Hey there @Former-Member 🙂🌺
yeah there’s loads to take on board - it’s not straightforward and the information released to public isn’t very well contextualised/put into context of how it fits with all the other therapies out there 🙂
The MAD’s are (usually) made by specialised trained staff like I was, within places that provide sleep assessment services/provision of equipment (I used to run/monitor a sleep laboratory which is where people go to have their sleep tests overnight), or dentists, and I trained with some GP’s who learned how to do it as a side hustle to complement their practice income.
Strictly speaking, a mandibular advancement device as the ones usually studied, are tailor made by a fully trained and certified person. The thermoplastic blanks you can buy and heat mould to your teeth don’t give anywhere close to the same effect on opening the airway by significant and specific measured advancement of the lower jaw, and the occlusion may not be very well aligned (how your teeth come together once you close your mouth/jaws - if this isn’t right, you can get jaw joint pain, etc). There are mathematical calculations around a persons jaw/face that provide a foundation on which you fit a proper MAD, for instance.
none of this happens when buying a thermoplastic blank and heat moulding it to fit your teeth impressions, which prevent it from sliding around or falling out, however it doesn’t have too much to offer in terms of increments of advancement of the jaw to open the airway (it’s less a forward displacement of the MAD, and more a rotational displacement…ie: opening a persons mouth a bit more at the hinge of the joint, by having something between the teeth).
Ok, I was trying to make this simpler, but I’ve added a bunch more info haha - I hope it’s helpful? 🙂🌺
There are a variety of manufacturers for MAD’s, and they may or may not be partially or wholly owned by companies that also have interests in air pressure splinting/ventilation devices, but from what I noticed during my years in the industry, this was a result of natural attrition over time (big companies buy small companies where they want to dominate the market - seems the way of the world, pretty much).
Anyway, where I used of work, the MAD was pretty much the same price as a base CPAP machine, so in terms of having only upper airway obstruction, patients would end up with basically a 60/40 split (in favour of air pressure devices like CPAP/APAP), and most people moved to MAD’s due to claustrophobia, partner sleep disturbance, affordability over time (the CPAP masks need to be replaced to maintain their seal capabilities and they and their parts are $$), and breakages, or need to travel without an air pressure machine in tow.
Most people - once fitted appropriately for mask and they actually have had thorough diagnostics to ensure they have the correct equipment and prescription settings - are super thankful and extremely happy with the benefits they gain from both MAD’s, CPAP/APAP, ventilation, and everything in between…what keeps you alive and well as opposed to being unwell and exhausted people usually love using 🙂🌺
interestingly where I worked, technician stats were tracked, and I had particularly high success rate with all different types of devices from across the plethora of items out there (including positional devices - which are yet another type of device used to treat obstructive sleep apnoea).
Over time, more people would prefer to use air pressure devices instead of MAD’s long term, and some people with purely OSA sometimes used a combination of both on alternate nights…
Anyway, I hope that’s a little more informative.
Keep in mind that MAD’s only work when someone doesn’t have any problems with their ventilation - if they do, a MAD will not do a thing besides cover their pillow with huge amounts of drool overnight, while their blood oxygen remains low because they need ventilation pressures to breathe ‘for’ them 🙌🏻🙂🌺
