Your Dental Sleep Appliance

USER GUIDE FOR YOUR DENTAL SLEEP APPLIANCE

EXPECTED BENEFITS

Snoring

For some people snoring may diminish substantially on the first night of using the appliance.  For most people, snoring will be present until the appliance is gradually adjusted forward to the correct position.

Unrefreshed sleep and daytime sleepiness

It is common for people who have suffered from snoring and sleep apnoea to have accumulated what is known as a “sleep debt”.  Several nights of good quality sleep may be required (once the jaw is in the correct forward position) before you feel more refreshed with more energy.  This improvement can continue over several weeks.

Breathing

If you have sleep apnoea, your partner may notice an improvement in your breathing pattern as the appliance is adjusted forward.  Your breathing should be less disturbed, with a decrease in gasping, choking and pauses in breathing.

Protection of teeth

Many people who snore and have sleep apnoea clench and grind their teeth and are unaware that they do this.  Damage to teeth and dental work from clenching and grinding mostly occurs during sleep.  Your appliance provides the added benefit of total protection from the destructive forces of clenching and grinding.

ADAPTING TO YOUR APPLIANCE

The mouth is a very sensitive part of the body and initially the appliance may feel somewhat intrusive causing you to wake an extra time during the night.  If you wake during the night and wish to leave your appliance out, feel free to do so.  Don’t feel you have to push yourself to sleep all night with the appliance from the start.  If you get an hour or two of sleep using the appliance on the first night that can be considered a good start.  For some people it is easier to build up use of the appliance over the first week until it is comfortable in the mouth and can be worn throughout the night.  The general rule is the more hours you use the appliance, the easier it will get.  The vast majorities of people adapt to the appliance within one to two weeks such that it feels comfortable and unobtrusive in the mouth and are getting a more solid refreshing sleep.  At that point you would rather sleep with the appliance than without it.

TEMPORARY SIDE-EFFECTS

Increased saliva

In the first week or two you may notice an increase in saliva – the brain reacts as if the device is food!  This is a normal response and will diminish, with the appliance becoming far more comfortable with continued use.

Jaw discomfort

Follow the instructions you have been given for adjusting the appliance forward however stop making adjustments if there is any tooth or jaw pain that persists for several hours.  Jaw pain can occasionally develop within the first week or two of receiving an appliance.  This can be a result of excessive clenching as well as bringing the jaw forward a little too quickly.

Studies show that many people clench excessively during sleep in the initial period of wearing a new appliance.  While this level of clenching will revert back to normal after adaptation to the appliance, there is the potential for jaw and muscle pain during this initial period.

If discomfort is present for a couple of hours following waking, this mostly diminishes over the next few days as you adapt to the appliance.  Sometimes it may be necessary to wind back the appliance.  If pain or discomfort is significant and persists, please call the clinic immediately – a simple adjustment may be required.  You may need to leave the appliance out for a few days and reintroduce it in a more retruded position.  You can then recommence winding the mechanism forward, at a slower rate, as advised by your doctor.  Occasionally a short course of anti inflammatory medication may be required.

Jaw joint problems can occur during the first few weeks of first using an appliance but usually does not recur after the initial period.

Tooth discomfort

It is normal to experience some minor tooth tenderness during the first few days of using an appliance.  This is usually noticed when you take out the appliance following sleep and should disappear within 30 minutes and you would expect it to be no longer occurring after several days.  If discomfort or pain persists beyond this, please contact the clinic – all that is usually required is a simple adjustment to the appliance.

Temporary change to the bite

When you first remove your appliance in the morning the bite (the way the upper and lower teeth fit together) should take less than 5 minutes to return to the usual position.  For some people, the bite can take more than 15 minutes to return to its usual position after the dental sleep appliance is removed following a night’s sleep.  This is usually a temporary side-effect and can be significantly helped by the use of bite tabs and several jaw exercises.

Exercises with Bite Tabs

The bite tabs are designed to exercise the jaw muscles and help the bite quickly return to its usual position.

After removing the dental sleep appliance in the morning, place the bite tab over the back teeth and squeeze together for 20 seconds with your jaw as far back as possible.  Repeat a second time putting the bite tab on the other side.  Also put the bite tab behind the top front teeth and clench down for 20 seconds with the lower jaw as far back as possible.

Jaw Exercises

If you are one of those people where the bite is taking more than 15 minutes to return to normal, please do the following exercises to help reposition the jaw.

Exercise One:

  1. slide your jaw with the largest amount of backward and forward movement for 5 seconds each way

  2. finish by clenching down on the back teeth with the jaw as far back as possible for 15 seconds

Exercise Two:

  1. open the jaw as wide as possible and then close it

  2. open the jaw, slide to thel left and then continue moving the jaw in a circular path to the closed position and squeeze your back teeth together with the jaw as far back as possible

  3. open the jaw, slide to the right and then continue moving the jaw in a circular path to the closed position and squeeze your back teeth together with the jaw as far back as possible

  4. repeat each exercise twice

Please contact the clinic if you are experiencing any bite changes that persist during the day.

Removing your appliance

Somne people wake and are surprised to find their appliance out of the mouth and lying somewhere nearby.  This usually does not necessarily mean that the appliance is loose.  In the initial weeks of receiving an appliance some people actually remove the appliance from the mouth while asleep and have no awareness of doing so.  This problem usually disappears as you adapt to the appliance. 

ADJUSTING YOUR APPLIANCE

Generally the appliance is set at 40-50% of the maximum forward position of the lower jaw and for most people the jaw is slowly moved forward, over several weeks, to around 70%.  This will allow you to more easily adapt to the appliance and to minimize the potential for any side-effects.  You will be given separate instructions on how to adjust your appliance.

How do you know when to stop adjusting your appliance?

1. If you have snoring but no sleep apnoea

If you are using your appliance just for snoring, then only make an adjustment forward if there is still an unacceptable level of snoring present.  There is no need to make any further adjustment once the snoring is gone.  The aim is to adjust the appliance the minimal amount that overcomes the snoring.

2. If you snore and also have sleep apnoea

Just because the snoring has gone does not necessarily mean that all the sleep apnoea is gone.  It is possible to no longer snore and yet still have a degree of sleep apnoea.  The aim is to continue the adjustments until you are waking feeling more refreshed, not sleepy during the day, and no disturbances observed with your breathing.  If you have mild to moderate sleep apnoea the goal is to go the minimal distance forward to achieve this result.  If you have severe apnoea the aim will be to adjust the appliance bringing the jaw to the maximum forward position that is still comfortable. 

SLEEP PHYSICIAN CONSULTATION

If you have been diagnosed with sleep apnoea the first stage in using a dental appliance is to overcome any signs and symptoms you may have such as snoring, tiredness, and disturbances in breathing while asleep.  When this is achieved, you may be referred to a sleep physician and for a possible follow up sleep study to objectively assess the improvement in your sleep apnoea. 

FUTURE DENTAL TREATMENT

If you require any dental work in the future, please take your appliance along with you so that your dentist can ensure that the shape of the teeth is not significantly changed and that the fit of the appliance is not affected.  Sometimes a simple adjustment to the appliance may be required. 

MAINTENANCE AND HOME CARE

  1. Always clean your teeth before fitting the appliance in your mouth.  This removes the invisible layer of plaque which contains bacteria.

  2. Clean the inside and outside of your appliance, after removal in the morning, with a soft toothbrush and toothpaste.  Weekly baths in a denture cleaning material will help to keep the appliance fresh and stain free.  Do not use warm or hot water as this can deform the appliance.  Please note:  Steradent Active Plus powder has been found to be an effective and safe product for cleaning the appliance and can be used daily.

  3. If your appliance includes a key, please do not store the key with your appliance in the box as it can rust.

  4. Regularly inspect your appliance for any material degradation or cracks.  Should you notice any problems please contact the clinic.

  5. Avoid exposing the appliance to excessive heat, including direct sunlight, as it could cause distortion.

  6. Beware of dogs – they love to chew dental appliances!

  

Please Note

  • A follow up consultation will be organised after the fitting visit.  It is essential that you bring your appliance to this appointment.

  • It is important to have any problem that may develop rectified quickly.  If you allow a problem to persist, without seeking assistance, it can become more difficult to rectify.

  • It is your responsibility to call if any problems develop.  It is our responsibility to schedule an appointment as soon as practicable. 

MDSA (Medical Dental Sleep Appliance) 

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Adjusting Your Appliance

When you first receive your dental sleep appliance it is generally set at 50 – 60% of the maximum forward position of the lower jaw.  Most people will need to adjust their appliance, thereby moving the lower jaw forward, to achieve the maximum benefit.

It is recommended that you do not adjust your appliance forward for the first ……. days.  This initial period is for adapting to your appliance and to minimise the possibility of any teeth, muscle or jaw discomfort.

The starting position is ……. Turns from the furthest back position of the mechanism.

Make one clockwise turn every …… days as long as there is no pain or discomfort.

Instructions on number of turns: ………………………………………………………………………………………….

…………………………………………………………………………………………. 

Please note that each clockwise 360 degree turn only brings the jaw forward one third of a millimetre so it usually takes multiple turns to notice a change.

For Snoring Only

If you are using your appliance just for snoring, then only adjust if there is still an unacceptable level of snoring present.  The aim is to bring the jaw forward the minimum amount that overcomes the snoring.

For Snoring and Sleep Apnoea

Adjustments will decrease your snoring as well as other symptoms you may have such as sleepiness, unrefreshed sleep, gasping, choking and pauses in breathing.  Feel free to make further adjustments if symptoms persist and there are no side-effects. 

Please Note:

  • The goal for people with snoring, or mild sleep apnoea, is to bring the jaw forward the minimal distance that overcomes the snoring and tiredness.  This will minimise the possibility of any side effects.

If you have significant sleep apnoea you may need to move the jaw forward as far as you can manage.

  • When you first use your appliance you can put the upper and lower components in separately and then bring the jaw forward to connect them.  After you have done several adjustments this may no longer be possible.  You will need to place the upper in position over the teeth, connect the lower to it, and then bring the lower jaw forward and close into the lower.  This can also be done in the reverse order by first connecting the lower first over the teeth, connecting the upper to it and then bringing the lower jaw forward and close into the upper.

If snoring and sleep apnoea returns

As we get older, and if we put on weight, the snoring and tiredness can return.  This can also occur if the appliance loses its firm fit.  Please do not hesitate to contact the clinic if this occurs.  It is often necessary to make a simple adjustment for the appliance to be effective again.