D1 MRD

If you find it uncomfortable to thrust your jaw forward as much as possible, you don't need to. The goal is to achieve just enough forward movement so that, when asleep and completely relaxed, your tongue doesn't touch the pharynx (back of your throat).

Gradually move your jaw forward by 0.5 mm every few days until you notice a difference. Once you find your sweet spot, you'll easily recognize it by how much better you feel in the morning.

D1 work by pushing or pulling your lower jaw forward. By doing this, your tongue is kept in a position that does not block your airway. This reduces the risk of snoring or that your tongue may obstruct your  airway during sleep. If this device is helping you, the sound of snoring should be gone entirely or lessened.

As with all treatments, not everyone gets the same benefit from oral appliances. For some, the OSA and snoring go away completely, while for other people, other forms of treatment are needed. Oral appliances are more likely to work if you have mild or moderate sleep apnea; more recent evidence supports use for some people with severe sleep apnea as well. If your sleep apnea gets better when you lie on your side (compared to sleeping on your back) and if you are not overweight, you are also more likely to benefit from this appliance. If you have central sleep apnea (a less common condition than OSA), then oral appliances are unlikely to be helpful. Until you have been properly fitted for an oral appliance and tried it, no one can know how well it will work for you.

CPAP (Continuous Positive Airway Pressure) is a reliable treatment for sleep apnea. Immediate results are typically seen with CPAP regardless of how bad the sleep apnea is. An oral appliance will usually improve your sleep apnea, but may not completely control it. If you have moderate or severe OSA, CPAP is more likely to work to correct your sleep apnea than an oral appliance. 

However, an oral appliance may be a better option than no treatment at all if you cannot tolerate CPAP. D1 are also not the main therapy if you have significant heart disease or are very sleepy during the day. In these cases, CPAP is the best treatment. A sleep specialist can provide guidance regarding the most appropriate therapy for you. For more information see the ATS Patient information series piece on “Continuous Positive Airway Pressure for Adults with Obstructive Sleep Apnea” at www.thoracic.org/patients.

If fitted well, the oral appliance should be comfortable during the night. However, because it acts to push your jaw forward, some people feel discomfort when first using the appliance. This discomfort tends to improve as you use it more. If discomfort happens, it is usually in the joint at the back of your jaw, just in front of the ear (the temporomandibular joint). This discomfort should go away when you take the appliance out in the morning.

Also, oral appliances may cause increased saliva in your mouth, or make your teeth feel tender. These symptoms usually settle down quickly the more you use the device. Over time, there may be tooth movement, changes in your bite, or problems with the joint and muscles of your jaw. It is important to have regular follow-up visits with the dentist who supplied you with the appliance to detect and manage problems early.

• Gently brush your D1 with a toothbrush and toothpaste after each use.To best clean, disinfect, and freshen your D1.
• Allow D1 to dry after cleaning. Keep D1 in its storage case when not in use.
• Do not use harsh chemicals or abrasive cleaners such as ammonia, bleach, or mouthwash that contains alcohol.

When an oral appliance is working well, there should be no snoring. If you are wearing the appliance because of sleep apnea, you may see improved sleepiness, fatigue and other symptoms of sleep apnea. A good way to find out if you are getting the help you need from your oral appliance is to have a repeat overnight sleep study with the oral appliance in place. If the study shows that wearing the oral appliance has helped your OSA, you should continue to use if every night. If it is not helping your sleep apnea, other treatments (such as CPAP) will  be recommended.

If symptoms of snoring or sleep apnea return (for example, feeling tired during the day), it is important to have a follow up appointment with your dentist or your sleep specialist. Your dentist might need to adjust the appliance. After a number of years, some people using an oral appliance find they need to consider other treatments for their OSA, especially if they have had weight gain.