Oral appliance therapy is normally a process.  In other words, when starting oral appliance therapy a very gentle mandibular advancement position is chosen in order for the patient to easily accommodate the appliance.  This is one of the things that makes oral appliance therapy so successful!  It is a very comfortable device to wear during sleep.  Usually, after the patient has had a week or so to get used to sleeping with the appliance, the appliance is adjusted to bring the mandible further forward.  However, some patients get a major amount of relief with the beginning position.  Patient #111 is such an example.  With only the starting position, she had in incredible amount of benefit in improved night-time oxygen levels.

As shown in the chart, her night time oxygen levels were dramatically and immediately improved.  Without the oral appliance, she spent 54 minutes with her oxygen levels below 90%.  With the oral appliance, she spent only 7 minutes with low oxygen levels.  We expect further improvements in her night time oxygen levels as her treatment progresses.

While everyone suffering from a sleep-related breathing disorder has some physical consequence to the repetitive interruption in the flow of life-giving oxygen, sometimes the effects have larger social consequences than others.  This patient, who could not tolerate CPAP experienced very significant daytime sleepiness from her disorder.  So why is this such a big deal?  She happens to be a school bus driver!  The level of daytime sleepiness she experienced placed her at the same risk of having a traffic accident as a drunk driver.

Oral appliance therapy completely resolved her daytime sleepiness and reduced it from a dangerously high of 16 on the Epworth Sleepiness Scale to a very normal 6.