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Home care instructions for your Pink Respire AT oral sleep device including what to expect, device adjustments (advancements), cleaning and side effects.
What to expect from your Respire Pink AT?
For the first several days, the appliance will feel foreign in your mouth.
Most patients adjust easily to the snug feeling around the teeth and are able to wear it the entire night.
For some this may take just a few nights, others may need to build up usage tolerance over several weeks.
Possible side effects
Increase in saliva production
- Most prominent in the first 30 minutes of the first few weeks
- You can swallow normally with the device inserted
Sore teeth and gums
- Very common and are usually gone within minutes to hours after removing the appliance
- If soreness persists, a minor device adjustment can be made to the appliance at your next visit
A slight change in the bite when you wake up
- This usually occurs for 5-60 minutes after removal
- This should return to normal once you have done your morning stretches/worn your morning aligner (usually discussed at the 2nd visit)
- Some patients may experience mild to moderate jaw pain when they begin wearing a dental sleep appliance
- If you need pain relief, use the type of over-the-counter medication that your doctor would suggest for pain relief (Ibuprofen, Tylenol or Aleve) before bed, upon waking, and if needed in the afternoon
- If the pain becomes severe, stop wearing the appliance and contact your oral appliance provider
- Jaw pain is almost always transient and is rarely a persistent problem
- Other options include very short oral appliance interval usage with a very slow increase in use
- Avoid sleeping with your mouth opened
- You may use elastics on your device to increase comfort and, in many cases, improve the results of therapy.
- If elastic hooks were not included in the design of your device, contact your sleep apnea dentist
Your appliance can build up debris and bacteria over time, just like your mouth. To increase the lifespan of your device, follow these home care instructions:
1. Brush and floss your teeth before inserting your device. This step is very important
2. Apply lip moisturizer
3. Rinse your dental device with cool water before inserting (optional)
4. Insertion, as demonstrated by your sleep apnea dentist
5. Insert upper segment first, followed by the lower segment
- Use both hands
- Do not “force bite” your appliance into place
6. Elastics. If provided and recommended, insert bands onto your device before inserting your device
7. Drink water only. Once inserted, you can swallow/drink water (most cases), but avoid other beverages
8. Go to sleep!
When removing the device, do the opposite of how you inserted it.
1. Remove lower segment using the metal bumps or rear edges of the device
2. Then remove the upper segment pulling down the rim of the back areas
3. After removing your device, it is normal to feel strange for up to an hour. We recommend performing these morning stretches:
- See full article on recommended stretches for oral appliance therapy: here.
- For additional jaw stretch exercise, watch this helpful video:
4. Wear your morning aligner (if provided) for 15 minutes each morning or later in the day.
- Seat the aligner onto your bottom teeth, and then look in the mirror and bite your top teeth, all the way into the imprint of your teeth
- Bite firmly until you feel your back teeth touch
- To clean your aligner, use cold water and dishwashing soap
- Warm or hot water will distort your aligner
- See full instruction article and video on how to use your morning aligner here
Cleaning & caring for your dental sleep device
- Clean the device daily with a soft toothbrush and liquid hand or dishwashing soap
- Pay particular attention to cleaning the metal components and inside surfaces to ensure that it’s free of all plaque and tartar deposits
- Do not use toothpaste or mouthwash to clean your appliance, as it is too abrasive on the acrylic
- Rinse well and let air dry in the container with lid open when possible
- Store your appliance out of reach of pets
- Traveling. When traveling, pack in your carry-on to prevent damage or loss.
- Discoloration can occur over time. If you see tartar buildup on your appliance, bring it to your yearly recommended dental sleep medicine check-ups or to your routine dental hygiene visits where the device can be cleaned.
For Extra Cleaning
Use Dr. Berland’s Cleanadent, Efferdent, Retainer -Brite or other retainer-denture cleaners.
- Put a cleaning tablet or liquid into a container of water
- Submerge the device for 10 minutes
- Rinse well
- Store as directed
These videos demonstrate the daily and weekly cleaning cycles:
With this device, you can also perform the 10-minute extra cleaning inside an ultrasonic home unit, such as Dr Berland’s Ultrasonic Cleaner.
Here’s a short video on how to use ultrasonic cleaning for your oral sleep devices:
How to know when to advance the appliance?
The initial setting of the appliance is at a significant protrusion from your normal jaw position.
This is the most effective device treatment position for some patients, but for many, further protrusion is needed for the appliance to be effective.
The following is a list of positive things that would indicate that minimal or no changes are needed:
- Bed partner or roommate observes that your snoring is significantly reduced or gone
- No apnea witnessed by bed partner and no waking up gasping for air
- Increased dreaming
- Decreased or complete elimination of nighttime walking or urination
- Decreased leg movements (for those who have Restless Leg Syndrome)
- Feeling refreshed upon waking and daytime sleepiness is diminished or gone
These subjective changes help us determine when to advance the appliance.
However, the best way to establish that it effectively treats your sleep apnea and eliminates oxygen desaturations is to perform another sleep test.
Once you are comfortable with general wearing but still have noticeable apnea symptoms, it’s time for you to advance your device.
How to advance your oral appliance device
TIP: I recommend outlining one side of the tool with a permanent marker. This will make it easier to see a full screw revolution. See video for a demonstration.
As demonstrated by your sleep apnea team, take these steps:
- Insert the red-orange driver into the back of the tube
- Turn 2 complete revolutions (1/2mm) COUNTERCLOCKWISE (if right-handed) or in the direction of the arrow
- Repeat the same number of revolutions on the opposite hinge, again in the direction of the arrow
Sometimes it may be difficult to see the number of adjustments.
To help with that, I recommend using a smartphone or magnifier and taking an image looking down on the device with it is seated upright on a table (upper teeth arch on the top.) See photo:
Remember that each line represents 1 mm and both sides should be adjusted the same amount.
You can repeat these advancements (adjustments) after every 3-4 nights of use at that setting.
Here is a quick video about advancing this device:
STOP advancing the device if one of the following occurs
- PAIN. If pain occurs, you may need to skip a night. If comfort doesn’t increase, you may need to return the appliance to the previously comfortable position
- All symptoms are resolved, and you “believe” it to be working well
- You reach the end of the adjustment range (7 mm showing) with no effect
- Do not advance past 7 mm
If you live alone and snoring is your only symptom
If you live alone or cannot receive feedback on your snoring levels, it may be challenging to know if the device is working and if an adjustment is required.
In some cases, a sign may be noticing fewer self-awakenings, gasping or fewer throat irritations.
A phone app such as SnoreLab may be a good start for adjustment guidance.
After you have a base night recording without the device inserted, repeat the home app Snorelab recording when you have the appliance inserted after advancements comparing the Snore Score Summaries.
If not much improvement, advance your device as directed and repeat in the intervals recommended by YOUR sleep apnea dentist.
Important: It is important to return to your oral appliance dentist to verify the device is working beyond symptom relief. In many situations, the device may need further advancements to eliminate oxygen desaturations/ sleep apnea events.
If you have questions or need help, please contact your prescribing sleep apnea dentist.