Sleep Apnea can be caused, or at least exacerbated, by a jaw that sits too far back. My sister in-law has a jaw that sits far enough back that it obstructs her breathing when she’s sleeping. Because she’s not overweight, her insurance won’t cover the cost of the surgery she needs. I think the mindset of the insurance company is that this should’ve been taken care of in childhood (it has to do with orthodontics [actually she said it's a medical problem... my mistake... it's the orthodontist who can tell with an xray if the jaw is recessed.] ) and if she’s lived with it this long, it must not be a big deal. She needs this surgery because of sleep apnea and severe tmj issues. Golly. I wonder if she gained a couple hundred pounds, if they’d cover the jaw surgery and the gastric bypass. Can you say “NONSENSE”??
I’m concerned about sleep issues with a couple of my kids so I’ve been talking to my long distance sister in-law about her issues and it’s scary! Have you read about the potential complications of poor quality sleep? That’s some serious stuff!
I don’t have anything major to add except links.
Here’s an excerpt of an email I sent her. I should’ve posted this instead of the lame attempt at an answer to the sleep question yesterday.
Everything, and I mean EVERYTHING, that I have read thus far points to sleep apnea in children potentially causing attention issues, among other things. The more I read, the more I can’t believe your dental insurance won’t cover your stuff. That’s ridiculous. Anyway, below are a few of the articles I came across last night on the subject.
Here’s an article on Childhood Sleep Apnea from Stanford. Note the symptoms.
Here’s another one I just came across while looking for the ones I had read previously.
From the American Sleep Apnea Association.
From the National Sleep Foundation.
and the last for now, an answer from Mayo to a parent’s question about their child.
You can get a thing like a gum guard to use which pushes your jaw forward and helps a lot. The pukka article is provided by a consultant and you are measured etc etc but my mother in law wore one she bought straight off the net for years while she was on the waiting list (5 years, to be precise). She also wanted to try it out before doing the whole NHS consultant thing.
She found it worked really well, she used to get migranes, now she hardly ever gets them and if she does it’s usually while she has a cold - you can’t wear the mouth guard while you have a cold as one of the functions is that it makes you breathe through your nose by blocking your mouth! She took a while to get used to it but once she did, she never looked back. She got hers from Snoreban, I think it’s http://www.snoreban.com or it may be a .co.uk [It's the .co.uk ending: http://www.snorban.co.uk/ - Mrs N] - it’s sold as a snoring cure, anyway, but just happens to also help with Sleep Apnea.
I hope this helps.
Cheers
BC
Ah there’s one with a company called snorepro which is outlined here http://www.sleeppro.com/html/product_details.html
that’s the kind of thing I was talking about I think. This is the one my mum in-law used http://www.snorban.co.uk - sorry I got the address wrong in my earlier post.
Good luck!
Cheers
BC
Thank you for both of the links. I sent them to my sil and am checking into one or the other of them for the snoringest kid in the house.
I’m curious what kind of surgery your mother in-law had/will have. Does it have to do with the jaw also?
Hi Mrs Nicklebee.
My heart goes out to your sister-in-law. Does she wear either the CPAP or BiPap masks to sleep. I have sleep apnea and have worn the CPAP mask for about 5 years. Uncomfortable for the first few days but you quickly get used to it.
Haven’t heard from you in a while hope all is well.
Bill
She’s not going to have any surgery but she was sent to a specialist to be fitted with a mask properly. Unfortunately I don’t know what type it is, only that she has to be able to breathe through her nose so she can’t wear it with a cold.
Having discovered what the mask was going to do, she bought the snorban one to be going on with to see how it felt. It worked really well but I think the made to measure one she now has from is more comfortable.
I think she might have had to have an op if the mouth thing hadn’t done the trick. We’re spending Christmas with them so I’ll try to remember to ask her about it.
Cheers
BC
I thought I replied to Bill on this one.
Bill, as far as I know she doesn’t have a machine. She has never mentioned it though so maybe she does and I haven’t heard about it.
You mentioned your sister-in-law’s dental insurance won’t cover the surgery??? I hope she continues to pursue this with the medical insurance. An oral surgeon will perform a mandibular advancement and might have experience working with insurance companies. I plan on going that route myself. I also have a recessed jaw. Years ago, they didn’t do anything for recessed jaws! Now they can move them forward while the child is still growing with a simple appliance. My daughter had that and it worked!!!
I would like to know more about the appliance you mentioned. One of my kids has seen an orthodontist and the ortho has confirmed that he has the same thing as my sister in-law.
Does your insurance cover the procedure? If so, how are they covering it? Is it with the simple “recessed jaw” diagnosis or is there more to it than that?
Please share all of the hoop jumping you have had to go through to get this covered!
The appliance my daughter had was a “phase one” twin block appliance. I can’t remember how long she wore it but she was around 9 years old. The orthodontist supplied it and it was covered at 50% with our orthodontic insurance which had a cap of $2,000. We paid the rest. Our dentist was pleasantly surprised at the result and thought for sure my daughter would need surgery. Both she and I sucked our thumbs. She sucked until age 7, I until age 10.
As far as my “hoops” go, I have had a sleep study so far which showed mild apnea. I am only in the beginning stages of looking into this. In all my reading on sleep apnea, recessed jaws are often a contributing factor. It seems like some research shows a significant success rate in surgical advancement of the jaw in people with this reason for sleep apnea. I don’t know what to expect since mine was mild.
I’m sorry if I mislead you about this being covered. I am totally in the way early stages.
The appliance that permanently moves the jaw forward has to be administered during a child’s growth. I asked the ortho about this at the time (12 years ago)and he said nothing short of surgery would work for me at this stage of life.
I have many steps to go, but I wonder how much this has affected my life as I’m tired all the time, I often have a sore neck and back (from poor posture) and my bite doesn’t have a good settling point. Anyway, it might be a “pipe dream” to have this covered but I’m going to try.
Sorry I couldn’t be more help currently.
You’ve been a big help. You didn’t say it was covered, I just assumed. You know what they say about people who assume. *blush*
I’m going to check into the device for my son. We don’t have a lot of options because of our insurance but it’d be worth asking the ortho and getting a second opinion if he’s not up on it. Right now Dub, 11, has a space maintainer because he has a lot of crowding and thousands of permanent teeth coming in at once. If only they made Robogrips for teeth. I’ll have to run out to Sears and see what they have.
I could take care of all of those loose baby teeth in a jiffy.
I hope it works out that you can get the problem taken care of. Mild apnea can become not so mild over time and body changes.
Thanks for your super quick reply. I did a double take when I saw it in there already!
Thanks for “talking”. I do hope things work out well for your son and that he can get by without any surgery.
Thank you!
Hey mcgee33,
If you happen to stop by again, I’m curious to know how things are going for you. Anything new in the jaw department?
Hello Mrs. Nicklebee,
I have a consultation regarding my sleep study next Tuesday. One of the recommendations was jaw surgery - I will try to remember to let you know how that goes.
Any developments for your son or sister-in-law?
Have a great day!
Nothing new on my son and I haven’t heard anything on my sister in-law recently. She was supposed to be having the first surgery this month or next I think.
I hope things go well at your consult. I’ll be praying for wisdom for you and the dr.
Thank you for your prayers, I’m leaving for the doctor in 45 minutes. You reminded me to pray as well, sometimes I get caught up in what I want and forget that my loving Father wants the best for me and I can totally submit myself to what He wants. Thanks for the reminder!
Things went okay with the doctor. He suggested a C-pap machine but thought I could have a surgical consultation as well. My sleep apnea is fairly mild so I’m not optimistic about insurance covering the surgery. I’m losing my motivation to pursue this. The insurance will cover the c-pap (~$2,000) but it will help with the symptoms, not the actual problem. We’ll see….
Well, I hope the cpap helps you enough that the surgery is unnecessary. I think I’d lose my momentum, too.
If it helps you at all, my Dad uses one of those and it has helped him quite a bit.
Do you think you will be getting the machine?
I don’t know, I really don’t want a machine, it seems like a real intimacy blocker, if you know what I mean! I think I will pursue the oral surgeon to at least get an opinion on the risk vs. benefit of maximandibular advancement surgery. After that, I might see the plastic surgeon to ask about a neck lift or a chin implant. What bothers me the most is cosmetic. The funny thing is that I lost 7 pounds and my profile looks better (my neck went down an inch). Anyway, if we keep talking, I’ll keep you posted.
I just reread what I wrote about “if we keep talking” I hope that doesn’t sound funny. I do like your website and talking to you. Thanks for your interest.
lol Thank you, and I didn’t think anything of it.
I understand what you’re saying about the machine. I wonder if it’d have the opposite effect though, if a person is finally getting their rest. It seems like it might have a cascade effect. Sleep better, have more energy, move more, go to bed tired, sleep better, have more energy, move more, eventually build up more endurance, … I don’t know anyone I’d be comfortable asking about a thing like that.
I would gladly give you part of my chin if chin transplants were possible. I have plenty of chin for two. *sigh*
lol - it’s always something! isn’t it????!!!!
So did you end up getting the cpap machine?
I got one 3 weeks ago, got sick after 2 days, was sick until about now, and I’m planning to try it again tonight. I really had trouble sleeping with it. I should have a follow-up with the doctor soon and then I’m hoping to meet with the oral surgeon for a $100 consultation and work-up for submission to the insurance company. I’m trying to hold things loosely and trust that if it’s a good thing, God will allow it, if not, I’ll let it go, accept my recessed jaw, and find contentment anyway.
That was a long answer to your question but that’s what’s going on here. Thanks for asking.
Hello again, I tried the CPAP for a while but always took it off around 2:00 am. Dr. is sending me for the surgical consult and work-up June 4th. He said apnea is mild now, but in 10 years I will need a CPAP if I don’t do something corrective. We’ll see what the oral surgeon says.
I’ll keep you posted. Thanks
Gosh, I obviously missed your comment!
One of my sons, without the recessed jaw, is getting a CPAP machine. He just had a titration study last night. He had very good results even though the mask was kinda weird. I was told that his sleep apnea was mild. That may be but I noticed a big difference in the way he woke up this morning. Maybe it’s different for kids.
He’s having his tonsils out sometime this summer in the hope that it will take care of the obstructive S.A. Do you still have your tonsils?
No, I had my tonsils out when I was 20.
I visited the oral surgeon today. He took a panoramic x-ray and some measurements and is filing an insurance claim. The main complaints are excessive fatigue and soreness of jaw and teeth. It should be 6-8 weeks before we hear anything from the insurance company.
We’ll see what happens.
Hope you continue to see improvements in your son now and especially after his tonsillectomy - that would be an easy solution!
Thanks! Me, too.
Your symptoms don’t sound fun. Hopefully the oral surgeon can get you straightened out and your insurance company will cooperate.
So far the insurance company won’t cover but we are going to appeal. The wording in the insurance policy is so vague - it has to be physiologically medically necessary or something like that. We will try to include their own language in the appeal letter. I will keep you posted. Thanks!
Well, gosh! I think being able to sleep and breathe at the same time might be physiologically medically necessary! lol
I hope your appeal works.
My appeal was approved! It’s been fun going through this with you and being able to let you know it was finally approved. I just read our conversation since Jan. and all the “hoops”, I’m glad it’s been recorded :-).
I was thinking about your sister-in–law today and wondered where she was in this whole process. A while back you mentioned she was going ahead with the surgery?? If you know anything more, I’d be interested.
I heard recently, that insurance companies sometimes deny claims the 1st time, then consider more carefully those who put the effort into the appeal process. I wonder if that’s true??? I included some information from the internet about jaw advancement surgery and sleep apnea from a study that said there was above a 95% success rate with this type of surgery. I’ll call Tuesday to see what the next step is in this process. I believe it’s about a 2 year commitment to braces and surgery. Thanks again for your interest.
I was wondering if it would be worth it for your sister-in-law to appeal her insurance companies decision and also to have a sleep study if she hasn’t already???
Anyway, “talk” to you soon!
Mcgee
I’m so happy for you!! Insurance companies can be real bears to deal with. I’m so glad for you that your appeal worked!! What a load off!! Will this be under your dental insurance or medical?
My sister in-law has sent all kinds of documentation to her ins co to no avail. They are still calling it cosmetic. I am not sure if she has had a sleep study. It might actually help to have the results of that to send in with another appeal. I’ll email her later and ask.
Yes, she has started her process. This winter she had her top jaw surgery done. Her Dad can tell a difference but from the photo I saw, I didn’t see one. She said, though, that there was a gap between her two front teeth after the surgery. If that’s the case, then there’s definitely a difference.
If I understood right, she had dietary restrictions for about three months. She wasn’t on a liquid diet for all that time but was gradually able to add more and more. My in-laws visited her in July for her birthday and they took her out to eat. My fil said that she had just started eating without restriction. I think her surgery was in April.
I think her lower jaw will be done this fall. Before I say another word, I’ll email her for the details and finish this reply then.
Ttyl!
This will be covered under my medical insurance. Can’t wait to hear more about your sister-in-law!
ttyl
As far as I know, all of her appeals for coverage for the work needed have been denied as cosmetic. You would think that TMJ would be enough of a reason (I can’t remember if I’ve mentioned that aspect of it) but what do I know?
I emailed her for an update but haven’t heard anything yet.
Will yours be done in a hospital setting or in an oral surgeon’s office?
Okay, I received a response from her and she is having her surgery done this month. She expects to be off work for at least a month but will know more after her appointment in a couple of weeks.
Hi Mrs. Nicklebee! Sorry it has taken me so long to reply. I do think my surgery will be done in a hospital. It will be both top and bottom jaw and also the chin advancement.
I met with the orthodontist in October and had a full set of records taken. They showed that my airway is only 6mm. I’ve read many articles on sleep apnea and found one that suggested an airway smaller than 9mm is an indication for surgical advancement. A normal airway is between 10 and 12 mm. So, I’m seriously considering this.
I know that probably sounds funny, I guess I have seriously been considering this all along. However, after gathering information on the cost (even with insurance ~$10,000 including braces), and the time, and the fact that it would change my appearance, I’ve been a little more hesitant. I also met with the sleep doctor again, wondering if this would cure my apnea and he, of course, couldn’t say for sure. He also wisely said that my reason for fatigue might be something other than apnea. There is one cheap way to find out and that is a temporary dental appliance. Wisdom says I should try this to see if I feel better. My desire to “just get on with it” says just go for the surgery. I think having a standard sized airway would be a good thing either way!
But, all that to say, I’m not sure what I’m doing yet. All this has transpired in the last couple of weeks. So, that’s the latest.
I hope your sister-in-law is doing well. How is your son?
Bye for now,
Mcgee
Wow! All at once, huh? That would be an intense few weeks recovering, not that you need me to tell you that. Have you tried the appliance yet? That would be the cheap way to confirm what you probably already know.
Out of curiosity, how did they measure your airway? I gag at the thought!
We haven’t done anything with my son lately in this regard. Not that son anyway. My older son had his tonsils out in July and is doing much better. He seems to be getting good sleep and his energy level is almost what it should be for a boy his age. Now we’re working on getting him to a healthy weight. He hasn’t been gaining, so that’s an improvement.
My sister in-law is recovering and that’s about all I know. I spoke with her a couple of weeks ago and she was feeling more like a human being. She still had some numbness in her chin and bottom lip. She was waiting to see if that was just from the swelling and the muscle rebellion. She did not need her jaws wired. Evidently they put titanium screws in so wiring them shut is not necessary. My husband, her brother, was going to send her some toffee or caramels or sugar daddies or something. He’s a real thoughtful guy that way. lol
Thank you for the update. I was wondering what was going on with you.
Wow! All at once, huh? That would be an intense few weeks recovering, not that you need me to tell you that. Have you tried the appliance yet? That would be the cheap way to confirm what you probably already know.
Out of curiosity, how did they measure your airway? I gag at the thought!
We haven’t done anything with my son lately in this regard. Not that son anyway. My older son had his tonsils out in July and is doing much better. He seems to be getting good sleep and his energy level is almost what it should be for a boy his age. Now we’re working on getting him to a healthy weight. He hasn’t been gaining, so that’s an improvement.
My sister in-law is recovering and that’s about all I know. I spoke with her a couple of weeks ago and she was feeling more like a human being. She still had some numbness in her chin and bottom lip. She was waiting to see if that was just from the swelling and the muscle rebellion. She did not need her jaws wired. Evidently they put titanium screws in so wiring them shut is not necessary. My husband, her brother, was going to send her some toffee or caramels or sugar daddies or something. He’s a real thoughtful guy that way. lol
Thank you for the update. I was wondering what was going on with you.
Mrs nicklebee my 21 year old daughter is being treated for severe tmj and a recessed jaw. She woke up with it one morning in May 07 and as been on pain medication since and also wearing a mouth splint 24/7. We are currently seeing an oral surgeon for her treatment and I do not have dental insurance but my medical insurance is paying for it. We already had arthroscopic surgery for the tmj to get the disk back into place it helped for a couple of months. We are out the point were we have to make a decision of her jaw right now. The doctor we see is our second. My first one never picked up the problem with here jaw nor did her dentist or orthodontic. My question is do we go for a third since we are at the point of possibly go for surgery and getting the lower jaw broken and corrected
Hi MMurph362,
Since I don’t know your situation, I can’t give much in the way of advice. I do want to strongly encourage your daughter to talk to the doctor who is currently treating her and ask him to spell out his plan for her treatment. If she is having a hard time remembering what it is that he has said, ask him to please write it down.
If she is not satisfied that enough is being done to take care of the problem, she always has the right to get another opinion. It may not be free, but it is her prerogative. You might do a Google search for a TMJ forum and try to find others in your area who have had the problems your daughter is having and have been successfully treated. You could find out who their dr. was.
I’m sorry I am not very helpful. I hope your daughter gets the treatment she needs to get some relief.
– Mrs. N