My Experience With MADs (Part 1): Starting Out
When I first received my sleep apnea diagnosis, I was a bit indifferent, to be honest. I had yet to understand the profound impact that sleep apnea was actually having on my physical and mental health. That insight would take me several years to realize.
At the time, I was most fixated on stopping my pervasive snoring, by any means necessary.
I’d seen a pulmonologist for my sleep test, and he was the first person to tell me about mandibular advancement devices (MADs). He said my treatment options were pretty much a MAD or a CPAP machine. At the time, I was dead set against using a CPAP. They just looked alien and unsexy to me. But a mouthguard? That seemed reasonable. I was already pretty familiar with those in the form of retainers, anti-grinding bite guards, and the like.
What is a MAD?
Here’s an explanation of how MADs work, paraphrasing from the American Sleep Association:1
People snore for lots of reasons. Most are related to partial blockage of the airway to and from the lungs, either by the tongue, throat tissue, or both. In my case, it was both: I learned that I naturally have a fat tongue (I prefer “phat”) and a narrow airway. As I got older, the throat tissue around the airway accumulated (a nice way of saying I put on pounds).
MADs treat the situation like a plumbing problem. They eliminate blockages for a freer flow of air through the pipes. MADs reduce blockage by moving the jaw (i.e., mandible) and tongue forward (i.e., advancing them – hence mandibular advancement device). Pulling the jaw and tongue away from the back of the throat expands the size of the upper airway. That can reduce the air resistance and vibration that leads to snoring.
Typically, MADs have two pieces that are molded to your teeth for a snug fit. The upper jaw functions as a fixed frame, while the lower jaw is moved forward. The better MADs provide a mechanism – some kind of hook and key -- that advances the jaw forward little by little (just millimeters at a time) until you reach the ideal balance between the back of the tongue and the soft tissue of the throat.
Once this happens, snoring stops. That’s an important point: If you don’t advance the lower jaw far enough, you won’t open the airway enough to stop the snoring. That point is different for everyone. You’d be really surprised how far forward your jaw may need to go to reach that perfect balance. I certainly was. I felt like a bulldog at times!
Choosing the TAP design
So, I was referred to a specialist in Dallas who actually invented his own MAD, called the Thornton Adjustable Positioner, or TAP® device. (Note: I am not receiving any incentive to write about the TAP from anyone; just sharing my own experience.) TAP devices are available from a lot of providers now.
The TAP design has evolved over the years, but essentially, there is a loop on the top piece and a hook on the bottom piece. You latch the hook on the loop, locking your jaws together. Then you turn a tiny key – a quarter-turn at a time, over a few weeks – to drag the lower jaw forward to the point where enough air flows through the pipes to eliminate snoring. The reason you need this key is that at least initially, you can’t even physically force your jaw forward enough to reach the free-flow zone.
Using my custom device
The price tag gave me sticker shock: $1,500. Fortunately, my insurance covered half of it. And, the devices typically last for several years. So, I decided to go through the plaster mold casting process and get my custom device.
From the very first night, my husband noticed a difference. Over the next couple of weeks, as I adjusted the device (doing so too quickly can cause pain and other problems), it got better. The worst of the snoring was eliminated to the point that he can sleep in the same bed, using earplugs.
And then we slept happily ever after!
Have you tried an oral device to treat your sleep apnea? Share your story below.
How often do you experience daytime fatigue?