Mandibular Advancement Devices: #1 Snoremate

If you've never seen one of these devices before, imagine it as a two gumshields stuck together, with the gumshield for the lower teeth fixed so that it forces the wearer to jut their jaw forward. The mandible is the jawbone, hence the term "Mandibular Advancement"

The idea behind this is that forcing the jaw forward creates more room in the airways by shifting muscles and fat forward slightly, reducing the likliehood and severity of airway obstruction.

Mandibular advancement (either by a specially made dental device, or by surgery) is a tried and tested concept of reducing snoring and sleep apnoea, so I'm not really putting that to the test, but rather I'm trying out the off the shelf concept, although my snoring is sleep-apnoea related, so unless the device can remedy the apnoea, I doubt that it will affect my snoring. 

SnoreMate

This is an off-the-shelf (but custom fit) mandibular advancement device (MAD).

The SnoreMate is made from a thermoplastic that you dip in hot water to make it soft, then bite into it to form a custom fit for your teeth. The SnoreMate can be adjusted by re-dipping it in hot water if you feel the need to advance your lower jaw more to increase the effectiveness of the mouthpiece, something that I did after a few nights of using it.

It was easy to mould, and is the most comfortable of the two mouthpieces that I've tried so far (the other device being the SomnoFit) which I found was too bulky to be comfortable for me). I was surprised that on the first night It stayed in place until around 2am, and on subsequent nights (to get used to it before I monitored it) it remained in place until the morning. It was actually quite easy to get used to. In fact it was surprisingly comfortable, so I purchased a second Snoremate and moulded that one slightly further forward rather than risk losing the comfortable positioning of the first one.

However, there are a couple of drawbacks to the mouthpiece, the main one is saliva build-up! I found myself waking at night just to swallow and clear my mouth. The other drawback is that my gums and a couple of teeth ached for a few of hours in the morning.

As far as snoring reduction went, using the method explained in this post, I was very surprised. I imagined that everything I used in addition to the Rematee would either improve on the Rematee's effect or make no change. I think that the graph shows why I was surprised...

The SnoreMate actually made my snoring louder! This would have been very annoying for anyone in the house as I managed to reach 98db (about the volume of a drill drilling!). This is an unacceptable volume when you consider that I was already sleeping on my side and wearing a mandibular advancement device. Although to be fair, it is an anti snoring device, and my snoring is more than snoring, it's related to sleep apnoea.

In the following clip it resembled a moose-call.

However, I had a lower AHI for the three nights (mean 2.05) with one of the nights using Snoremate with the Rematee giving me my lowest ever AHI of 0.77.

If I had to speculate as to why the snoring increased in volume (and sounded slightly different in tone) yet the AHI was lower, I'd have to say that it was probably due to the fact that, by design, it is impossible to breathe through your mouth with the SnoreMate, so the air has a to take a different path through the nasal passages, rather than through the open mouth of the snorer.

Even wilder speculation:  The SnoreMate was probably doing what it was intended to and tightening / stretching the muscles in the airways meaning that they were less prone to relaxing, hence less hypopneas. Again, further speculation, but it is possible that this also caused the snoring to be louder in the same way that in deflating a balloon a screech caused by keeping the neck taut is louder and higher pitched that if you were to let the neck relax causing a quieter lower-tone rapserry sound.

I was so intrigued by this hint that it was working, that I've made an appointment at my dentist to have a professional Mandibular Advancement Device constructed for me and I'm looking forward to being able to compare the results. My hope is that the professional device will allow me to further advance my jaw, keeping my airway muscles even tighter, elimating my apnoeas and maybe my hypopneas (and hopefully snoring too).

Snoring Remedies? Results for 5-HTP

Using the method detailed in this post I decided to see if 5-HTP had any effect on my snoring.

I was keen to try out 200mg of 5-HTP first, given that it had previously had such a positive effect on my AHI.

My thinking was that if 5-HTP had been able to reduce the gross movements of my airways that are responsible for obstructive sleep apnoea, then maybe it would also be able to reduce the smaller movements that are responsible for snoring. However, I suspected that as it hadn't been able to completely prevent airway restrictions that it wouldn't have an effect on the smaller movements. 

It seems that I was wrong. The results were promising to say the least. 

5-HTP was able to reduce my snoring further than that offered by just sleeping on my side.

Given that from my data alone there are two indications that 5-HTP is beneficial to sleep (AHI reduction and a reduction in snoring) I would love to see a larger scale experiment or trial take place, after all I am just "n=1".

Prior to taking 5-HTP I researched it in medical literature with regards to dosage and possible side-effects. After seeing my results I went back to the literature and started looking for a possible mechanism or explanation as to why 5-HTP might have this effect.

I'm working on a summary of what I've found and will post it in the near future.

For the future:

• I'm curious as to whether the 5-HTP would reduce my supine snoring index, given that my snoring is at its loudest and most frequent when on my back so I will record a three-night mean of 5-HTP sleep when I will be free to move and produce supine and free-to-move snoring indexes via the Visi-Download software.
• I'm also curious to see what different doses would achieve, so I'll carry out three night mean trials of side-sleep + 50mg, 100mg and 300mg of 5-HTP and measure the effect on my AHI, snoring profile and sleep stage data.

Snoring Remedies? Introduction and Positional Therapy Results

Snoring occurs when the tissues of the airways relax during sleep causing the air to vibrate as it passes over them, in a similar way that deflating a balloon causes the balloon's neck to vibrate and make that familiar raspberry sound.

This can be illustrated by the following airflow waveform taken from my snoring using Stowood's Black Shadow Sleep Monitor.

What should have been nice smooth breaths like these... 

...ended up becoming jagged saw-toothed breaths like these...

...resulting in a rasping snore.

To give you an idea of what the Visi-Download software allows me to see (and how the vibrations above actually sound) I've made a short video of a few snores that I recorded on one of my baseline nights:

Snoring can simply be just that - a noise, it can be a nuisance if it's too loud as it can wake others in the house, if it's loud enough it can actually wake the sleeper! However, it can also be much more than just a noise. Besides being the cause of much nocturnal anger and maybe even the cause of a relationship breakdown, it can also be a sign of a greater health issue such as sleep apnoea.

I snore. In fact my snoring is sometimes so loud that I hear it in my dreams.

If only that were as as serious as it got, but my snoring is actually due to sleep apnoea. As documented in many posts on this blog, I have mild sleep apnoea.

I've found some ways to bring the apnoea to acceptable levels with a typical AHI of between 1 and 3, (an AHI of under 5 is considered normal if it doesn't cause symptoms such as daytime tiredness etc). The way that I did this was to keep off my back when I slept by using a Rematee belt. This also had a knock-on effect of reducing my snoring, but not eliminating it.

On the nights that I've recorded while using the Rematee to keep me off my back, my AHI has been stable and my snoring has reduced (the residual respiratory events are mainly hypopneas, although the lowest that my oxygen saturations drop to has improved, it still drops to around 79%).

Besides looking for other ways to bring my AHI down even more, I want to go further and eliminate my snoring. I guess that my long term quest is to see if it's possible to have the much hyped perfect night's sleep.

Many snoring remedies (and there are many) say that they are not suitable for snoring that is caused by sleep apnoea, so with my new found side-sleeping "normal" AHI and some residual snoring I now find myself in a good position to put them to the test.

Quantifying Snoring 

The problem is that snoring is hard to quantify. Yes, you could ask a partner, but that answer would be fairly subjective. You could judge by how you felt in the morning, but again that is subjective. You could even place a Dictaphone beside the bed to record your snoring but besides but again, how do you score the recording?

One of the channels that Stowood's Black Shadow sleep monitor measures is snoring, and it does this via a calibrated microphone, allowing you to quantify how loud each snore actually is. It also derives a second channel from the sound to identify individual snores, thereby allowing you to actually have a snore-count. From there it calculates a snore-index (a number of snores per hour, grouped according to volume).

So, my method is this:

By keeping off my back I am essentially apnoea-free, leaving only the snoring to be addressed, so to ensure this and to eliminate the effects of a variable sleep position on my snoring (and to bring my AHI to normal), I'll be wearing the Rematee belt whilst putting a different snoring remedy to the test each night hoping to eliminate my remaining snoring.

I'll record sleep data for three nights per selected remedy and calculate the mean snoring profile for each by graphing each remedy according to:

• Hourly snores between 55db and 65db
• Hourly snores between 65db and 75db
• Hourly snores greater than 75db 

This "Snore Profile" will not only allow me to see if the total snores have been reduced, but it will allow me to see if the remaining snores are quieter.

This graph shows the mean snore profile for my Supine Baseline, Free-to-Move Baseline (calculated from the same nights), and my Rematee baseline. 

The majority of my snores are louder than 75db regardless of whether I sleep on my side, back or am free to move around! Not unexpectedly then, it follows that the next largest chunk of my snoring falls between 65 and 75 db with hardly any under 65db.

The "Remedies"

There are plenty of "remedies" available. Some of these are traditional remedies (using the term loosely), and some are more modern commercially available remedies.

• Positional Therapy - (Tennis Ball / Rematee) already shown above

It's clear to see the positive effect that side-sleeping has on reducing my snoring. It reduces my snoring by over 50%, so it is likely that this in itself will be a clear leader in the remedy league table. I suspect that for many snorers (where their snoring is not caused by apnoea) that the Rematee and side-sleeping could eliminate snoring completely.

• Mandibular Advancement Devices
• Nasal dilation
• Snore Spray
• Humidifier by the bedside
• Anti-Snore Ring (Acupressure)
• Anti Snore strip (on roof of mouth)
• Drinking a glass of water before bed
• A night time garlic gargle
• Toothpaste under the nose
• Electric snore-shocker devices
• Nasal irrigation

 I also want to explore the following to see if they have an effect on my snoring.

• 5-HTP
• Melatonin
• L-Tryptophan
• Blood sugar levels
• Large dose of vitamin B6

I'll pick from this list (avoiding some completely) and put them to the test for three nights to get a mean snoring value. To avoid creating a very long post I intend to create a separate post introducing each remedy (and how well it performed). When I've finished I'll then chart the results together. 

Besides bringing my AHI to an acceptable level to address the residual snoring, part of the reason for staying on my side for the entire night is that it will allow a fair comparison of snoring in all sleep stages (I typically spend around 2h10 minutes in REM and 45 minutes in Slow Wave Sleep). I'll also be keeping an eye on my Zeo stats to see if any of the methods have an effect on my sleep composition. I expect that the methods that rely on disturbing you during snoring episodes may have a negative effect on REM or Slow Wave Sleep.

Update on Saturday, May 19, 2012 at 1:08PM by Hypnagogia Blog

5-HTP Results

Using the method detailed in this post I decided to see if 5-HTP had any effect on my snoring.

I was keen to try out 200mg of 5-HTP first, given that it had previously had such a positive effect on my AHI.

My thinking was that if 5-HTP had been able to reduce the gross movements of my airways that are responsible for obstructive sleep apnoea, then maybe it would also be able to reduce the smaller movements that are responsible for snoring. However, I suspected that as it hadn't been able to completely prevent airway restrictions that it wouldn't have an effect on the smaller movements. 

It seems that I was wrong. The results were promising to say the least. 

5-HTP was able to reduce my snoring further than that offered by just sleeping on my side.

Given that from my data alone there are two indications that 5-HTP is beneficial to sleep (AHI reduction and a reduction in snoring) I would love to see a larger scale experiment or trial take place, after all I am just "n=1".

Prior to taking 5-HTP I researched it in medical literature with regards to dosage and possible side-effects. After seeing my results I went back to the literature and started looking for a possible mechanism or explanation as to why 5-HTP might have this effect.

I'm working on a summary of what I've found and will post it in the near future.

For the future:

• I'm curious as to whether the 5-HTP would reduce my supine snoring index, given that my snoring is at its loudest and most frequent when on my back so I will record a three-night mean of 5-HTP sleep when I will be free to move and produce supine and free-to-move snoring indexes via the Visi-Download software.
• I'm also curious to see what different doses would achieve, so I'll carry out three night mean trials of side-sleep + 50mg, 100mg and 300mg of 5-HTP and measure the effect on my AHI, snoring profile and sleep stage data.

Lucid Dreaming - Sending a Signal to the Waking World

Lucid Dreaming seems to be a bridge between the waking and dream worlds. You are dreaming, yet you are conscious of dreaming and capable of having rational thoughts during a jumbled dream.

Being lucid doesn't mean that you have full control over your dreams, despite being aware that I'm dreaming I still find that I am compelled to "play along" with the dream that I'm given. So, for example, if I find myself dreaming of a street scene, I can't magically transform it into countryside. In order to change the scenery I have to make the change fit into the story somehow, even if the scene-change is something as crude opening a shop door and "knowing" that it takes me to the countryside.

All this is wrapped in the fact that (for me at least) lucid dreaming is a constant struggle to remain lucid, it doesn't take much to lose lucidity and slip back into a normal dream. 

So when I suggested sending a signal from a dream in this blog-post, I thought it unlikely that I'd ever be able to remain lucid and have the presence of mind to consciously send a signal to the Zeo Raw Data (via ZeoScope) marking the lucid dream.

I'd been briefly practicing what sort of a signal to use before going to sleep every night, hoping that it'd stick inside my head if I was fortunate enough to have a lucid dream. Given that the signal has to be based on eye movements I was fairly limited in what I could do, but the practice sessions showed me that flicking my eyes from side to side just seemed to produce a very noisy signal and something that could be interpreted as EMG noise from my forehead, so I settled on eye movements to the right, then centre, which produced a nice peak on the raw EEG data (it is this type of peak that the Zeo filters to use for its EOG signal).

Because the eye movements were forced as far right as I could manage the amplitude of them rose above the normal eye movements of waking and REM. 

(Normal eye movements during a period of REM (right to centre first, followed by left to centre)

On Wednesday night I became lucid in a dream and managed to stop and send a signal using my eyes that was picked up by the Zeo.

The first thing that I remember about the dream was that I was late to get to a party and I still had to stop off and buy a bottle of something to take along. I lifted up and flew along the coast of the Thames Estuary not far from where I live. 

This was the thing that prompted me to become lucid. Flying is such a break from the everyday laws of physics that it jolted me into realising that I was dreaming.

So, I went along with the dream, flying to the party but stopping off at a small stone-clad Welsh off-licence (I have no idea why I ended up in Wales). As I landed and my feet touched the ground I remembered that I was wearing the Zeo headband and recording the raw data, so I darted my eyes sharply to the right and centred them again.

Then I thought, "That's just one, maybe it'll get lost in the other data", so I repeated it 5 more times, then bought my wine and Jaffa Cakes, lifted into the sky and headed for mainland Europe (where the party was apparently).

Shortly after arriving at the party (which turned out to be in a 1970s church hall), I woke up and glanced at the clock before falling asleep again.

In the morning I found it easy to see the signal that I'd recorded. The peaks were a lot larger than my typical eye movements. The first peak is my initial signal, then after a pause I gave 5 more right-eye movements.

So, not as significant as a signal picked up by SETI but still, this is a signal from the dream-world to the waking world. It actually reassures me because several people have asked me, "How do you know that you're not just dreaming that you know you're dreaming?" implying that lucid dreaming is itself a dream. This shows that it isn't. At the time of the signals, I remembered that I was actually asleep in bed and not outside an off-licence in Wales and although I was still standing on the cobbled street and not able to sense the waking world I was able to make an impact on it via this signal.

From the Zeo raw data it seems that a broken night played a part in triggering this dream, and I suspect that respiratory arousals were the cause again as I wasn't wearing the Rematee belt. A rough breakdown of the time surrounding lucidity is as follows...

• 04:34:45 Woke from a long stable period of N1/N2 (light) sleep
• 04:39:15 Entered REM (from wake)

Repeated awakenings and a mixture of N1/N2 and REM until... 

• 05:00:15 Entered stable REM
• 05:03:26 Began to signal lucidity
• 05:03:37 Gave last eye movement of lucidity
• 05:06:14 Woke and looked at the clock before going back into REM again
• 05:11:14 REM ended

So this places my lucid dream within REM, which was the subject of speculation for years until Stephen LaBerge confirmed that lucid dreams are actually REM dreams. 

Jeff Warren also has a good explanation of the technique in this exerpt from his book, "The Head Trip". 

Stephen LaBerge, William Dement, Lynn Nagel and Vincent Zarcone took things a lot further and even recorded morse code signals from a lucid dream via muscle-movements.

I'm still not any closer to seeing a trademark brainwave pattern of lucid dreaming, but I suspect that this is due to the single site EEG. 

I'd like to practice this further and if I'm fortunate enough to be able to do this again I'd like to try to repeat the signal every 60 seconds (as it appears to me in the dream), or at key points in the dream (such as taking off and landing, meeting a person etc etc) it would be interesting to see if these signals can be used as markers to chart the flow of time through a dream.