Note: This post may contain statements that I no longer consider true.
See: The Vivos mRNA Appliance Didn't Improve My Obstructive Sleep Apnea.
Another month has gone by, so here’s another update. My health and fitness continue to improve, but the CPAP pressure trend has gone backwards this month and I noticed something weird about my expansion measurements.
The good news this month is that I’ve been exercising more: I do 30 bicep curls, lat pull-downs and squats 3 days a week, sing for an hour and play drums for a total of about an hour each day. It feels great to be able to exercise again and I don’t need to have a sleep or even lie down in the afternoon.
The rest of the news, is not so good…
I’ve been taking meticulous records of my appliance use and every adjustment I’ve made since starting treatment. Everything seems to be going fine in terms of ongoing expansion, but this month I noticed a discrepancy between my adjustment records and the size of the physical gaps in the appliance.
According to my records, I’ve turned the middle expander screw on the upper appliance 43 times since starting, which at 0.25mm per turn equals 10.75mm. However, when I measure the gap in the appliance with a ruler, it’s only 6.5mm. Similarly, I’ve turned the expander screw on the bottom appliance 38 times, which equals 9.5mm; but the gap between the left and right sides is only 5mm.
I tried winding the upper appliance back to the start while counting the turns to confirm that my records are correct, but I could only do 25 turns before the screw got really tight because my provider has been adjusting the wire bar on the front gradually as we expanded. I didn’t want to risk damaging the appliance by forcing the screw or make any adjustments just to answer this question so I couldn’t wind it back all the way necessary to verify the total number of turns I’ve done. I’m super diligent about counting and tracking turns so I can’t see how I could be out by such a huge margin.
I’ll check with my provider that the screws in my appliance really are 0.25mm per turn, but the only conclusion I can reach is that they have been regressing without me noticing so some weeks I thought I was making a full turn when in fact I was just putting the screw back where it was at the start of the week. I’ll be more diligent about checking this in future.
The net effect is that I’ve only been expanding at about 0.65mm/month rather than 1mm/month, and all my previously published expansion figures are incorrectly inflated.
Perhaps I could have been expanding faster, but it’s difficult to know for sure. The upside of expanding slower is that it’s safer and gives more time for bone remodelling, perhaps at the expense of overall treatment time… but it’s impossible to really say.
I also started trying half-turns twice a week this month. It’s more work because I must adjust the appliance twice as often and it requires me to keep track of where the screw should be. The result is that the appliance never feels as loose as it does at the end of a full week; but this is probably a good thing. Intermittent cyclic forces are good for bone growth, but the period of the force applied by advancing the screw is so long that changing it from 1 week to half a week is probably more than offset by having a greater force applied half the week because the appliance never gets as loose.
The main advantage of turning the screw twice a week is probably that it prompts me to be more diligent about checking for regression. Correcting regression requires knowing whether the screw should be mid-way through a turn or at the end of travel, which can be remarkably difficult to remember, so I updated my spreadsheet to track this.
Usage is still awesome at an overall 16.37 hours/day. Here’s the usage graph:
Here’s this month’s CPAP pressure trend analysis which disappointingly shows a slight increase in CPAP pressure. Sigh:
That doesn’t help the overall CPAP pressure trend to turn around:
Events are up too:
The overall event trend is down, principally due to central events falling, but no thanks to this month:
19 Comments
James · August 29, 2021 at 6:59 AM
I’m a bit confused with the talk about expecting 10.75 mm expansion. I just ordered the DNA appliance in Maryland about a month ago, and it’s about to be installed in about week or so. The dentist told me 6 mm of expansion forward and sideways is all the appliance is capable of. Then if I want more expansion, I have to get a new device and go through another course of treatment for up to 6 mm more. Is that not your understanding? Or could it explain your actual expansion only being around 6 mm? I was told .25 mm per two weeks, which is 1 mm every two months.
Graham Stoney · August 29, 2021 at 7:26 AM
There are a lot of factors at play determining how much expansion the appliance will give you, including the physical capability of the appliance and your genetic potential. My provider says there are 7 or 7.5 mm of development within each screw. The degree of expansion of our actual teeth and jaws will be somewhat less. It’s relatively easy to measure the sideways expansion on the upper and lower appliance by measuring the gap between the two sides, but the forward expansion of the upper appliance is hard to measure due to the Y configuration. I thought I had been expanding one 0.25mm turn every week, but I now believe the screws in my appliance have been winding themselves backwards without me noticing, so in reality I haven’t made as many turns as my records suggest and my actual rate appears to have been more like one turn every 12 days or so; which is close to what you were told.
James · September 8, 2021 at 5:06 AM
Interesting. I wish there was more good information about all of this out there, especially from the manufacturer. From what I can tell, a lot of the information about the appliance comes through the dentists or orthodontists who are trained to treat patients with them.
As an aside, I’m wondering if the genetics can be helped along with measures that increase human growth hormone (HGH), which naturally decreases in adults. Most medical literature I’ve seen says that adults don’t grow new bone. But the Vivos DNA appliance claims it does stimulate new bone growth in the jaws. If so, maybe HGH would play a role in supporting that new growth? There are several ways to stimulate HGH, including taking a 2-5 mg melatonin supplement and some GABA nightly before bed, as well as L-Arganine (when taken without exercise). If taken on a sustained basis, I’m wondering if this might aid the process. And HGH seems to be healthy, as it promotes better bone density and muscle mass, even without growing bone. I think I’m going to give it a try. Why not?
Graham Stoney · September 8, 2021 at 8:22 AM
Great question about Human Growth Hormone James; I’ve been thinking the same thing myself and I mentioned recently started cardio exercise for this reason in my eleven month update. It looks like GABA is quite effective at boosting HGH, so I’ll definitely give it a try and consider melatonin and L-Arganine too. Cheers, Graham
John · August 28, 2021 at 9:11 AM
Thank you for chronicling your journey! Has your maxilla advanced at all due to Vivos?
Graham Stoney · August 28, 2021 at 10:42 AM
I’m glad you’re finding it helpful John. I have no easy way of measuring whether or by how much my maxilla has advanced; in theory I’ve turned the forward advancing screw 43 times, which should equate to about 10mm, but I’ve recently realised that the screws wind themselves back over time and if it’s anything like the sideways expansion screw, I’ve probably only really turned it 2/3 of that amount for say 6 or 7mm. How much maxillary advancement that equates to is hard to say. Cheers, Graham
Ben D · August 22, 2021 at 11:30 AM
Hi Graham – I’m a fan of your blog, and I also have breathing and sleeping problems. I wanted to commend you on your decision making process that lead you to start with the DNA. It was smart to start with a non-invasive treatment. I went with MSE w/ surgical assist, and I regret not starting with the DNA. The MSE did not improve my breathing, and I feel caused damage to my nose that may require another surgery to correct. Anyway, I’m rooting for you on the your journey, and best of luck!
Graham Stoney · August 22, 2021 at 12:07 PM
Hi Ben,
Thanks for your kind words. I’m sorry to hear that your treatment hasn’t improved your breathing. I understand that the surgical assist used with MSE reduces the risk of expander failure, but also reduces the force on the bones required to expand the nasal cavity. I hope you can get whatever damage it did corrected… I’m rooting for you too!
Cheers,
Graham
paco · August 18, 2021 at 9:37 AM
have you heard of the remastered water bottle and exciteosa ?
Graham Stoney · August 18, 2021 at 10:28 AM
Thanks for the tip about the remastered water bottle; it looks like a cool idea since I already use water bottles anyway. eXciteOSA looks to me like a lazy man’s myofunctional therapy, which you can do for free. Their claim to be “the world’s first daytime therapy proven to strengthen weak tongue muscles known to be the root cause of sleep apnea and snoring” is simply false given that myofunctional therapy was known to be effective at least as far back as 2015. Cheers, Graham
paco · August 5, 2021 at 5:44 AM
The good news this month is that I’ve been exercising more: I do 30 bicep curls, lat pull-downs and squats 3 days a week, sing for an hour and play drums for a total of about an hour each day. It feels great to be able to exercise again and I don’t need to have a sleep or even lie down in the afternoon.
>>.
so is this a good sign? like before dna /mrna treatment would trying to accomplish all these activites be an unaccomplishable feat?
or is it just a mattter of willpower?
Graham Stoney · August 5, 2021 at 7:32 AM
It’s certainly good news, but it can be explained by acclimatising to CPAP rather than expansion by the mRNA. No it wouldn’t have been possible before. You can’t overcome the fatigue caused by untreated sleep apnea with willpower.
Kevin · August 3, 2021 at 1:05 AM
Out of paranoia I too have “reset” my DNA appliance and started from the beginning to make sure that I had made the correct number of adjustments (I had). It’s good to know other folks have been down this path too.
I am a big proponent of longer gaps in between adjustments. I feel the device is most effective when adjusted at the 3 week mark. I know that extends the wear time of the device but I really feel that this slow, extended pressure is more beneficial. With more frequent adjustments I felt i risked pushing my teeth and the tightness of the device I felt out a strain on the appliance. I went to see my dentist last week and he confirmed and even said it’s okay for the bottom alliance to not be at the same setting as the top appliance! During this same visit the technician polished/sanded a portion of the bottom (plastic) that was causing severe gum irritation. Has anyone else experienced this?
Graham Stoney · August 3, 2021 at 6:24 AM
I think you’re probably right that expansion rate isn’t overly important so long as we’re not expanding too fast. I’m envisaging a 24 month treatment time and at 1mm/month that would give 24mm which is extremely unlikely. Half that is probably more realistic, so I was always going to need to slow down at some point and taking it slower the whole way so that the jaw bones get more time to remodel makes a lot of sense to me. Yes, I’ve had lots of impingements requiring acrylic to be shaved off my appliance. For the first few months of treatment they were every couple of weeks as my provider was very conservative about the amount he removed to retain as much strength in the appliance as possible. Cheers, Graham
Clark · August 3, 2021 at 1:52 PM
My provider said gum impinging shows that “it’s working”, like growing out of shoes as a kid, if you had no expansion you’d be able to fit the appliance with the screws at factory default
My provider has put me on a 10 hours for 12 days schedule and I feel in terms of effective compliance it is much more practical than the initial 16 hours/7 days (even with work from home), you could wear it for 24 hours everyday with incorrect tongue posture and your progress won’t be that much further than someone doing it without the appliance
It is normal for one appliance to lag behind another, and since the top teeth is meant to sit in front of bottom teeth, my provider has stopped me expanding my lower appliance for a month now
I feel 3 weeks is excessive, the Vivos paper says it is the act of swallowing that activates the appliance (tongue muscle pushes on maxilla, acrylic transfers it as lateral force by exerting onto teeth, repeated numerous times per day, accumulated over years), especially with the posterior third of your tongue
Your dental arch doesn’t magically start widening by the miniscule amount of tension exerted from the appliance itself, in fact it’s what turns the screws back (hooray Second law!)
This is a youtuber who has been mewing for 1.5 years, a misnomer for correct tongue posture
https://cdn.discordapp.com/attachments/532882375450034176/871946561033232454/unknown.png
The changes are there but it is subtle, Vivos is mewing on steroids and the paper published by Dr Singh has some before/after pictures with more pronounced differences
Clark · August 1, 2021 at 4:08 PM
I had addressed this with Jalal back in early June, as I took a month off of Vivos from my septoplasty surgery, I was shocked to find that a two weeks break seemingly had wiped off a month’s progress, it was then I realised the appliance actually winds itself back from the constant pressure, since then I have been checking and winding my appliance to the edge every morning
As it is with impostor syndrome, I thought no one else had this issue, it’s not as if I suddenly get an exemption from Newton’s second law, things are always bleedingly obvious in hindsight
Graham Stoney · August 2, 2021 at 1:23 PM
Thanks for the tip Clark! Unfortunately, “You can’t change the laws of physics!” (said with a Scottish accent).
David Korobov · August 1, 2021 at 12:31 PM
I noticed the same thing with my Homeoblock!! I thought I was at 5.75mm, but checking with the ruler gave me about 5mm flat. Seems like the screws have a tendency to get loose with time, especially with all that saliva and water from cleaning. Very frustrating to embark on a long treatment plan and discover that a good chunk of time was lost to appliance malfunction. Providers should be checking for this sort of thing…
On the bright side, no harm was done to your teeth, and the slower rate probably helped cement your expansion. Plus you have an extra 4mm to improve your airway now! Just got to be very diligent with the appliance… I’m checking mine every night.
Graham Stoney · August 1, 2021 at 12:55 PM
Wow, that’s really interesting David. I’ll keep an even closer eye on it from now on. It’s definitely good to look at the bright side. Cheers, Graham