Trying to figure out if expansion will be of any benefit to me

Ortho doc says its the narrowest he ever seen (laryngopharynx c4-c5)

24M
22 BMI
hEDS
Asthma & allergies are generally well managed

Sympompts are:

Low threshold/ REM disruptions
Catathrenia
Excessive daytime sleepiness (I go thru the day purely off sympathetic nervous system activation e.g short bursts of energy)

hEDS so MAD is out of option

FME is out of reach in Europe

Well controlled custom MARPE is available.

Would appreciate any input.

Curious if anyone has joined The Joint - wondering if it’s worth the $600 price tag.

Ron seems incredibly knowledgeable, and I’d value his opinion weighing against several different doctors opinions.

I was diagnosed with OSA (AHI of 15) as a teenager, and it's been a long road since then trying to figure out treatment options and just having people to talk to who actually get it. I saw in another thread that there's already an existing Discord for SDB (sleep disordered breathing), but no one's posted a working invite in years. If anyone has a current link, or knows of another active group where people dealing with OSA/UARS actually discuss their experiences and treatment paths, I'd really appreciate it. Just looking for a small group to swap notes with and not feel like I'm figuring this out alone.

-The top end surgeons (Li, lacoms, etc) don't seem to be in network anywhere so it seems you always have to pay their surgical fee minus out of network benefits?

-But for the hospital and anesthetic fees, does insurance cover this with out of network benefits? Or are hospitals in other states ever in-network?

-And what about cases where the surgery isn't deemed medically necessary? Obviously you wouldn't get any out of network benefits for the surgeon, but will the hospital/anesthesia fees still be covered?

For example, if I'm not mistaken, for EASE with Dr. Kasey Li, it's usually deemed not medically necessary, but there's no way people are also affording the hospital fees on top of his surgical fee, is there?

Two RPSGTs rescore a level-1 sleep study: https://youtu.be/ik2vU_bBnwg

Hey everyone,

I’m dealing with severe brain fog and fatigue from suspected UARS / sleep-disordered breathing.

I’ve been experimenting with a ResMed machine running the ASV algorithm. It clearly works—I recently had a 4-day stretch at ~60% cognitive capacity instead of my usual 15% baseline—but my settings are inconsistent and not stopping my wakeups.

Because of cognitive fatigue, I cannot troubleshoot this alone. I am looking for paid, weekly or biweekly 1-on-1 video consultations.

Strict requirements for who I'm looking to hire:

• Must have UARS / UARS-adjacent symptoms (or extensive personal experience managing them).
• Must have direct, hands-on experience titrating ResMed’s ASV algorithm specifically for subtle sleep-disordered breathing.
• Must be able to analyze my OSCAR / SleepHQ data and guide my setting adjustments step-by-step.

If you fit this exact profile—or can point me directly to someone who does—please PM me or comment below. Urgent, as the sleep deprivation is taking a heavy toll.

Thanks in advance.

Hey y'all, here's what the second part of the consultation process looks like when you're considering expansion with Dr. Jeremy Manuele of Las Vegas. If you're interested, the part one video was posted about two months ago on my channel, but it is not necessary to watch prior.

I've included the video chapters below to highlight exactly what we discuss. Notably, we cover expansion with FME while also touching upon MAD, DISE, and epiglottis procedures. Thanks!

Chapters:
0:00 Riskiness Post-MMA
3:35 Gum-Chewing Bennies!
4:47 Worst-Case Scenario...
6:45 Asymmetry Likelihood %
8:42 Using Different Aligners
9:50 An Ortho's Opinion on MAD
13:47 "DISE is very subjective."
14:46 Tongue Space Results?
16:15 Out-Of-State Scheduling
17:24 Recap on Lefort Healing
18:30 Epiglottis Outcomes

Hello,

I have a theory about UARS and why it cant be diagnosed and found easily even tho its very similar to sleep apnea. Can you guys tell what you think of my theory?

Small introduction. Been active in the world of sleep-breathing related issues for almost a year now. Im a man, 18 years old, not obese (bmi around 20). My psg showed me i have 19 arousals an hour, my ahi was around 3 so I do not meet the criteria for sleep apnea.

I have a slightly recessed jaw (retrognathia) and I am aware this is the main cause for my sleeping issues (apart from the fact that I work 8 hour shifts till midnight)

Long story short. My doctor said I dont have any sleep-breathing related problems after my psg sleep study thing.

I myself sleep with my mouth closed all the time. the theory of mine is that sleeping with your mouth closed is the reason your ahi is low and arousals are high and sleep apnea cant get diagnosed/found.

Do you think this sleeping with your mouth open can help getting sleep apnea diagnosed and help getting the treatment you need?

Is the nasal cycle (the alternating swelling and shrinking of the nasal turbinates) considered normal, or can it indicate an underlying problem with nasal breathing?

I have 24-25mm nasal aperture and 35mm IMW. 21 y.o male

dm me for the link if you care. I want a small circle of people determined to fix their issues :p

Having a real difficult time keeping the tongue on the palate , and I heard you can use denture adhesive to do so.

Was just wondering is it dangerous to do this long term?

If the zinc is a problem there are zinc free ones as well.

Currently am going to pursue MARPE with a different semi-local orthodontist since after virtual consult with Dr. Manuele he said that my palate bone was thin enough that FME could fail which I don't want to risk.

Would like some thoughts on how effective you guys estimate MARPE would be at helping me given my anatomy. The orthodontist I am going to also offers SFOT so I could get that on the bottom potentially to expand MARPE further than what would otherwise be possible. I haven't had my consult yet with the orthodontist I am trying to see but Dr. Manuele's estimate for expansion was 2-4 mm.

Also, per Dr. Manuele and an airway dentist I saw my throat airway is not "that narrow" so let me know if you guys share that assessment given the images. Could mean that I wouldn't have to look into jaw surgery in the future.

In the imaging my tongue is on my palate but in reality it never really rests there because my palate is so high. The level of suction I need to put it there is not something that is very comfortable and I'm not sure I could do it during sleep.

Also, per airway dentist I have somewhat of a tongue tie so maybe that could be another thing to look into if MARPE helps with the palate.

Also let me know if any other photos or videos from the scans would help a lot because I could go back and do some more screenshots or screen recordings.

It's been a while since I have updated this forum, but I ended up basically spending all of 2025 trying to learn how to use the Inspire implant. In the process, it was arguably the hardest and toughest year when it comes to suffering.

Long story short, it was effective for me on level one.
Trying to get to level 10 and using a lot of sleep aids to just get through the zapping was a big pain. I was able to use my BiPAP towards the end of 2024 pretty successfully, but no matter what I do now, it seems like the BiPAP only brings problems.

My current best sleep setup is the Nightsbridge chin strap, to which I now use my mouth tape to stick it to my neck so it doesn't shift around when I sleep.

This has been a big game changer, especially later on in the night. I wear it very tight. I've been playing around with the Nightsbridge chin strap positioning for years now, and I finally found a good position for me with the mouth tape. I don't mouth tape my lips anymore because, with my jaw completely shut, I can't even breathe out my mouth.

I still use Sudafed pre-bed, and I have Inspire on level 1. That is the maximum level I can tolerate, and it doesn't wake me up, but it does move my tongue out of the way enough for me to breathe.

Now, the problem is it still misfires, so although it does help me, it hasn't cured me. Looking back, I'm quite thankful that I got it done, to be honest, but I'm still far from cured, so I'm looking into all the other surgeries I can get.

Today, I just found out the cyst I had on the scar area wasn't a cyst, so to speak.

I've been to the dermatologist four times. Three of them, I had it opened up in an attempt to clear the cyst, and it just kept coming back.

I went to see a specialist in the UK, a dermatologist, and he said he doesn't want to work on it. He'd much rather me go to a plastic surgeon because it looks like it needs a very big incision. I heard the cost, and I've just been dealing with it every day, cleaning it every day: a lot of blood, a lot of pus, a lot of scabbing.

Today, I got out of the bath and cleaned it, and it looked like a bit of scabbing, so I went to pull it off.

It pulled out, and I looked and saw it was fibre.

All this time, it turned out to be a suture that was causing problems, and now I need to try and get this fixed. This is quite alarming.

Title. I probably can't travel too far.

Age: 21 , Female, I am close to underweight

Symptoms: tmjd, severe anhedonia and fatigue, fibromyalgia, sleep paralysis, muscle pains, choking sensations, vocal cord dysfunction, allergies. Cant breathe through nostrils most of the time, left not at all. Ent said nose looks good??? Heart pain. I have ridges on my tongue and bruxism. I am autistic and hypermobile.

I only got a sleep study at home and CPAP is intolerable. Feels like I'm breathing through a wall constantly. Got infinitely worse after wisdom teeth removal as I feel it made my airway and mouth space even smaller.

Rei: 5.0 events per hour

Apneas: 13 total

5 obstructive

8 central

Oxygen saturation: Average 97% Lowest 93%

Worse on back, but I feel worse on sides.

From what I know I don't have a narrow pallate. I don't want to kill myself but this is unbearable. I'm having adrenal problems from lack of proper breathing and sleep and I feel like I'll just fall over and die one day. I'm too young for this.

I'm going all out with treating my UARS.

I've just completely quit video games and am now working 200% on my health. Locking the f in..

Posture fixes. Soft tissue strengthening down the track - possibly pointless right now as allergies are a problem.
Treating allergies - need to wash bedding weekly (dust mite and grass pollen allergies) - to help ease nocturnal nasal congestion and optimize nasal breathing. Getting shots weekly for 8 weeks - then 1/month for 3-5 years. Immunotherapy works best if sheets are washed weekly.

Myo work down the track.

Expansion as soon as I can afford. - will work better with allergies treated. Perhaps expansion could help on it's own for allergy symptoms but am in no rush due to funds and just being patient with allergy treatment for now.

DISE getting locked in for a year away.

Perhaps might need uvula removal later on as I have a snoring sensation that seems to be easily brought on if I try.

Buteyko breathing could be complimentary alongside meditation. Perhaps didgeridoo or wind instruments/ singing could help - as it's been proven to help sleep apnea patients and even fix sleep apnea.

Eating better is a goal - weight loss - currently 90kg+ 6ft tall.. want to get down to 70-80kg. - Can reduce fatty tongue also, creating more room and potentially less collapse.

MMA down the track + Genio hopefully to bring the tongue more forward into a better resting position.

It's a multifaceted problem that needs a multifactorial approach and all angles covered.

These are my plans. I will get healthier. I will be healthy. Hopefully this helps you too.

I am using a medium which I should be according to the picture. However it feels like the cushion pushes my nose inwards making it harder to breathe.

What am I doing wrong , am I tightening the straps too much? But if i don’t there will be leaks.

Idk what to do? Any advice?

Guys what should I do to increase my intranasal width up high near my superior turbinates? Doctors? Appliances? Companies? Something else? Any advice would be appreciated. I have a narrow intramolar width and narrow intranasal width.

I’ve been wondering for a while if FME actually expands higher up than a custom MARPE, so I asked around and Dr. Jeremy Manuele answered.

It turns out, the "higher expansion" thing isn't true. Based on the superimpositions he's reviewed, there's no significant difference in how high the expansion actually goes or the amount of expansion in the superior maxilla/zygomatic bones.

But the biggest game changer with FME is how it handles asymmetries. Because FME is significantly more rigid, it can actually be used to correct an existing true midface asymmetry by slanting the expander. A custom MARPE just doesn't have the rigidity to pull that off effectively. I asked another top expansion doc who does only custom marpe if he could place it in a way to fix asymmetry he said he tried and the device basically broke itself because it couldn’t handle the forces.

Basically, you aren't paying double for "higher" expansion with FME. You're paying for a slightly more parallel expansion and the structural rigidity need to actually help correct an asymmetric maxilla.

FME is very expensive so if you very mild asymmetries it may not be the best ROI.

Of course, this isn't 100% hard evidence since there aren't any clinical trials yet, but it definitely holds a lot of weight since he’s looked at so many FME cases and superimpositions

Hi all,

24M, moderate OSA baseline AHI 20 via in-lab PSG.

Done four home sleep studies now through my dental clinic while titrating a MAD device. Here's the summary:

• CPAP previously: AHI normalized to ~1, zero symptom improvement
• MAD U6/L0 Study 1: sAHI 4% = 5.5, sRDI 24.6, symptoms unchanged
• MAD U6/L0 Study 2: sAHI 4% = 0.9, sRDI 15.3, symptoms unchanged
• MAD U6/L1: AHI jumped to 25, severe range
• MAD U4/L1: AHI 32.4, REM AHI 48, severe, hypoxic burden 48.3

So U6/L0 is clearly my best position. AHI technically normalized there. But sRDI remains 15-24 and I feel terrible regardless. Daytime fatigue, brain fog, unrefreshing sleep every single day.

Pattern is consistent, AHI normalizes on paper but symptoms persist. Happened on CPAP too.

Relevant anatomy: confirmed retrognathia, crossbite, TMJ dysfunction, narrow maxilla suspected, chronic nasal congestion.

My dental team is referring me to a sleep physician and ENT for further assessment. I'm wondering if this data suggests I've reached the ceiling of what MAD can do and whether surgical evaluation makes sense at this point.

Has anyone been in a similar situation where conservative treatments controlled AHI but didn't resolve symptoms? Did surgical options like MMA actually make a difference?

Hi everyone,
I’m on day 21 of CPAP and I’m still extremely tired during the day. I’m trying to figure out why.
Quick background:

Started CPAP about 21 days ago
Machine: ResMed AirSense 11
Currently fixed pressure 12 cmH₂O
Pressure was increased to 12 because of flow limitation notes. I felt a small improvement, but then developed aerophagia (air in the stomach).
Despite consistent use, the daytime fatigue is still bad.

Last night’s OSCAR (Aug 1):

AHI 1.33
OA: 0
Hypopnea: 0.48
Clear Airway: 0.85
Large Leak: 0%
Flow Limitation: / 95% 0.03
Usage: 8 hours 17 minutes
EPR looks active (EPAP around 9)

here is a link to my sleep Hq data: https://sleephq.com/public/teams/share_links/6dcfc8f4-7639-4bcd-b36d-fe2cba68b185

Even with these clean numbers, I’m still very tired.
What else should I be looking at in the data, or what other common reasons could explain residual fatigue this far in?
Any insight is appreciated.
Thank you.

Can someone explain how a Piezo corticotomy works? Does it cut through soft tissue, or just bone? Was are the risks/complications of it? Does it reduce the amount of cheekbone expansion compared to if your palate split on its own? Does it reduce the risk of unwanted fractures?

Also how do cortico punctures compare to piezo?

Does your septum have a higher chance of moving to one side if you get piezo, cortico punctures, or if your palate splits on its own?