4 ms·

Tangential, but I have sleep apnea. Fortunately I have it mild enough to get away with a mouthpiece instead of a CPAP (which is good anyway because I also have

by tombert 7mo ago

Tangential, but I have sleep apnea. Fortunately I have it mild enough to get away with a mouthpiece instead of a CPAP (which is good anyway because I also have bruxism). The mouthpiece works great and I would recommend everyone get tested for sleep apnea if your insurance covers it, but I have to admit that paying for it bothered me. Even with insurance covering some of it, it cost me about $600. I know that there's a deceptively high amount of engineering required for these kinds of things, but it was very hard to wrap my head around paying $600 for what amounted to a couple pieces of clear plastic. I actually got them to send me the STL of the scan of my teeth, and some back of napkin math indicated that it would have cost me about fifteen cents of resin to print it out myself. Instead I'm paying about 4000x that price. Obviously this is not apples to apples, I'm sure they're using different and/or better resin that what I have, and as I said there's probably engineering and fine-tuning for this, but even still it was not fun to pay for. All the same, I sleep like 10x better, so I suppose that considering that $600 is a cheap price to pay.

chrony3705 7mo ago
> All the same, I sleep like 10x better, so I suppose that considering that $600 is a cheap price to pay. First time? Price is not determined by cost to produce. It’s determined by the price a customer is willing to pay.
- moffkalast 7mo ago
  And the material cost also isn't the main thing you're paying for, it's time and expertise involved in scanning and designing it.
- tombert 7mo ago
  I suspect the introduction of the infinite-money pits of insurance doesn't help either. Since I do have the 3D scan of my teeth, I've debated designing my own, but I'm not sure which resins to buy that I could safely put in my mouth every night.
  - jopsen 7mo ago
    Even if you find a safe resin. Might there be microscopic layer lines? Or other unknowns you're not familiar with? Making 3d prints that can be cleaned is non-trivial, maybe there is a surface finish involved, etc. Also how do you know your design is correct? Won't cause your teeth to move? A 3d scan doesn't mean you know what a mouth guard should look like. All of a sudden, having a product that's made with a vetted process is pretty attractive -- and 600 USD seems like a bargain. What's the cost of having your teeth fixed, if they accidentally move? (Not to mention the discomfort, which can be considerable)
    - tombert 7mo ago
      I'm not entirely sure what you're trying to convince me of. I did pay the $600, I even said that it's probably a cheap price to pay to treat the apnea. That doesn't really change the fact that it feels kind of viscerally wrong to pay $600 to pay for two glorified pieces of plastic, and a part of me still does feel I could clone it competently. I haven't bothered for the aforementioned safe resin, and also because I already have it and I have enough money to just eat the cost and complain about it.
- shiandow 7mo ago
  An important corollary to this rule is that that customer need not be you.
- hobofan 7mo ago
  Every company operating on that basis is a busniess waiting to be disrupted by a cost-plus competitor.
  - bad_haircut72 7mo ago
    The company competing on cost plus is wasting resources by solving problems that arent very profitable to solve
  - regularfry 7mo ago
    Every business still operating on that basis has a moat somewhere else.
    - mayukh 7mo ago
      Yes this. Either have a moat or be a commodity. Commodities are cost plus
      - chaboud 7mo ago
        In a market with perfect price discovery, sure. However, over the years I have learned that even the best products for the job can (and will) lose without the right marketing, sales, distribution, etc. Sometimes the entrenched default that collects an inertial premium doesn't get disrupted... But, yes, anyone without a moat who operates with a presumption of retention runs the risk of being knocked off of their perch; their fate left to others.
        mayukh 7mo ago
        marketing, sales, distribution, branding, supply chain, intangibles... can all be moats.. as long as the owner of that moat gets it and others dont
  - lotsofpulp 7mo ago
    As is every individual earning more than median income.
lxe 7mo ago
> I know that there's a deceptively high amount of engineering required for these kinds of things I think there's a deceptively low amount of engineering required for most medical and medical-adjacent tech. The high costs are rooted in pervasive industry-wide centuries-long FUD campaigns.
- gunapologist99 7mo ago
  > centuries-long FUD campaigns That dastardly Ben Franklin with his bifocals..
s5300 7mo ago
[dead]
SilverElfin 7mo ago
I’ve tried custom molded mouthpieces for grinding but couldn’t adjust to sleep with them. I notice them and feel the discomfort of it not feeling natural despite it being a pricey professionally manufactured piece. It just feels too artificial. I also wonder about the long term effects of polymers in the mouth for long periods of time daily.
- tombert 7mo ago
  It took me a couple weeks to get used to it, but get used to it I did. I would still prefer a universe where I didn't have to wear it, but at this point it doesn't bother me too much. I agree the plastics might be bad for me, but I justify it because I suspect that just continuing with the apnea is almost certainly worse for me, considering how many diseases appear to be caused by it.
- wpm 7mo ago
  Every mouthpiece I got tasted awful, made me drool all night, and within days my apparently mega jaw would just grind right through them
operatingthetan 7mo ago
>Even with insurance covering some of it, it cost me about $600. Well that's pretty close to how much the entire CPAP system would cost depending on the sale.
- tombert 7mo ago
  The CPAP actually would have cost me less with insurance! At the time it would have cost me about $400.
tredre3 7mo ago
I think your comment would have been more insightful if you had at least pretended to try to account for labor before saying "They charged me 4000x the cost of goods!". To be clear I'm not even asking for you to account for the cost of your printer, the 3d scanner, and software licenses in your math. Let's assume that all those are free. How many hours of specialized human time was spent on consultations, scans, design, reviews, to produce working guards for you? The next question is then, of course, how much do they charge for subsequent guards now that the scan has been done and validated? Is it still 4000x the cost of raw resin?
- tombert 7mo ago
  I did qualify multiple times that there are costs associated with engineering, So I feel that it it's implied that the 4000x figure is a naive one. I'm sure labor is involved, and maybe it's a lot, but it still seems like an awful lot of money for a piece of plastic.
- ricardobeat 7mo ago
  Yes, they will charge a similar amount for producing another guard from an existing scan - I’ve had that done. It was also completely unnecessary in my case, it’s clearly an easy money grab for some offices.
- cryzinger 7mo ago
  Even if the actual specialist labor had been minimal, there's also the amount of time and effort it takes to accumulate enough knowledge to become a specialist. It's like the joke about spending $200 for a repair guy to come kick your printer in just the right spot to fix a print jam--you pay him $50 for kicking it, and $150 for knowing where to kick it :)
y-curious 7mo ago
With sleep apnea, I highly recommend you look into myofunctional therapy, which is like airway physical therapy. (full disclosure, my mom is a myofunctional therapist). It worked for several friends; They still use their cpap but they get much better sleep after committing to a routine. Not advertising but spreading the word, find someone local!
- tombert 7mo ago
  I hadn't heard of this. I'll give it a look and see if I my insurance covers it...thanks!
  - y-curious 7mo ago
    If it doesn’t, you can try and find some free resources online. If you’re in NYC, my mom’s business is HappyMyo and you can tell her her son sent you from HN. Good luck and I hope it helps you, it sounded really hippie and lame when I heard the name but I’m a believer now.
    - tombert 7mo ago
      I do live in NYC and I actually did see that practice when I was searching. I might check it out though apparently my insurance will not cover it. I'll dig a bit further.
- wisemang 7mo ago
  Or just take up the didgeridoo https://pmc.ncbi.nlm.nih.gov/articles/PMC1360393/ https://pmc.ncbi.nlm.nih.gov/articles/PMC1360393/
emeril 7mo ago
fwiw, if your sleep apnea is when you're on your back, consider somnopose/torena and put your phone is a running vest like https://www.amazon.com/dp/B0D24X29WQ https://www.amazon.com/dp/B0D24X29WQ life changing for me
baby 7mo ago
I have a MAD I got online as well and the experience is a bit subpar, lots of parts broke (the bands) and I can’t easily get replacements parts. My MAD also broke, and I can’t replace it easily (they sent me a new one but it doesn’t fit). They also are not testing me to see if there’s any difference (I think it works because I wake up less, and definitely wake up less to pee). Figuring out what band to use is also a esoteric process. It’s amazing that this exists besides a CPAP but we are really beta testers at this point. Oh and I learned later that they don’t replace your retainers

by tombert 7mo ago

chrony3705 7mo ago

> All the same, I sleep like 10x better, so I suppose that considering that $600 is a cheap price to pay. First time? Price is not determined by cost to produce. It’s determined by the price a customer is willing to pay.

moffkalast 7mo ago
And the material cost also isn't the main thing you're paying for, it's time and expertise involved in scanning and designing it.
tombert 7mo ago
I suspect the introduction of the infinite-money pits of insurance doesn't help either. Since I do have the 3D scan of my teeth, I've debated designing my own, but I'm not sure which resins to buy that I could safely put in my mouth every night.
- jopsen 7mo ago
  Even if you find a safe resin. Might there be microscopic layer lines? Or other unknowns you're not familiar with? Making 3d prints that can be cleaned is non-trivial, maybe there is a surface finish involved, etc. Also how do you know your design is correct? Won't cause your teeth to move? A 3d scan doesn't mean you know what a mouth guard should look like. All of a sudden, having a product that's made with a vetted process is pretty attractive -- and 600 USD seems like a bargain. What's the cost of having your teeth fixed, if they accidentally move? (Not to mention the discomfort, which can be considerable)
  - tombert 7mo ago
    I'm not entirely sure what you're trying to convince me of. I did pay the $600, I even said that it's probably a cheap price to pay to treat the apnea. That doesn't really change the fact that it feels kind of viscerally wrong to pay $600 to pay for two glorified pieces of plastic, and a part of me still does feel I could clone it competently. I haven't bothered for the aforementioned safe resin, and also because I already have it and I have enough money to just eat the cost and complain about it.
shiandow 7mo ago
An important corollary to this rule is that that customer need not be you.
hobofan 7mo ago
Every company operating on that basis is a busniess waiting to be disrupted by a cost-plus competitor.
- bad_haircut72 7mo ago
  The company competing on cost plus is wasting resources by solving problems that arent very profitable to solve
- regularfry 7mo ago
  Every business still operating on that basis has a moat somewhere else.
  - mayukh 7mo ago
    Yes this. Either have a moat or be a commodity. Commodities are cost plus
    - chaboud 7mo ago
      In a market with perfect price discovery, sure. However, over the years I have learned that even the best products for the job can (and will) lose without the right marketing, sales, distribution, etc. Sometimes the entrenched default that collects an inertial premium doesn't get disrupted... But, yes, anyone without a moat who operates with a presumption of retention runs the risk of being knocked off of their perch; their fate left to others.
      - mayukh 7mo ago
        marketing, sales, distribution, branding, supply chain, intangibles... can all be moats.. as long as the owner of that moat gets it and others dont
- lotsofpulp 7mo ago
  As is every individual earning more than median income.

lxe 7mo ago

> I know that there's a deceptively high amount of engineering required for these kinds of things I think there's a deceptively low amount of engineering required for most medical and medical-adjacent tech. The high costs are rooted in pervasive industry-wide centuries-long FUD campaigns.

gunapologist99 7mo ago
> centuries-long FUD campaigns That dastardly Ben Franklin with his bifocals..

s5300 7mo ago

[dead]

SilverElfin 7mo ago

I’ve tried custom molded mouthpieces for grinding but couldn’t adjust to sleep with them. I notice them and feel the discomfort of it not feeling natural despite it being a pricey professionally manufactured piece. It just feels too artificial. I also wonder about the long term effects of polymers in the mouth for long periods of time daily.

tombert 7mo ago
It took me a couple weeks to get used to it, but get used to it I did. I would still prefer a universe where I didn't have to wear it, but at this point it doesn't bother me too much. I agree the plastics might be bad for me, but I justify it because I suspect that just continuing with the apnea is almost certainly worse for me, considering how many diseases appear to be caused by it.
wpm 7mo ago
Every mouthpiece I got tasted awful, made me drool all night, and within days my apparently mega jaw would just grind right through them

operatingthetan 7mo ago

>Even with insurance covering some of it, it cost me about $600. Well that's pretty close to how much the entire CPAP system would cost depending on the sale.

tombert 7mo ago
The CPAP actually would have cost me less with insurance! At the time it would have cost me about $400.

tredre3 7mo ago

I think your comment would have been more insightful if you had at least pretended to try to account for labor before saying "They charged me 4000x the cost of goods!". To be clear I'm not even asking for you to account for the cost of your printer, the 3d scanner, and software licenses in your math. Let's assume that all those are free. How many hours of specialized human time was spent on consultations, scans, design, reviews, to produce working guards for you? The next question is then, of course, how much do they charge for subsequent guards now that the scan has been done and validated? Is it still 4000x the cost of raw resin?

tombert 7mo ago
I did qualify multiple times that there are costs associated with engineering, So I feel that it it's implied that the 4000x figure is a naive one. I'm sure labor is involved, and maybe it's a lot, but it still seems like an awful lot of money for a piece of plastic.
ricardobeat 7mo ago
Yes, they will charge a similar amount for producing another guard from an existing scan - I’ve had that done. It was also completely unnecessary in my case, it’s clearly an easy money grab for some offices.
cryzinger 7mo ago
Even if the actual specialist labor had been minimal, there's also the amount of time and effort it takes to accumulate enough knowledge to become a specialist. It's like the joke about spending $200 for a repair guy to come kick your printer in just the right spot to fix a print jam--you pay him $50 for kicking it, and $150 for knowing where to kick it :)

y-curious 7mo ago

With sleep apnea, I highly recommend you look into myofunctional therapy, which is like airway physical therapy. (full disclosure, my mom is a myofunctional therapist). It worked for several friends; They still use their cpap but they get much better sleep after committing to a routine. Not advertising but spreading the word, find someone local!

tombert 7mo ago
I hadn't heard of this. I'll give it a look and see if I my insurance covers it...thanks!
- y-curious 7mo ago
  If it doesn’t, you can try and find some free resources online. If you’re in NYC, my mom’s business is HappyMyo and you can tell her her son sent you from HN. Good luck and I hope it helps you, it sounded really hippie and lame when I heard the name but I’m a believer now.
  - tombert 7mo ago
    I do live in NYC and I actually did see that practice when I was searching. I might check it out though apparently my insurance will not cover it. I'll dig a bit further.
wisemang 7mo ago
Or just take up the didgeridoo https://pmc.ncbi.nlm.nih.gov/articles/PMC1360393/ https://pmc.ncbi.nlm.nih.gov/articles/PMC1360393/

emeril 7mo ago

fwiw, if your sleep apnea is when you're on your back, consider somnopose/torena and put your phone is a running vest like https://www.amazon.com/dp/B0D24X29WQ https://www.amazon.com/dp/B0D24X29WQ life changing for me

baby 7mo ago

I have a MAD I got online as well and the experience is a bit subpar, lots of parts broke (the bands) and I can’t easily get replacements parts. My MAD also broke, and I can’t replace it easily (they sent me a new one but it doesn’t fit). They also are not testing me to see if there’s any difference (I think it works because I wake up less, and definitely wake up less to pee). Figuring out what band to use is also a esoteric process. It’s amazing that this exists besides a CPAP but we are really beta testers at this point. Oh and I learned later that they don’t replace your retainers