it) so your condition can be treated as much as possible… ESPECIALLY if you have UARS and sleep apnea.
Graham Stoney · February 7, 2021 at 11:09 AM
Thanks for the suggestion, but I’ve already checked the settings and I’d rather focus my effort on treating the underlying problem so I can dispense with the machine entirely. Cheers, Graham
Sam Stone · February 4, 2021 at 7:30 PM
Just left 2 long comments under anonymous names here warning strongly against the DNA. Worried your spam tracker may have deleted them.
I’ll check back later to see if they came through. Long story short, tooth-borne appliances will not work in adults – you are tipping alveolar bone only and will not grow any mandible or maxilla bone.
Anonyboy · February 4, 2021 at 7:23 PM
…me again.
To add a professional opinion: Here’s Dr. Bockow, a seattle Periodontist & Orthodontist, discussing Agga: https://www.youtube.com/watch?v=V-SDWP5NH0w
Unfortunately AGGA/FAGGA/DNA/RNA/ALF are all tooth-borne and will fail for this same reason.
Graham Stoney · February 4, 2021 at 7:37 PM
I’m familiar with Dr Bockow’s views and while she has a lot of experience with MSE, her views on tooth-borne appliances aren’t consistent with the science on bone remodelling.
I don’t consider AGGA and DNA/mRNA in the same league; I rated them quite differently in my analysis.
Anonyboy · February 4, 2021 at 7:12 PM
Graham – I would highly caution you AGAINST the DNA. Like, you may want to stop wearing it today. I’ve been doing more research since my comment last month and feel morally obligated to reach out and tell you this. The DNA will not affect your maxilla or mandible in any way. All it is doing it tipping the alveolar bones and quite possibly damaging your teeth.
There’s a reddit user named ‘ciras’ who is extremely well-informed on this stuff (and an engineer like yourself, I believe). His arguments against DNA were highly convincing to me and I encourage you to read them. Just ctrl+f “DNA” on this page and you’ll find them. https://www.reddit.com/user/ciras?count=50&after=t1_gkuu4vd
There are more on his profile beyond that page. I know “some guy on reddit” is not usually considered a source but…he’s pretty f*cking thorough and completely changed my view.
Basically, your IMW may increase but you will experience no change in mandible or maxilla. Ciras really hammers home the lack of evidence in 10 years from DNA compared to the wealth of evidence of nasal and maxilla changes from MSE. I do not believe any amount of chewing or myofunctional therapy will mitigate this.
For true Maxillary expansion in an adult male, our options are MSE/EASE/Some variant thereof and MMA surgery. Tooth-borne appliances just won’t do I’m afraid 🙁 I wish it wasn’t the case, but I wanted to get this information to you.
Do what you will with this info – I don’t know you and have no skin in this fight, I’m just a random guy who found your blog while looking for sleep apnea solutions. I was seriously considering DNA myself until reading the posts on reddit.
If CPAP isn’t working as well as you’d like/you’re still unrefreshed, BIPAP or ASV may be better options for you. Here’s a presentation by Barry Krakow – who himself has apnea and made the switch to BiLevel – on his success with these therapies where cpap wasn’t enough: https://youtu.be/Syv7YcHbTCI?t=1323
Wish you the best. Sorry this is probably not a comment you wanted to read.
Graham Stoney · February 4, 2021 at 7:31 PM
I’ve heard these arguments before; I even participated in them myself before committing to using a DNA Appliance because I wanted to know if it was defensible. I decided there was sufficient evidence to support it, and did my own reading and research to see if the claims for it stacked up. I concluded it was worth trying before more aggressive treatments like MSE/EASE/MMA/etc and I haven’t seen anything sufficiently compelling yet to convince me to change course. Cheers, Graham
Anonyboy · February 4, 2021 at 7:49 PM
Haha! Fair enough you wild man – I would not be comfortable with the risk. Feel free to delete the Sam Stone comment if you don’t want this section cluttered. Hopefully the BiPAP/ASV info was something new or useful at least.
David · February 5, 2021 at 8:15 AM
Ciras is wrong. I know he’s wrong because there are many, many stories of people successfully doing non-surgical expansion in adults. I am one of those people, as is Graham. So what you have is a conflict between a bunch of studies he has bookmarked on his computer – which never actually prove that non-surgical expansion is impossible, given the right appliance and nutritional / environmental precursors – and real life success stories. Which tells you that mainstream science simply hasn’t caught up yet. And that’s fine, history shows us that conventional science is routinely overturned time and time again. I believe this is one of those cases.
sarah · February 15, 2021 at 5:35 AM
david, what’s your success story
David · February 15, 2021 at 1:03 PM
I’ve done 3.5mm expansion for my UARS and experienced a lot of relief, everything from fatigue to anxiety to digestive symptoms.
Graham Stoney · February 15, 2021 at 3:51 PM
That’s awesome David, I’m very happy for you. Cheers, Graham
???? · February 3, 2021 at 10:06 PM
Isn’t the real test a sleep study?? I don’t think you should just go by symptoms as to whether or not you’re cured of sleep apnea. Sleep apnea cuts off oxygen to the brain which causes damage etc etc… no idea why you’re eager to test that way
Graham Stoney · February 3, 2021 at 10:14 PM
Yes a sleep study is the real test, and I plan to do one when I think I’m not getting benefit from the CPAP machine any more; but I can’t do a sleep study every night whereas I can wear a pulse oximeter and look at CPAP data every night to get a sense of when to do the sleep study.
David · February 2, 2021 at 12:13 PM
Hi Graham, good to hear things are going well. Did you ever measure your intermolar width prior to beginning treatment? Do you know how much you’re targeting? And are there any signs of slowing down? Sorry for all the questions but I’m curious, thanks!
Graham Stoney · February 2, 2021 at 12:41 PM
Thanks David. My intermolar width on the CBCT scan prior to treatment was 39.8 mm. I don’t have a specific target in mind; it’s more about expanding and advancing the maxilla and mandible as much as possible to leave enough space behind my tongue. No sign of slowing down so far; if anything, it’s speeding up: I expanded the lower appliance twice this week because by mid-week it was so loose. Cheers, Graham
Peter · February 2, 2021 at 6:34 AM
Glad to have an update from you Graham, however I understand the worry about the Facebook group.
Regarding waking up with buzzing what do you mean by this exactly and would that be caused by breathing problems on your back?
Graham Stoney · February 2, 2021 at 8:07 AM
Thanks Peter. I wake up with an unpleasant buzzing sensation through my body, which I assume is caused by my sympathetic nervous system due to lack of oxygen due to my airway being obstructed sleeping on my back. Cheers, Graham