Good Night, Sleep Tight

Hate your CPAP? Oral appliance relieves apnea, improves lung function

Shortly after relocating to Florida, Richard Remer began searching for a source of income and found a position with a local grocer. Richard remained with that employer for 20 years and eventually became a manager over the dairy and frozen foods departments.

Photo courtesy of Richard Remer.

Richard Remer

“The job wasn’t just strong back work,” Richard, 50, asserts. “I filled orders and managed inventory, activities that kept me mentally engaged. There were also times when I zoned out and let my body go through the motions of doing the physical tasks. I enjoyed the job, and it worked out well for me because I was raised with a strong work ethic.”

Today, Richard is semi-retired and self-employed. He spends his days doing research and writing. He has multiple manuscripts in various stages of the writing process.

“If I organized my notes and put them together in a publishable form, I’d probably have six or seven nonfiction books covering topics from philosophy and psychology to mythological studies,” Richard shares. “I have two or three fiction books as well that I’ve been working on since time immemorial. Working on the books is easy. It’s finishing and getting paid for them that’s difficult.”

Something else difficult for Richard was breathing, especially at night when trying to sleep. Years of smoking contributed to the problem, which progressed over time.

“I began smoking when I was 15, and it finally caught up with me,” Richard elaborates. “When I was 38, I noticed changes. I had shortness of breath, a buildup of phlegm and other symptoms. At the time, the problem was noticeable but not debilitating. I could still do my job.

“Then, around 2012, I could feel myself starting to run out of breath and I became very tired and lethargic. After only a little physical exertion, I had to take a breath and rest. In 2014, I finally went to a primary care doctor who referred me to a pulmonologist. He told me that I have COPD.”

COPD is chronic obstructive pulmonary disease. The most common conditions associated with it are emphysema and chronic bronchitis. COPD damages the lungs and causes shortness of breath, wheezing, chest pressure and chronic cough.

“The pulmonologist told me I had only about 30 percent of my lung function and that if I didn’t quit smoking I was looking at three years to live, tops,” Richard reports. “He also diagnosed sleep apnea because my sleep was very shallow and I was constantly waking up. The doctor performed a sleep study and recommended a CPAP.”

Sleep apnea is a potentially serious disorder in which breathing repeatedly stops and starts. Sleep apnea is often treated using Continuous Positive Airway Pressure, or CPAP, therapy.

“The CPAP machine was an absolute nightmare,” Richard admits. “It was like the Spanish Inquisition except the Spanish Inquisition was better, because after they tortured you all night you didn’t have to clean the torture chamber so you wouldn’t get an infection when they tortured you next.

“It got to the point where I didn’t sleep with the CPAP, and that missed the whole point of the machine – to open up my airway so I don’t have an apnea. Then the pulmonologist explained that there was an alternative to the CPAP, an oral appliance that I could get. I was interested, so he referred me to Dr. Aljonaidy.”

Compliance Importance

Huda Aljonaidy, DDS, of Blossom Dental and Facial Aesthetics in Ormond Beach, creates oral appliances for patients to wear at night to treat sleep apnea and increase the flow of air into their lungs.

“When I first met Richard, he was struggling with sleep apnea along with breathing issues, primarily emphysema,” Dr. Aljonaidy reports. “With emphysema, the lungs are not fully capable of using the oxygen in the air. When emphysema is combined with sleep apnea, the risk for complications is high. Richard’s doctor had prescribed a CPAP machine.

“CPAP is the gold standard for treating sleep apnea and it is effective, but only when patients use it. Failure to comply and adhere to CPAP therapy are factors that prohibit its success. Oral appliances have been in use for 20 years and are also effective, and compliance and adherence to using them are much higher than CPAP.”

The oral appliances Dr. Aljonaidy creates for her patients are about the size of a mouthguard. They’re designed digitally by the dentist in her office and fabricated at a specialty dental laboratory.

“Each oral appliance is custom-made to the patient’s anatomy,” Dr. Aljonaidy informs. “We scan their teeth digitally using a camera about the size of a marker that is placed inside the mouth. And although I have CT technology at my disposal in the office, I work with FDA-approved labs that actually make the appliances.

“There are a variety of materials used for oral appliances. The most common is polymethyl methacrylate, or PMMA. That’s a common material in dentistry, often used for sports guards and dentures. Another material that’s becoming popular is nylon. It’s changing the game plan because it’s thinner and feels less like a foreign object to the patient.”

After meeting with Dr. Aljonaidy, Richard agreed to move forward with an oral appliance.

“After using the appliance for a few weeks, Richard returned very excited,” Dr. Aljonaidy reports. “He said he was sleeping better and was not tired. Best of all, he was breathing better. His lungs still require treatment, but he’s getting more air. He’s no longer dealing with lungs that are 100 percent compromised.”

Improved Lung Function

Before visiting Blossom Dental and Facial Aesthetics, Richard’s sleep was consistently disturbed due to his sleep apnea. His sleep wasn’t any better after being prescribed a CPAP. It was only after he received his oral appliance from Dr. Aljonaidy that his situation improved.

“Prior to getting the appliance, I woke up constantly at night,” Richard remembers. “I would be semi-conscious, knowing that it’s nighttime, then I would go back to sleep. The only time I slept with the CPAP was out of sheer exhaustion.

“But with my oral appliance, I sleep continuously through the night until I wake up in the morning. And I feel refreshed. And when I last saw my pulmonologist and had a breathing test, my lung function was up to 40 percent. So it’s increased by 10 percent just by using the appliance. That’s pretty good.”

Richard approves of the appliance’s provider as well.

“Dr. Aljonaidy is brilliant, very detailed and precise,” he describes. “I was impressed with her from the get-go, particularly the depth of her knowledge and her ability to communicate. She was exact in explaining, This is what’s happening, this is what we’re going to do and this is why it works. She’s very impressive as a professional, and she’s a great person as well.

“I look forward to my appointments at Blossom Dental and Facial Aesthetics.”

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