Note: This post may contain statements that I no longer consider true.
See: The Vivos mRNA Appliance Didn't Improve My Obstructive Sleep Apnea.
Well the months are flying by at a glacial speed, so here’s another update. This month’s CPAP pressure trend continues to show a very slight downwards slope. I’m heading in the right direction and things seem to be on track.
I still feel a bit lousy with a constant mild headache and don’t think I’m getting a great night’s sleep though, so I remain eager to get to the point where I don’t need CPAP any more. When I have a really bad night’s sleep due to insomnia or just not going to bed early enough, I really notice it the next day. Nevertheless, my daytime energy levels continue to improve overall and I’m hopeful I’ll one day feel normal again.
My compliance is up slightly this month and my overall average wear time is 16.46 hours/day. I always aim for 16 hours, but I also try to cycle the appliance every hour so it’s not easy to hit the target precisely. Also, I’m still not sleeping with the facemask so I want to maximise the number of daytime hours when I’m wearing it. This generally means I leave the appliance in and wear the facemask while I’m watching TV at night, so I’m prioritising facemask hours over cycling. I still don’t go out in the evenings since I’m pretty much committed to this treatment for now; and Australia just went into COVID lockdown again anyway so it’s the perfect time to be chilling out in front of episodes of Dr Who with an mRNA in my mouth and facemask on my head and chest.
Here’s this month’s usage graph:
I’ve expanded my upper appliance a total of 9.8 mm sideways and 8.8 mm forwards, and expanded my lower appliance 8.5 mm sideways and advanced it 6.5 mm forwards. I continue to expand at one full turn per week and haven’t had to stop due to impingements for a while now. After a question on the Vivos Support Group about whether a half turn twice a week is better than a full turn once a week, I’m going to try doing a half turn twice a week for at least the next month.
I noticed something weird with the advancers on the lower appliance, and when my provider measured them he notice that one side was about a millimetre more advanced than the other. I can’t account for this since I’ve been meticulous in tracking all my adjustments, and since I’d been feeling some tension in my jaws and neck I would the left advancer back 6 turns so both advancers now look even.
There was one day this month where the CPAP data in OSCAR was essentially missing, with only half an hour’s data and no events. It’s possible I got out of bed due to insomnia and didn’t put the mask back on when I went back to bed, or somehow the machine didn’t switch on when I put the mask on. I certainly hadn’t been messing with the machine or the CF card. I can’t really explain this.
This month the overall pressure trend continues in a very slight downward direction:
I’ve still got a way to go to reverse the long term trend though:
My AHI went up this month due to an increase in central events. I suspect this is due to emotional stress as my mother was diagnosed with cancer on 16th June, the same disease that killed my father 18 months ago. After this I experienced insomnia and my central events went up.
Long term though, my AHI has still improved significantly:
I’m finished with university for first semester so I have the next month to relax and focus on using my appliance, playing music, and looking after my mother.
35 Comments
Christine · August 26, 2023 at 9:14 PM
Hi Graham,
It’s been a while since I’ve commented on here. I’m so sorry to hear the appliance didn’t work.
After 6 years, I’m still looking for an orthodontist to help me with my orthodontic relapse.
I found someone that does the MSE, and he was going to treat me, but had done a 360 on me and had now decided he doesn’t want to, so I’m wondering if you know anyone who does complex orthodontic cases in Victoria?
I also have narrow airways and sleep apnea.
Any information will be greatly appreciated,
Christine.
Graham Stoney · August 28, 2023 at 10:14 AM
Hi Christine. Thanks for the comment. I don’t know anyone in Victoria but my suggestion would be to see an oral maxillofacial surgeon familiar with sleep apnea to evaluate your jaws and their relationship to your airway. They should be able to tell you if lateral expansion like MSE is going to help you, and refer you to an orthodontist who understands ariway. Cheers, Graham
Aimann Rasheed · July 30, 2021 at 1:59 PM
Congrats on the progress Graham. I started about 8-9 months ago with homeoblock. I only have 4mm of expansion (upper only for now) and I’ve been really cautious to go too quickly. Trying to listen to my body and not force it to happen too quickly. My breathing has improved, although I dont have full blown sleep apnea and havent measured anything in that regard. Thanks for continuing to update us!
Curious to know if you plan to scan/xray to ensure no periodontal issues at the rate of expansion you’re going at. No dehiscence or tooth resorption risks, etc?
Graham Stoney · August 3, 2021 at 6:20 AM
Thanks Aimann. I hope your Homeoblock treatment goes well. I agree that listening to our body is really important. I want to avoid X-ray exposure as far as possible so I avoid non-essential scans. I’m trusting my provider to keep an eye on periodontal issues and I also see an independent dental hygienist every six months who should spot any problems. Cheers, Graham
Mark · July 28, 2021 at 9:12 AM
Hi Graham, how are you measuring that your lower jaw has come forward 6.5mm?
How much can your appliance expand? I thought they were capped around 10mm or so – it sounds like you’ll be maxing out soon. Will you get another one and keep going?
Graham Stoney · July 28, 2021 at 9:25 AM
I’ve turned the left and right advancers on the lower mRNA appliance 26 times each, at 0.25mm per turn = 6.5mm. I’m not sure how far it can expand; I’ll ask my provider next time I see him. I will get another and keep going if I still have more growth potential and there don’t seem to be any problems with doing so, but I haven’t discussed this my provider yet. Cheers, Graham
Mark · July 28, 2021 at 6:33 PM
I’m not sure what you mean by lower advancers? I thought the lower appliance only has one width advancer, and only one in the middle (aka to make it wider)
Graham Stoney · July 28, 2021 at 7:10 PM
There are 3 adjustment screws on the mRNA lower appliance: a width expansion screw in the centre, and two screws (one on each side) that adjust the degree of mandibular advancement.
Dave · July 23, 2021 at 8:49 PM
Hi Graham,
I have been using CPAP for 5 years for my severe UARS. I have recently determined that the reason for my severe fatigue and CFS-like symptoms is poor sleep quality sleep due to a sensitive nervous system that reacts to CPAP itself; so, in other words, while CPAP is fixing my breathing obstructions, it is, at the same time, also greatly disrupting my sleep. I wanted to pursue some form of maxillary expansion but I’m too ill to even leave my house. Do you anticipate full resolution of your symptoms when all is said and done with your Vivos expansion?
– Dave
Graham Stoney · July 23, 2021 at 10:13 PM
Sorry to hear about your situation Dave, that must be really rough. I also suspect CPAP is preventing me getting truly refreshing sleep. Yes, I am hoping for a full resolution of my symptoms once my Vivos expansion is complete and I can start sleeping properly without CPAP. You may find The Gupta Program or ANS Rewire give you some relief in the mean time, if you haven’t tried one of them already. Good luck! Graham
Carl · July 20, 2021 at 9:00 AM
I am very frustrated with my OSA, it’s mild in terms of AHI, but it’s sever in the sense that my airway closes up TOO easily. I’m with Dr. Steven Park, and he prefers that I stay on CPAP, but after seeing how I’m struggling on it, he suggested the inspire implant. I can tolerate CPAP but it leaves me at the mercy of multiple chemical sensitivities. Any normal household odor I cannot tolerate it while using CPAP, to the point where it prevents me from falling asleep or even downright wakes me up in the middle of the night. I’m confused! I don’t know if I should get surgery, or become more of a control freak over the air quality in my living space and use the VIVOS device to expand my jaw. But I will tell you when I sleep right, the ANS Rewire program works. When I don’t sleep right, then the ANS Rewire program is difficult to implement.
Graham Stoney · July 20, 2021 at 9:25 AM
I hear you Carl, OSA is frustrating as all hell. I’m curious why Dr Park recommends Inspire over an expansion treatment like Vivos or MSE? I get that Inspire is new technology that’s fun for doctors to play with, but it’s not addressing the root cause of the condition. Similarly, I got no benefit from ANS Rewire until I was sleeping properly.
Carl · July 21, 2021 at 3:05 AM
Dr. Park simply felt that I would not benefit from a palatal expansion like Vivos or MSE becuase he felt that the way my throat closes is too severe. He said I had a severe tongue collapse and a sever soft palate collapse. This morning I just got a bright idea, to ask another sleep doctor for a second machine, one that I can use alongside my CPAP. I can get a machine that somehow connects to the CPAP tubing and that machine will offer oxygen. This I believe can offset the allergic reactions I’m getting from multiple chemical sensitivities. I just have this strong urge to breathe in fresh air, so I think supplementing with oxygen might help me tolerate CPAP. If this happens, then I will take my sweet time and start a palatal expansion treatment like you ASAP.
Graham Stoney · July 21, 2021 at 6:35 AM
I don’t understand Dr Park’s logic. Soft tissue collapse is only a problem when our skeletal structure is insufficient to maintain our airway, and if your skeletal structure is particularly poor, you would have the most to gain from expansion treatment either surgical or non-surgical. If that isn’t enough to cure you, then maybe Inspire is a reasonable option to get you off CPAP, but I wouldn’t personally do Inspire as a first-line treatment. That said, this is a confusing field, Dr Park is a world-leading expert in it, the experts don’t always agree and don’t always recommend what seems logical to me.
You may find that your allergies and multiple chemical sensitivities reduce as your sleep improves, particularly if your autonomic nervous system is stuck in fight-or-flight mode and you can switch it back to parasympathetic. Have you tried breathing exercises like Patrick McKeown’s Oxygen Advantage, or Roger Price’s approach using the Address Stress app? They won’t correct a skeletal insufficiency but they may address your allergies and the feeling that you’re not getting enough oxygen while you get your OSA treated.
Cheers,
Graham
Erik · July 12, 2021 at 2:29 PM
Hi, Curious what your exercise routine looks these days, have you been able to increase intensity??
Thnx..
Graham Stoney · July 17, 2021 at 12:25 PM
I appreciate you asking Erik; I recall you’ve been following for a while. I’m gradually ramping the exercise up and do 10 bicep curls, 10 lat pull-downs and 10 squats three days a week. I also do an hour of singing practice, an hour of keyboard practise, and 15 minutes on drums most days of the week.
Didi · July 12, 2021 at 2:05 AM
Will pray for your Mom as well as you. Thank you for all your posts, they really help out.
Graham Stoney · July 12, 2021 at 6:47 AM
Thanks Didi. I’m glad you find them helpful. Cheers, Graham
paco · July 9, 2021 at 10:10 AM
just wanted to share an update i found on jimbo the smash faced youtuber!
https://www.youtube.com/watch?v=AAQ7UACtFnw
he’s not done with dna still and he had tongue ties and sleeps much better. did your cbct show a narrow airaway and do you have tongue ties??
Graham Stoney · July 9, 2021 at 10:36 AM
Thanks for the heads-up… I was wondering how Smash Face Jimbo has been doing. Yes my CBCT showed a narrow airway, but I have no signs of tongue ties. Cheers, Graham
Sammy · July 9, 2021 at 6:37 AM
Hey Graham, considering all the expansion you’ve done with your appliance so far, has that translated into any appreciable cosmetic changes as well, such as less sunken eyes or more prominent cheekbones? Appreciate all the content you’ve been putting out. Your blog played quite a big role in me choosing the DNA & mRNA appliance to hopefully treat my apnea.
Graham Stoney · July 9, 2021 at 10:34 AM
Hi Sammy, thanks for the feedback. I can’t say I’ve noticed any cosmetic changes, but I haven’t been looking. I hope your DNA & mRNA appliance is wildly successful! Cheers, Graham
paco · July 7, 2021 at 3:15 AM
has your palate dropped? i heard that’s something MSE can’t do.
Graham Stoney · July 7, 2021 at 5:52 AM
Not as far as I can tell.
Claudia · July 4, 2021 at 11:28 PM
Hi Graham. Sorry about your mom’s diagnosis. There is a book that I can’t seem to find now of an American woman that cure her own cancer. There is also a science called the new Germanic medicine of a German doctor called Ryke Hamer that found the relationship of feelings and traumas with cancer and depending on the area where is located it tells you what trauma or negative feeling that person is holding. Is a controversial topic but I hope you find it helpfull.
Graham Stoney · July 5, 2021 at 7:28 AM
Thanks for the suggestion Claudia.
David · July 3, 2021 at 4:00 AM
Sorry to hear about your mom Graham, but it’s good to hear about your progress and sounds like things are moving in the right direction. In addition to airway expansion, have you tried various sleep supporting measures like circadian rhythm alignment (getting sunlight immediately after waking and around sunset, blue-light blocking glasses), nutritional support (keeping vitamin D + B levels high to support acetylcholine), temperature control (cooling down before bed to facilitate deep sleep) etc? I have been expanding with homeoblock, albeit slower than you, but I am finding now that these sleep supporting measures are having a much greater effect on me than prior to expansion. My personal belief is that SDB throws off our natural sleep mechanism and airway improvement, in conjunction with various sleep support, is a fast-track to success.
And on a different note – are you getting close to maxing out your current appliance, and do you think you will you need a second?
Graham Stoney · July 3, 2021 at 7:53 AM
Thanks David, I appreciate the kind words. Yes, I do some of the things you mentioned like getting up around sunrise and getting sunlight after waking, avoiding high lights in the evening, and keeping my bedroom cool. I have some blue light blocking glasses but I never found any effect from them, and I read somewhere that having lights above the horizon is what tells our brain that it was still daytime more than the blueness of the light does. I prefer a diet rich in vitamins to artificial supplements because I believe the body metabolises them better, so I eat a heap of green vegetables that are high in B group vitamins. Vitamin D is really a hormone whose purpose is to tell our body what season of the year we’re in so it can regulate it’s energy use accordingly, which is why it varies according to sunlight exposure that is high in summer and naturally reduces in winter; so I prefer not to mess with it. I’m with you about SDB throwing off our natural sleep mechanisms though and that sleep support is important.
I think I’m getting close to maxing out the forward expander on my upper appliance. I don’t know if I’ll need a second one. I suspect it takes time for the dental forces to transfer to the rest of the jaw bone, which is why some people report having to go back a lot when they can’t wear it for a few weeks because they lose or break it and it needs to be replaced, so it may be a matter of maxing it out and then stopping there for a while. I’ll ask my provider next time I see him.
How is your Homeoblock going?
Cheers,
Graham
David · July 5, 2021 at 4:21 AM
Very interesting point about Vitamin D, I will have to look into it some more. There is a lot of talk going around the internet of chronic vitamin D deficiency, but no mention that a seasonal variation may be normal or even desired. Anyway just wanted to offer some suggestions in case you hadn’t tried them before. Although you’ve probably tried just about everything by now, as have I 🙂
Homeoblock is going quite well; I am an unfortunately located far from my provider so I have not had a single check-up. This has resulted in a few hiccups along the way; I experienced pain several times, dialed it back, and lost a couple months in the process. One of my teeth has flared out which could have been avoided. I think Homeoblock is naturally a bit more challenging to fit properly in the mouth since it’s greatest “selling point” (ie the unilateral bite block) is also a potential downfall, since the appliance itself is asymetrical. My provider has not been helpful but I seem to have figured it out now; no more issues for a while. I’m at 5.5mm expansion, generally feeling better BUT continuing to suffer from UARS. I am not yet cured.
Graham Stoney · July 5, 2021 at 7:30 AM
Thanks for the suggestion David. Sorry to hear about your Homeoblock challenges; I hope you get the result you desire. Cheers, Graham
Abhishek · July 2, 2021 at 6:59 PM
Thanks for another update. Glad things are slowly but surely getting better. Really sorry to know about your mother’s diagnosis though. I hope she gets better soon.
Paco · July 2, 2021 at 3:21 PM
Have you considered or tried the regular face mask that pushes on the chin for sleeping? I was thinking since you use the mrna it doesn’t matter if it pushes on your mandible . The main concern with the face mask is tmd issues if the jaw is pushed back all night which can’t happen with the mrna. Just mentioning it in case it’s useful
Graham Stoney · July 2, 2021 at 6:24 PM
No, I’ve only tried The Bow, but thanks for the suggestion I’ll keep it in mind.
persephone · July 2, 2021 at 6:44 AM
do you side sleep or back sleep?
Graham Stoney · July 2, 2021 at 7:47 AM
I tend to side sleep, but I do roll onto my back sometimes. I tried a tennis ball T-shirt for a while but it was rather uncomfortable and I didn’t get sufficient benefit from positional therapy to make it seem worthwhile since I had apneas even lying on my side. Cheers, Graham