How to get an MAD prescription when RDI = 4
Hi all, my friend has severe UARS-like symptoms (unrested after 12 hours of sleep, wakes constantly at night, anxiety, cognitive symptoms) and strong OSA physignomy (small mouth, recessed jaw, sleep ). Her father has OSA and UARS as well.
I convinced her to do a watch-pat based sleep test. The WATCH-PAT test found an RDI of 3.5. However, she slept only had 10% rem 10% deep sleep and the test was cut short by her waking of for work after 5.5 hours. She also had an average heart rate of 77, which is crazy high. Test did not report the RDI in REM separately because I used crappy Sleeplay provider.
I suspect that she was too alpha activated by flow limits to enter deep sleep or REM often, and therefore her RDI was artificially low or miscalculated by the WATCH-PAT.
What's my best path to getting her a mandibular advancement device in the US (DMV area). I'm worried that most sleep clinics here don't care about flow limits at all, so they will just dismiss her. I could get another better study done?
I know insurance may not cover the MAD, but I would gladly buy it out of of pocket. But in the US you need a prescription to even buy one, a dentist can't just make it.
Does anyone have a suggestion?
Btw way, the recent RCTs on UARS have shown the MADs are effective and they use RDI or flow limits to score patients in, which Guilleminaut also advocated for.
