info regarding MAD/MAS devices, CPAP/AVAPS, and masks, gathered from my other posts discussing these things, copied here for easier access:
@Shaz51 @Jynx @D1ng0 @Healandlove @DogMan79
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MAD/MAS/CPAP = these are interesting devices…I used to fit custom ones (take a mould from someone’s teeth, manufacture the MAD/MAS/splint, and customise on final fitment), which were ordered/prescribed by sleep specialists and some dentists, alongside setting up the ventilators/APAP/CPAP/ASV/BiLevels (depending on the type of issue causing limited breathing resulting in low blood oxygen).
They work well with people who have good day breathing/diaphragm & accessory muscles of breathing function.
There was a specialised way to manufacture customised mandibular advancement devices that were designed to work with individual jaw and temporomandibular joint alignments, to ensure best comfort and least amount of occlusion malalignment 🙂
Theres lots on the market, including thermoplastic prefab MAD blanks that people can fit for themselves using hot water at home however they don’t have the same comfort as far as I’ve seen when people used to bring them in for review (when they found they were challenging to use at times).
The interesting thing is that they (MAD and CPAP) are both designed to splint the airway open, just in different ways: if the airway becomes unobstructed when laying down, without any inability to breathe (which isn’t related to throat obstruction; it is related to the ability and strength of the diaphragm and accessory muscles of breathing), then something (be it a MAD/MAS or a CPAP/APAP device, because they both splint the upper airway open) while awake, then a splint device (which could be either the air pressure splint = CPAP, or the mechanical splint = MAD) may work.
If there is a muscular or other insufficiency with the diaphragm or accessory muscles of breathing, then it doesn’t matter if the upper airway is unobstructed by either a MAD or CPAP - neither can push air in and pull it out to enable what is called ventilation (the fancy word for the action of breathing)…this is taken care of using ventilation devices, that effectively take over the action of the diaphragm and accessory muscles of breathing if and when a person has an unobstructed airway but they aren’t ventilating.
Having said all that, it’s personal choice regarding choosing between MAD and CPAP as the device that splints the upper airway open (they’re both valid choices - the difference usually as SmilingGecko has kindly illustrated, is compliance, or adherence to therapy - which is much easier using a MAD mechanical splinting as opposed to CPAP air splinting).
The tricky part is discovering if someone has just an upper airway obstruction issue (obstructive apnoea), or they have a diaphragm/accessory muscles of breathing issue (clear airway apnoea), or a combination of both (called mixed apnoea)…keeping in mind that apnoea is the fancy word for ‘not breathing’ (apnoea is literally ‘absence of breathing’ - it covers all methods of ‘not breathing’ eg: someone holding their breath is currently having an apnoea - a period of ‘not breathing’).
there is a distinct difficulty in discovering what type of breathing issue exists, because it’s often masked by other disorders or compensatory patterns of breathing that people have.
anyway, I hope that’s helpful in clarifying the differences between what supports obstruction, and what supports ventilation
The MAD’s are (usually) made by specialised trained staff like I was, within places that provide sleep assessment services/provision of equipment (I used to run/monitor a sleep laboratory which is where people go to have their sleep tests overnight), or dentists, and I trained with some GP’s who learned how to do it as a side hustle to complement their practice income.
Strictly speaking, a mandibular advancement device as the ones usually studied, are tailor made by a fully trained and certified person. The thermoplastic blanks you can buy and heat mould to your teeth don’t give anywhere close to the same effect on opening the airway by significant and specific measured advancement of the lower jaw, and the occlusion may not be very well aligned (how your teeth come together once you close your mouth/jaws - if this isn’t right, you can get jaw joint pain, etc). There are mathematical calculations around a persons jaw/face that provide a foundation on which you fit a proper MAD, for instance.
none of this happens when buying a thermoplastic blank and heat moulding it to fit your teeth impressions, which prevent it from sliding around or falling out, however it doesn’t have too much to offer in terms of increments of advancement of the jaw to open the airway (it’s less a forward displacement of the MAD, and more a rotational displacement…ie: opening a persons mouth a bit more at the hinge of the joint, by having something between the teeth).
Ok, I was trying to make this simpler, but I’ve added a bunch more info haha - I hope it’s helpful? 🙂🌺
There are a variety of manufacturers for MAD’s, and they may or may not be partially or wholly owned by companies that also have interests in air pressure splinting/ventilation devices, but from what I noticed during my years in the industry, this was a result of natural attrition over time (big companies buy small companies where they want to dominate the market - seems the way of the world, pretty much).
Anyway, where I used of work, the MAD was pretty much the same price as a base CPAP machine, so in terms of having only upper airway obstruction, patients would end up with basically a 60/40 split (in favour of air pressure devices like CPAP/APAP), and most people moved to MAD’s due to claustrophobia, partner sleep disturbance, affordability over time (the CPAP masks need to be replaced to maintain their seal capabilities and they and their parts are $$), and breakages, or need to travel without an air pressure machine in tow.
Most people - once fitted appropriately for mask and they actually have had thorough diagnostics to ensure they have the correct equipment and prescription settings - are super thankful and extremely happy with the benefits they gain from both MAD’s, CPAP/APAP, ventilation, and everything in between…what keeps you alive and well as opposed to being unwell and exhausted people usually love using 🙂🌺
interestingly where I worked, technician stats were tracked, and I had particularly high success rate with all different types of devices from across the plethora of items out there (including positional devices - which are yet another type of device used to treat obstructive sleep apnoea).
Over time, more people would prefer to use air pressure devices instead of MAD’s long term, and some people with purely OSA sometimes used a combination of both on alternate nights…
Anyway, I hope that’s a little more informative.
Keep in mind that MAD’s only work when someone doesn’t have any problems with their ventilation - if they do, a MAD will not do a thing besides cover their pillow with huge amounts of drool overnight, while their blood oxygen remains low because they need ventilation pressures to breathe ‘for’ them
The gold standard in MAD’s is full custom using a reputable brand/fitter so you know it’ll last and not cause jaw/tooth issues, I tend to think 🙂
Thanks for sharing the article 🙂 there’s a fair bit in there that isn’t clarified (for instance, the severity of OSA doesn’t determine whether a MAD will be sufficient to treat; it’s all about the anatomy of someone’s soft palate and upper airway, and the function of that area, while they are sleeping…someone can have mild OSA but need high pressure CPAP because a MAD isn’t suitable …it’s all about the structure and function of someone’s airway, and not how many times they are having obstructions - which is what determines if OSA is mild, moderate or severe; it’s all about the number of obstructions, which in no way determines efficacy of a type of treatment)☺️
It’s really distressing at times to live with untreated OSA, or CSA (clear-airway sleep apnoea - the people who need a ventilator due to muscles not working to make them breathe), for sure, as well as having numerous health impacts that can be serious 🌺
I’m glad I could bring something new to the table in your search for info
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