Note: This post may contain statements that I no longer consider true.
See: The Vivos mRNA Appliance Didn't Improve My Obstructive Sleep Apnea.
You know the drill by now; it’s been seven months since I started wearing my Vivos mRNA Appliance in the hope of curing my severe obstructive sleep apnea, so it’s time for another regular monthly update.
Over seven months, I’ve expanded and advanced my upper appliance 7.5 mm and 6.5 mm respectively. I’ve also expanded my lower appliance 6.3mm. I stopped advancing my lower appliance at 6.5 mm last month because one of the advancers didn’t seem to want to go any further, and I felt my jaw muscles starting to get tense if I went any further.
I feel a little more refreshed and have been taking more time out to rest during the day now that summer is over and I’ve dropped one of my university subjects which was a huge amount of work that I wasn’t enjoying. I also feel a little less sleepy during the day and don’t struggle to stay awake during late-afternoon choir rehearsals.
As usual, my compliance is excellent at an average of 16.18 hours/day total wear time:
I haven’t been sleeping with the facemask this month since it was making it hard to get a semi-decent night’s sleep, and I felt my health suffering as a result. Also the rigmarole I was going through to apply it was a pain in the ass: the elastics make my mouth leak air and saliva, so I sealed it with Polident denture adhesive… which I then had to clean off the appliance every morning. I still hope to go back to sleeping with it when I’m feeling more refreshed, but for now I just wear it as much of the day as possible… which is only a few hours given that I can’t really do anything that doesn’t involve lying down with it on.
This month’s pressure trend is mostly flat, with a slight decrease in median pressure. It’s not huge, but it is at least going in the right direction:
I’ve still got a fair way to go though as the overall CPAP pressure trend is still rising, but this could be partly a statistical artefact given it was increasing over the first five months. Here’s the trend over all seven months so far:
A few people have asked how my AHI has varied over this time. At first I thought it probably wasn’t significant since my Auto CPAP machine is attempting to minimise it, so it’s more a function of the machine’s algorithm than anything. However, it does show a couple of interesting trends. Here’s this month’s AHI trends:
The biggest contribution to my AHI by far is Central events, so I put them on the secondary axis. It all looks pretty good; everything is dropping so I may have turned the corner. The seven month chart is also interesting:
My Central events have dropped significantly, which I suspect is due to acclimatising to the CPAP machine and less emotional stress generally. This is the primary reason for the overall drop in my AHI. Hypopneas are also reducing, while obstructive events are increasing in line consistently with the overall increase in CPAP pressure. Hopefully this will start dropping too if each consecutive month continues to show a downward trend.
So it’s all good news this month, but progress continues to be glacially slow. This is what I expected, but I have to admit that I find the process gruelling and emotionally challenging at times. If it really cures my obstructive sleep apnea and liberates me from my CPAP machine, I’m sure I’ll look back and say it was all worth it, but at the moment the uncertainty gives me a lot of anxiety and the day-to-day routine of wearing the appliance consistently takes a lot of motivation to maintain when the results aren’t spectacular as yet.
Mentally and emotionally this ain’t easy, but I remind myself that none of the alternatives are either. If you’re on the Vivos journey too, I highly recommend reaching out to someone for emotional support. Drop me a line if you want to talk because I’m always happy to connect with fellow travellers.
25 Comments
Aaron Bennett · August 27, 2021 at 7:56 AM
Hi. have you noticed that even with it off, your back molars don’t connect? like it’s throwing off my entire bite, since it’s training my lower jaw to be more forward while sleeping. i find it really bizarre and don’t know if that is normal?
I’m on month 4 of the Vivos, by the way.
Also, at night i find i’m just CLAMPING down on it, like grinding. Any thoughts?
Graham Stoney · August 27, 2021 at 8:05 AM
Yes, I notice that too. It will be interesting to see how it changes over the course of treatment. How are you finding it? I’m wondering if you’re using an mRNA and/or are on CPAP as well, since grinding can be an attempt to keep your airway open. If you have an mRNA, perhaps you could advance your lower appliance more. I believe grinding can also be due to unexpressed anger or possibly habitual.
Penloep · May 28, 2021 at 12:34 AM
I was just curious if you considered the grummons protractionnmask https://www.greatlakesdentaltech.com/grummons-protraction-face-mask_155-125.html
Graham Stoney · May 28, 2021 at 7:09 AM
I wasn’t aware of it until after I bought my Bow, but there is a description of it in this video. I like that it doesn’t apply any backwards force on the mandible, but I see a couple fo disadvantages:
Cheers, Graham
Sam · May 18, 2021 at 4:43 PM
Hi Graham,
I’ve been wearing an upper DNA appliance for six weeks and have seen a midline diastema. I’ve been advised to turn the screws only once a week.Did you also get a midline diastema? If so, when did you start to notice such a diastema? Thanks. Sam.
Graham Stoney · May 18, 2021 at 8:11 PM
Hi Sam. I don’t have a midline diastema between my central incisors, but I do have one between some of my other teeth as shown in the pictures in my four month update. A midline diastema suggests that your maxillary suture is expanding, which is good news. Dr Ben Miraglia has said that gaps appear and can move around as the teeth settle when doing adult palate expansion. Cheers, Graham
Nikki · July 4, 2021 at 8:26 AM
I’m on month 9 of wearing my Vivos. I noticed the diastema within the first 12 weeks (it might have even been in the first 6 weeks but I can’t remember). My dentist simply adjusted the springs to get the teeth to go back together.
Evelyn · May 16, 2021 at 11:21 AM
Hi Graham,
I am also using the DNA appliance and think I have started to notice some changes in the alveolar bone around my top incisors. I have been reading about root damage and thinning of alveolar bone after expansion and wanted to ask you whether you have had a second CBCT, and if it displayed either? Apologies if you have already covered this in another post. Cheers, Evelyn
Graham Stoney · May 16, 2021 at 11:30 AM
Hi Evelyn, No I haven’t had a second CBCT since I’m averse to unnecessary X-rays. I’m curious what changes you’ve noticed in your alveolar bone? Cheers, Graham
Evelyn · May 16, 2021 at 1:31 PM
The alveolar bone above my teeth seems to protrude a little more than It used to. It’s hard to tell what’s abonormal. Dr. Khan does not believe my teeth are tipping and I don’t believe they are, but they are moving. I’m finding it a bit tricky finding reports or studies online measuring alveolar bone changes with Vivos. I will have to ask him next I see him.
Graham Stoney · May 16, 2021 at 2:21 PM
OK, got it. Let me know what he says!
Abhishek Gupta · May 14, 2021 at 3:53 AM
Hey Graham
Read your latest monthly update and I must say that I’m inspired by your tenacity and determination. I’m rooting for you and I hope that you get rid of this once and for all.
I had a question regarding the Vivos appliance. Has your mandibular bone actually grown and has your mandible moved forward since you started wearing the appliance? I’m a bit confused when you say expansion in your post.
To give you some context, I’m a class 2 malocclusion patient who has been advised a BSSO (mandibular advancement surgery) but I’m too scared to get it because of all the risks associated with it. I too believed that the DNA appliance was too good to be true but if wearing it for a period of time can actually advance my mandible, then it’d be a huge relief considering how less invasive and risky this option is.
Also, I had my wisdom teeth extracted (all 4 at the same time) as prerequisite for lower jaw surgery and the extraction experience was enough to deter me once and for all. Besides, given the correlation between extractions and sleep apnea, I’m already freaking out that my wisdom tooth extractions could lead to sleep apnea. (I’ve had multiple permanent tooth extractions during my camouflage orthodontic treatment already). Do you believe that there is a risk of developing it?
It’s a long message but I’d really appreciate your feedback. Thank you.
Graham Stoney · May 14, 2021 at 7:25 AM
Hi Abhishek,
Thank you, I appreciate your support.
That’s a great question about the mandible, and it’s something I was just thinking/worrying about last night. My lower appliance has a sideways expander at the front, but it doesn’t have a forwards expander like the upper appliance does, probably because there’s no way to fit one in the mouth with tongue in the way. What it does have is advancers on either side which advance the mandible. This is supposed to do two things: hold the mandible forwards during sleep to open the airway like a mandibular advancement device does, and reposition it forwards so the condyles in the temporomandibular joint remodel in the new position. I’m hoping this moves my mandible forwards enough to unblock my airway once my maxilla has expanded forwards enough to unwrap my mandible; otherwise I’m going to need BSSO too, and possibly the full MMA.
The ENT surgeon who assessed me for MMA surgery said I would need my wisdom teeth extracted for it. I don’t know if this is routine or not but I haven’t heard anyone who has had MMA/BSSO mention it. I’ll be seeking a second opinion if I end up needing MMA or BSSO because I don’t want any more extractions. I was contacted online by a guy who was convinced that routine wisdom tooth extraction caused his obstructive sleep apnea, but that could be a coincidence. I suspect the wisdom teeth play a role in holding the cheeks out and maintaining the airway, but I haven’t seen any research on this. I’m very keen to keep mine whatever I do. I know this probably isn’t what you want to hear and I’m sorry to hear you’ve lost yours; I can’t say for sure what the impact might be.
Cheers,
Graham
Abhishek · May 15, 2021 at 11:18 PM
Hey Graham,
Thank you so much for your reply. I have been absorbing and trying to understand everything.
I have a few questions regarding the same.
In your seven months of treatment so far, has your mandible advanced at all? If so, by how much?
Also, how much has your maxilla advanced? To give you some context, I need about 3mm advancement of my mandible. That would be enough.
Last but not the least, I had my wisdom teeth extracted in early March. Do you believe that this will affect my DNA Vivos treatment in any way? My wisdom teeth hadn’t erupted and were deep in my gums. So the bone will heal and possibly form in the next 2-4 months. Do you think that this could possible aid or hinder my DNA Vivos treatment if I go for it?
Again, appreciate your patience and feedback. Thanks a lot in advance.
Graham Stoney · May 16, 2021 at 11:26 AM
It’s a bit hard to give a definitive answer about mandible advancement since there’s so much play in the TMJ. The condyles in the TMJ can remodel resulting in permanent advancement, but it’s not clear to me how much gain I can expect from this. I’ve advanced the lower portion of my appliance 6.5 mm, and that seems to be as far as it will go before the muscles in my TMJ get tense.
I’ve advanced my upper appliance 7 mm forwards, and again I can’t say for sure how much maxillary growth that translates into. Getting 3 mm of forward movement of your mandible sounds quite feasible to me. I don’t really pay too much attention to the numbers because what I really care about is my airway staying open during sleep, and the connection between it all is so multifactorial it’s hard to predict what expansion is needed where for that to happen.
I’m sad to hear about your wisdom teeth being extracted. Extractions cause bone loss which leads to jaws shrinking, which is the opposite of what I want. I have heard of someone having their wisdom teeth erupt once their DNA appliance expanded their jaw sufficiently to make space for them. Losing your wisdom teeth may be a setback, but I doubt it makes much difference as to whether DNA Vivos will help your or not compared to other treatments. A DNA appliance provider should be able to give you a better answer.
Cheers,
Graham
Abhishek · May 16, 2021 at 6:43 PM
Thanks a lot for your reply and all your wisdom Graham. I really appreciate it.
All the best on your journey. Like I said, I’m rooting for you and I hope that you finally get rid of your OSA once and for all.
Cheers,
Abhishek
Graham Stoney · May 16, 2021 at 7:17 PM
Thanks Abishek, I’m rooting for you too. Let me know what you decide to do and how it goes. We’re all in this together. Cheers, Graham
Lauren · May 5, 2021 at 9:54 AM
question: you wrote about dr. liao’s book in a blog entry where you talked about the forward pull headgear. i got the book too and i can’t the difference that i’m suppsoed to notice for the x-ray picftures of the 50-soething old men that was mad compliant with his forward headgear. Dr. Liao wrote look at the yellow circle being covered in the after photo but i don’t get what that means. or am i supposed to just look for the airway difference? did you get what he meant for those pics? i thought it was reassuring and kinda shocking and kinda dubious that he mentions surgery then says headgear is effective 90% of the time with compliance
Graham Stoney · May 5, 2021 at 10:17 AM
I assume you mean the two x-rays on Page 136 of Six Foot Tiger, Three Foot Cage. I don’t see what the yellow dot is meant to show either, but the guy’s maxilla looks further forward. It doesn’t help that the second picture is really blurry; if I was Dr Liao, I’d want this evidence as clear as possible. I don’t recall him mentioning surgery. This is a good reminder to get back to wearing my facemask at night. Cheers, Graham
Enoch · May 5, 2021 at 2:10 AM
Have you noticed any more gaps between your teeth on the top or bottom or flaring of the teeth?
Graham Stoney · May 5, 2021 at 6:57 AM
I don’t notice any difference in the gaps compared to what I had in my four month update, but I can now get a green pikster between all my teeth where previously only a blue fitted. There is no flaring of any of my teeth. Cheers, Graham
Elizabeth · May 3, 2021 at 12:37 PM
Is it possible to see photos? The visual would really help. Thanks. Elizabeth
Graham Stoney · May 3, 2021 at 12:56 PM
Thanks for asking, but I want to wait until I have a result before posting incriminating photos. Cheers, Graham
John · May 3, 2021 at 10:26 AM
I’m wondering if the true benefit will show up when you are finished with the expansion and stop wearing the appliance. Is it possible that your tongue position while sleeping is almost identical to when you started (other than a small amount of forward growth) because the appliance still blocks your tongue from the roof of your mouth. But at the end when you stop wearing it (at least some nights) then your tongue will hopefully be able to rest all the way up in your upper palate.
Graham Stoney · May 3, 2021 at 10:35 AM
Yes, that’s probably true as the appliance does take up some tongue space. After I’ve finished expanding, I expect to require clear aligners to close the gaps between my teeth and will probably need to wear the last tray for life as a retainer; the advantage being that clear aligners don’t take up any tongue space.