Note: This post may contain statements that I no longer consider true.
See: The Vivos mRNA Appliance Didn't Improve My Obstructive Sleep Apnea.
This month I’ve been focussed on recovering from nasal surgery, wearing my myofunctional therapy spots, grieving my mum’s death, going back to Uni, optimising my sleep hygiene, and having a life.
I’m still waiting to hear back from Vivos via my provider with their analysis of my mid-treatment CBCT scans taken back in November. Appliance wear isn’t my top priority until I hear from them whether it’s likely to tip my teeth any further. I still sleep with it, but my usage has dropped down to an average of about 12 hours a day this month. I haven’t tried sleeping with the facemask this month since I found that challenging and my highest priority is getting the best sleep I can in the hope of alleviating my daytime fatigue and headaches.
I wear the facemask when I can during the day, but that only averages about 2.5 hours/day since I can’t wear it while I’m doing most of my daily activities and it requires me to have the appliance in.
I think my health is gradually improving but I’m aware I’ve said that before; even before being diagnosed with obstructive sleep apnea. Nevertheless, I’ve been doing weekly swimming lessons and a half hour exercise class at Sydney University Sport and Fitness, samba dance classes with Sydney University Movement and Dance Society, and surfing lessons with Waves of Wellness. I’ve been optimising my sleep hygiene by avoiding eating, TV and lights late in the evenings.
I’ll let you know when I hear more from Vivos. In the meantime, here’s this month’s graphs:
19 Comments
Tegan · May 14, 2022 at 8:34 AM
Has anyone had any experience or information on being treated by Dr. Hang?
Roger Daniels · May 13, 2022 at 6:15 AM
Expecting to cure your sleep disordered breathing from a procedure that only addresses the nasal airway is not realistic though. It’s necessary to address all the bottlenecks, and EASE is only step 1, which is why you wouldn’t see people being cured from only that. If your jaw is recessed (which most OSA patients are), then it’s a multi step journey; Step 1 – expand the nasal airway, Step 2 – advance the jaw to open up the pharyngeal airway. From following Graham’s journey, it doesn’t appear Vivos is capable of doing either of these steps.
Kenneth Wayman · May 23, 2022 at 11:55 PM
Roger, I see a lot of people saying that expansion is the first step and jaw advancement is the second. Do you know of any reason why it couldn’t be the other way around? In other words, could you have an MMA surgery first and then go through DOME/MSDO afterwards? Is there a deeper reason for the ordering other than that the usual first step is somewhat less invasive?
Roger Daniels · June 14, 2022 at 4:44 AM
You can do expansion after MMA, but it could be affected by the lefort cuts that were done during MMA. This may or may not be a big deal depending on the type of expansion you do. Dr. Li does EASE on patients after MMA and seems to have pretty good success, but his method is very particular and I’m not sure it would go as well with other methods like DOME. You would also need wait ideally around one year after MMA, and need to do two rounds of orthodontics (once before MMA, and one after expansion). So the timeline would be longer, and it would cost more. But it’s not impossible if you’ve already done MMA, or want to do MMA first. It’s possible you could find you don’t need expansion after MMA, which is a a bit of a gamble that could pay off.
Kris · May 7, 2022 at 11:49 PM
Graham, thanks for this and all the useful information that you put out regarding Vivos. I’m currently in the first 6 months of treatment, so very helpful to learn from someone further along. Unrelated, one thing that stuck out to me is that your AHI figures seem to still be a bit high, even though they have trended down over time. Maybe you have already done this, but wondering if you’ve considered speaking to a sleep specialist about titrating your CPAP settings. Just from my experience, I found that when I started and the APAP settings were 5 to 20, my pressure would typically settle in around 8 and my average AHI was 3.5. I reviewed my data with a sleep tech and tightened my range up to 9 to 12 – that dropped my AHI to an average of 1.4. Just some food for thought.
Graham Stoney · May 11, 2022 at 2:04 PM
Thanks for the suggestion Kris. Were most of your events apneas or hypopneas before the titration? Most of mine are clear airway/central events, so I was assuming that a manual titration wouldn’t help.
George · March 19, 2022 at 5:31 AM
What about MEAW? Have you tried that? MEAW by Multiloop edgewise arch wirse orthodontics?
Graham Stoney · March 20, 2022 at 8:46 AM
No, I’ve never heard of it before now.
Doug · April 1, 2022 at 9:22 AM
George –
Kind of fascinating, reading a bit about it now: “Its underlying concept is based on the hypothesis that selective changes in the inclination of the occlusal plane can compensate various types of malocclusions by utilizing the adaptability of the temporomandibular joint.”
My provider has spent 20 years studying the TMJ and treating cases, and he follows a strategy that leverages Vivos DNA but also some of his other techniques. Notably, he actually starts with the lower jaw first and gets that into a proper physiologic position, then works to bring everything else around that. But the process takes a long time, for me it was 6 months to get the mandible to move itself to where it preferred to rest … and then we had to let it heal there for 3 months, then we were able to start working on everything else.
Sam · April 12, 2022 at 9:07 PM
Hey Doug,
Would it be possible for you to drop details of your provider?
Thanks
Joe · June 2, 2022 at 2:52 PM
Hi Doug, if you feel comfortable sharing the information I’d also be interested in learning who your provider is. Kind Thanks, Joe
jamie · June 10, 2022 at 2:41 PM
Interested in the name of your provider Doug! please let us know if your comfortable with that
Mike · March 17, 2022 at 12:12 AM
I’m starting vivos next month. Looking forward to it!
Clark · March 16, 2022 at 2:17 PM
While researching SARPE I saw a comment here from Jay about the EASE from Dr Kasey Li, I emailed him about a consult and he restated his profession’s position
“Vivos makes NO physiologic sense and zero data. Will only push your teeth out.”
A large amount of patient self-reports on symptom improvements also mention being assigned tongue physio, tongue tie releases, or their front teeth were angled posterior anyway (where pushing out teeth incidentally helps)
All those reduce AHI events for OSA and in turn the patients all rave and assign the entire credits to Vivos, who themselves make conservative claims of effectiveness
If it is within the budget I might be jetting across the pacific for it, this is going to be the most expensive and shittiest vacation ever, I think
Clark · March 17, 2022 at 3:02 PM
For my UARS and not very complex anatomy I was quoted 28-32k USD for EASE, before hospital, anaesthetist, travel, accommodation
Not such thing as “treatment option not available”, it’s a matter of is it more painful to cough up 40k or more painful recovering from LeFort cuts and 6-12 months of pre/post orthodontics
Good luck to everyone on their journey to recovery
Doug · April 1, 2022 at 9:13 AM
Hey Clark – I hope the treatments you pursue end up giving you some relief. But have you spoken with any other UARS patients that tried EASE? In my experience so far, it seems like all of them are saying they can breathe a little bit easier – but none are saying they felt it cured their UARS. This seems to be everywhere you look – in their FB groups, in their Reddit forums, and in their chat servers.
As for Dr. Li’s blanket statement, it’s not at all surprising. And as a triple-board-certified surgeon, certainly he deserves a lot of respect for his accomplishments in life. But that doesn’t mean that every word that comes out of his mouth is 100% medically accurate. And frankly, on the “zero data” statement … he is completely objectively wrong on that matter.
There are multiple peer-reviewed studies of Vivos’ approach improving sleep apnea patients. Last time I looked, there were about 5 published peer-reviewed studies – all multi-patient, all “consecutive patient” studies (that’s important) stretching from 2016 to today.
Contrast this with Dr. Li’s EASE research – a single peer-reviewed study. It was not a “consecutive patient” study, so Dr. Li could have simply looked back through his files and picked his best patients – we don’t know. With the Vivos studies, they are consecutive patient studies, so you can’t just pick the best ones. That’s a higher bar in terms of clinical evidence.
I understand that Dr. Li doesn’t believe it makes physiological sense. That’s not really surprising. But I really would suggest asking other patients who paid Dr. Li $30k whether it actually cured their UARS or not. Ask them for their pre-treatment and post-treatment sleep studies. I don’t want you to have the “most expensive and shittiest vacation ever.”
Wishing you luck whatever path you choose…
Clark · April 7, 2022 at 1:17 PM
Hi Doug – As always I appreciate your well thought out posts, and on your recommendation I’ve joined the discord server for the UARSNew subreddit to speak to a few EASE post op patients, and surprisingly most of them report no noticeable symptom reductions despite significantly improved day time breathing
This is a pre-septoplasty/turbinoplasty scan, as you can see here my anterior nasal aperture width isn’t that bad at 26mm
https://cdn.discordapp.com/attachments/902335254612832337/961435606314008626/unknown.png
But once you swap over to the sagittal view it’s a lot more clearer the issue lies in my very narrow nasopharynx posterior
https://cdn.discordapp.com/attachments/902335254612832337/961438127363338240/unknown.png
https://youtu.be/vsqs8KAqSzE?t=590
Dr Kasey Li notes the MSE/SARPE being a cone shaped expansion, which might work for some but not for others with a different anatomical structure, similar to Vivos being able to treat some patients whose primary symptoms are TMJ rather than strict OSA (many of which would only benefit from MMA, especially with premolar extractions) but many patient reports confuddle these overlaps, a lot of the facebook group operate under very uninformed opinions, such as one asking if Vivos could help their turbinates being reduced, nasal congestion comes with 8-10 different considerations, it’s not as overly reducionist as the layman likes to pretend it just comes down to a septoplasty let alone intermolar width/high palatial arch
The fact each group (Vivos/Homeo/ALF vs MSE/SARPE/EASE) thinks the other camp is a narrow minded cult goes to show they’re echo chambers at best and personal research along with consulting with specialists is the only way you can find answers for yourself, patient profiles are rarely commutative, while I can’t and won’t refute tooth borne appliances’ efficacy in some patients, to me it feels like the uncertainty and strict patient compliance with respect to length of wear and time of treatment isn’t worth the risk reward in the end, bone remodelling without splitting sutures to me feels like trading alveolar tipping for wider dental arch which can still be a net positive in DNA patients
I will see what Dr Li has to say for me in mid June, it’s also entirely possible I don’t qualify or he tells me I’d benefit more from MMA
Doug · April 10, 2022 at 4:41 AM
“surprisingly most of them report no noticeable symptom reductions” – yep, exactly. Despite a couple of years of MSE/EASE patients rather aggressively harassing patients curious about something like ALF or DNA, it’s stunning that none of them can come up with a sleep study post-treatment after their MSE or EASE and demonstrate clinical efficacy. In fact, if you look back far enough in their chat server (including the archive of the previous server before that moderator freaked out) it’s something like 80%+ are failing to cure their symptoms … by their own numbers they are tabulating.
But they’ll still totally tell everyone they should go do it. So that’s I why I didn’t want you to have the “most expensive and shittiest vacation ever.” Ask for the data from those that pitch it the hardest.
For my own needs, I felt comfortable enough with the multiple studies Dr. Singh has published across different journals and the methodologies he used … even though he is the author. I was comfortable with this, because I’ve spoken directly with multiple post-treatment patients (who also shared their sleep studies with me) and they had similar results to the published research. To me, real people sending me their sleep studies and seeing they cured their OSA … weighed in so much heavier than the “it will just tilt your teeth!” screaming (the patients I spoke with did not have their teeth all whacked out, their bites were fine). So I felt it was worth a shot – for me. Every patient is different. If someone is dead set on doing MSE or EASE, it makes no difference to me – but that’s always the advice I give, ask for the data from those that pitch it the loudest and went through it.
I’m going to be curious to see the results from Graham’s sleep study when he goes (and his next Vivos Airway Intelligence Report) because he and I are very similar in terms of our start times and where we were starting from. But in my own case so far the results have been positive. If you know about where I post, you can see my actual real-world in-lab sleep studies that have validated significant improvement … and we’re not even done yet. I’m not sure if I’ll get all the way to AHI < 5 or not, but I'm hoping so. Going from 41 down to 11 has been huge for me.
Again, best of luck to you whatever treatment path you choose!
Clark · April 11, 2022 at 3:39 PM
Having engaged with r/UARSNew over the weekend, it’s not too different to the same echo chamber groups of Vivos patients use to reduce their cognitive dissonance about their recovery, instead of tooth borne bone-remodelling-and-expansion-despite-fused-sutures, it’s a place of groupthink where expensive and invasive MMA procedures gets normalised with the undercurrent of secretly hoping to benefit from cosmetic improvements
You are veering towards an inverse fallacy with that reasoning, just because EASE patients continue to experience symptoms does not mean the treatment was ineffective, you can still have multiple causes contributing to the same problems of which EASE does not fully resolve, it is also worth noting a majority of these self reports are within the first 1-3 months post op (when even ENTs will tell you it takes 3-6 months before you feel the full benefits), on top people don’t necessarily come back to report “everything fine life good”, quite a sharpshooter fallacy from the sampling selection
Vivos markets itself as a treatment for both TMJ AND airway, but the latter is important because how much is considered cured? Expanding the dental arch in this manner does potentially lower the nasal floor for more air volume, but is it enough to get off PAP? How much could you attribute to with confounding variables like patients getting tongue tie releases or doing tongue physio which themselves reduce AHIs
https://www.uarshelp.com/img/sdb-chart.png
Within anatomical sleep disordered breathing, UARS is the less life threatening but more severe CFS symptoms little cousin of OSA, Vivos might do very well at reducing your AHI from 41 to 11, you are still unable to get off PAP entirely and perhaps won’t be able to go below 5, and I hope for your sake you don’t go all the way to the end of DNA just to end up at my very own starting point: UARS
What are your options then? If advancement is still necessary after 2 years of DNA, could it have been optional the whole time?