SUAD Dental Device

By sadcat Latest Activity January 13, 2011 at 8:23 pm Views 7,307 Replies 23 Likes 3


I'm supposed to get my oral appliance to help my sleep apnea problem next week, so I called the sleep dentist's office today to make sure it would be there by my appointment and found out some interesting info.
The device is called a SUAD device and there is a website that explains a lot about it.
I'll post some info about how it feels and how welll it works after I finally get it.
It looks like a good option for some people who don't like/can't tolerate a CPAP machine. My dentist had to get it pre-certified by my insurance, and they are payin for 80% of it.

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Replies (23 replies)

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  • Tracy
    Tracy May 5, 2012 at 9:08 am   

    sadcat - would love to hear a follow up report from you and your experience with SUAD…how's it going?
    thinking of you

  • sadcat
    sadcat June 30, 2011 at 5:44 pm   

    I just got the results from my last sleep study, which was checking the effectiveness of the SUAD device (oral appliance) and the news is good! With the appliance the hypopnea events were almost 100% limited to when I was sleeping on my back, during REM sleep. I don't spend much time on my back (11.8% of the time) or in REM sleep (14%). So the SUAD device has been declared a sucess for me!! The apnea diagnosis now is 'Supine and REM dependent Obstructive Sleep Apnea'.
    The Periodic Limb Movements in sleep are still a pretty significant problem as are 'Repetitive Intrusions of Sleep' - not exactly sure what, but something keeps me from getting slow wave sleep (0% of time in Stage 3 or 4 sleep). 50% of the time was Stage 2 sleep.

  • sadcat
    sadcat June 10, 2011 at 8:57 pm   

    Well, I at the sleep lab toniet so they can check the effectiveness of the SUAD device(SleepDentist 1.5mm spacers) for my sleep apnea and the requip for my Periodic Limb Movement Disorder. 2 studies ago (last summer), I had an AHI of 6.2, with all the events hypopneas that occured during REM sleep, mainly if I was on my back. The index is low overall, but during the REM phase it was around 27. The study in the fall (where I tried a CPAP) had AHI 0, becuae I only had 6 minutes (that's not a typo) of REM sleep.So there's no telling what this one will show!

  • Damnifiknow
    Damnifiknow May 3, 2011 at 9:16 am   

    Sadcat, thanks for the info. I too grind my teeth at night, and sleep with a bite guard, which was made by my dentist. I am waiting for the page to open, so I can go check it out. I was not aware that I did grind my teeth untill last year when my NEW dentist discovered the problem, which was too late. My top teeth are about only half there because of the grinding at night time. This bite guard has helped alot & I can't sleep without it. I am wondering if it is kind of like the same thing? Thanks again for the info. and please let me know how it turns out. I am curious now.

  • SleepDentist
    SleepDentist May 2, 2011 at 11:50 pm   

    We look for two things when aiming for MCE (maximum clinical effectiveness). Silence and lack of fatigue. Do you have a bed partner who can assess your noise? If not, there's an app for that :-) This would also depend on your original numbers. What was your original AHI? Doesn't your dentist have a home unit they can give you to test effectiveness?

  • sadcat
    sadcat May 2, 2011 at 11:06 pm   

    I'm doing pretty well with the SUAD. I've only managed to get to the 1mm spacer, but I seem to sleep better with it. The only thing I don't like is the place on the bottom part where the metal rod is screwed to the device - it sticks out a little , but otherwise it is comfortable. I bent one of the lower rods, I guess by grinding my teeth? I have an appointment with my sleep doc (in same practice as sleep dentist) to see what she wants to do next. They may have me go for another sleep study to see if the SUAD had the apnea (or hypopnea) issue under control. Then they can play with the meds to help the PLMD problem.
    How do you know when the devide has the right amount of spacers in it?

  • SleepDentist
    SleepDentist April 30, 2011 at 10:54 pm   

    How are you doing, sadcat? I would be happy to answer any questions you have about the SUAD or many of the other dental appliances we use for OSA. Not looking for patients - just offering help!

  • sadcat
    sadcat January 29, 2011 at 5:28 pm   

    I have Aetna insurance and this was covered under durable medical equipment (I think, I'll double check). My sleep dentist had to get this pre-certified (or approved), but that happened without incident. I did spend a night in the sleep lab trying out a couple of models of CPAP masks, but really didn't feel comfortable with them.

    The sleep doc told me that the sleep dentist (same practice) would only recommend these devices for people who he thought it would help, so hopefully you can find someone like that also that will be honest with you about the chances of it working. My sleep apnea index is just over the threshhold to be called OSA.

    It's too early to tell so far if it helping yet. There are levels of adjustments (small spacers that are 0.5mm or 1.0mm in size. They started me off with 1.5mm, and that caused my jaw to be very sore in the morning (I'm a jaw clencher and grinder). I baxked off to no spacers for 2 nights (no pain), then 0.5mm spacers for 2 nights, also with no pain. Tonight I'll try 1.0mm. The goal is to build up to the level that helps upi sleep (up to 3mm). The changes should usually be done in 2 week increments, so once I get to 1.5mm (the original starting point) I'll switch to the 2 week adjustments.

    It's very comfortable to wear, and there is a 'bite repositioner' to use in the morning to realign your jaw. I think it will be OK once my jaw gets used to it. It's also easy to take care of.

    The website has a 'find a practitioner' place on they're website, but it's under construction. You can email them and see if they can recommend someone in your area. The sleep group I'm dealing with is listed down at the bottom of their web page (in the orange links are)

    I'll keep you posted on how it's going. Good luck with your search.

  • Hunter29016
    Hunter29016 January 29, 2011 at 12:34 pm   

    I too am interested in this dental device that you have found.Let me know how well it worked for you.I have been interested in a dental device for quite some time,just am not sure if it would really help.I have spoken to my dentist and he is looking into this for me to find some one who does the work in my area.What kind of insurance do you have?

  • SleepDentist
    SleepDentist May 6, 2012 at 1:07 pm   

    Hey Hunter,

    Did you ever find help? If not, let me know where you live, and I will try to help. We look at various parameters to discern the likelihood of an appliance working well. They do not work well on the morbidly obese, and when the AHI is extremely severe, it's very difficult to get the numbers below 5. Extreme gaggers do not tolerate them well.

    Other than these situations, we get better success if the AHI is much worse on your back (supine) compared to your side sleep. CPAP pressures under 11 are a good indicator, as are lower AHIs.

    One thing to seriously consider is that if you are not wearing CPAP, you need to do something, so please do not let someone intimidate you into not getting the treatment you need.

  • Applewomyn
    Applewomyn May 4, 2012 at 1:24 pm   

    Oral appliances are bad news… they need to be taken off the market. I wore SUAD for just over a year and at age 38 now find myself in braces. The SUAD *ruined* my bite. I was told by my dentist that I would need surgery if I continued to use it and now I've been in braces for 10 months to correct the problem. The device never eliminated my symptoms or apnea despite the fact that I have VERY mild apnea (pressure = 7) and now I'm paying the price for wearing it. Despite what ANY dentist will tell you, ANYTHING that anchors to your teeth (especially something that is going to titrate your jaw) is GOING to move your teeth. BEWARE!!!!

  • SleepDentist
    SleepDentist May 5, 2012 at 9:59 pm   

    I'm sorry you feel this way, Applewomyn. Yes, bites can change, and your dentist should have told you about this possibility before he/she ever proposed the treatment. You should have been told that if you notice your bite changing, you should stop wearing it if you did not like the change. Certainly, if it was not helping your symptoms, you should have stopped wearing it.

    I assume you had a follow up sleep study to determine that your apnea was not controlled with the SUAD? What were the numbers with the study?

    BTW, studies have shown that bites do change with mandibular advancement, but in a minority of patients, so it's a bit disingenuous to imply that they will always change your bite. However, I understand your frustration, especially if your dentist did not give you fair warning.

    I do think that we all need to consider how important it is that we breathe and get proper oxygen during sleep. If you can't wear CPAP (which can also change your bite), the American Academy of Sleep Medicine says that an oral appliance is the next step. We really do care about your health, and honestly, a breath is more important than a perfect bite.

  • Tracy
    Tracy May 6, 2012 at 12:05 pm   

    Please explain how CPAP can change ones bite
    thanks for the education

  • SleepDentist
    SleepDentist May 6, 2012 at 12:59 pm   

    Primarily, we see retrusion of the maxilla, but also retroclination of the upper incisors (they duck back), tooth loss as well as other anatomical landmark changes. These changes occur more often with nasal masks using straps that place pressure on the upper jaw, but can happen with any form of mask. I am on the plane right now, but can send a study or two when I get home if you would like to read it.

  • Tracy
    Tracy May 6, 2012 at 1:10 pm   

    yes, thank you, I would love to have you send me a "study or two". I can only imagine this happens when a patient needlessly overtightens masks straps. I've been on bilevel therapy at very high pressures for 23 years with no dental problems

  • mslovelife
    mslovelife May 9, 2012 at 2:46 am   

    hello my name is Pat and I have problems going to sleep. I just had the cpap machine or should I say the watch like gaget and both those things on 2 of my fingers which I had to get those 2 fingernails cut dow. Now that part I didnt like. So can someone give more info about sleeping disorders please. Thank You

  • Tracy
    Tracy May 9, 2012 at 6:21 am   

    Pat, one of the quickest ways to learn about sleep disorders is to click on the LIVING WITH A SLEEP DISORDER section - find it in the left navigation area of all pages. It has a lot of basic information for you to start your search. If you have specific questions, please just ask!

  • SleepDentist
    SleepDentist May 6, 2012 at 3:01 pm   

    Posting this to see if it goes through. Not sure what is allowed.

    Craniofacial changes after 2 years of nasal continuous positive airway pressure use in patients with obstructive sleep apnea.

    Tsuda H, Almeida FR, Tsuda T, Moritsuchi Y, Lowe AA.


    Department of Oral Health Sciences, The University of British Columbia, Vancouver, BC, Canada. Small



    Many patients with obstructive sleep apnea (OSA) use nasal continuous positive airway pressure (nCPAP) as a first-line therapy. Previous studies have reported midfacial hypoplasia in children using nCPAP. The aim of this study is to assess the craniofacial changes in adult subjects with OSA after nCPAP use.


    Forty-six Japanese subjects who used nCPAP for a minimum of 2 years had both a baseline and a follow-up cephalometric radiograph taken. These two radiographs were analyzed, and changes in craniofacial structures were assessed. The cephalometric measurements evaluated were related to face height, interarch relationship, and tooth position.


    Most of the patients with OSA were men (89.1%), and the mean baseline values for age, BMI, and apnea-hypopnea index (AHI) were 56.3 ± 13.4 years, 26.8 ± 5.6 kg/m(2), and 42.0 ± 18.6/h. The average duration of nCPAP use was 35.0 ± 6.7 months. After nCPAP use, cephalometric variables demonstrated a significant retrusion of the anterior maxilla, a decrease in maxillary-mandibular discrepancy, a setback of the supramentale and chin positions, a retroclination of maxillary incisors, and a decrease of convexity. However, significant correlations between the craniofacial changes, demographic variables, or the duration of nCPAP use could not be identified. None of the patients self-reported any permanent change of occlusion or facial profile.


    The use of an nCPAP machine for > 2 years may change craniofacial form by reducing maxillary and mandibular prominence and/or by altering the relationship between the dental arches.

  • Applewomyn
    Applewomyn May 6, 2012 at 8:57 am   

    Sleep Dentist:

    Sadly, there are many more than me that feel this way. I believe that the majority of dentists peddling these things (SUAD or otherwise) are not warning their patients *enough* about the reality of bite changes and teeth movement. While I was given a waiver to sign (no more liability to my dentist), the risks were downplayed. I was told that the "repositioner", if used daily, would prevent issues. After talking with an orthodontist, I now know that's not really possible. Further, since I was told to expect *some* change, without more involved care, it's difficult for a patient to know *when* the movement is leading to an irreversible change. I brought the issue to the attention of my dentist and was given a different "repositioner" to try - not told to discontinue use.

    Honestly, I don't think the data/studies on these things are conclusive. They haven't been in use that long and it's not clear that those who have been using them have used them consistently enough to evaluate the results. I wore mine every single night for over a year. I was heavily compliant. The device did help with my apnea, but did not eliminate the snoring (shown by follow up tests).

    I do not think it disingenuous in the slightest to suggest what orthodontists have been predicting with these things for years… lots of new clients. One simply can't anchor a device like this to the teeth, apply force and expect no change - *that* is misleading and disingenuous. Let's face it, NO ONE wants to have to use a CPAP… I hated mine when I got it and looked for any alternative. These oral devices seemed promising and for many they may indeed be the answer. But we're kidding ourselves if we believe they will not have unwelcome side effects in the jaw and in the teeth. I can't agree more that for those with apnea, alleviating the condition and preventing co-morbidities might be a higher priority than maintaining a bite, but honestly, there shouldn't have to be a trade off. I hold these device manufacturers to a higher standard and dental practitioners should be far more cautious about how they monitor and advise patients with these devices.

  • SleepDentist
    SleepDentist May 6, 2012 at 9:21 am   

    Again, I undstand your frustration, Applewomyn, because this has happened to you. I must say, however, that these appliances have been used for more than 25 years (15 by me), which is enough time to get good studies on bite changes. However, there are no studies that I know of showing which appliances cause the most change…or least change.

    I have hundreds of patients who have been wearing these more than a year without bite changes, so I am just trying to keep the record straight. Not all bites will change, but there's no way to know who's bite will change and who's won't. Your orthodontist needs to get a bit more education here if he believes differently. Maybe he needs to understand that he only sees those who have had an orthodontic change, so he will naturally be biased.

    Changes can occur due to a recapturing of the TMJ disc, to lengthening of the muscles of mastication, to remodeling of the TM joint, to edema, etc.., but we even have difficulty in any specific patient with discovering the reason. Some believe this is actually a better position for your lower jaw, and that the appliance is simply allowing you to find a better, more natural "home". But…no studies to prove that.

    BTW, even though this is a dental device, this is actually medicine. Sleep apnea is a medical problem, not a dental problem. When you look at medicine, no procedure is without potential side effects. If you are looking for a treatment modality that is absent of these, you will be looking for a very long time.

    I truly wish you success in solving your sleep apnea. It should not be left to create more health issues for yourself…or danger to others.

  • Tracy
    Tracy January 16, 2011 at 11:41 am   

    Lucky you that your insurance is paying 80%! I am wishing you success and will be anxiously awaiting to read your posts, sharing with all of us your experience in using this oral appliance.


  • Avera
    Avera January 13, 2011 at 11:21 pm   

    Thanks for the link to the web site. I can't wait to hear how it works for you.

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