In this article, we will review cleaning and adjusting(advancing) instructions for the Prosomnus CA-LP sleep apnea mouthguards to eliminate snoring and obstructive sleep apnea symptoms.
CA-LP is synonymous with the Prosomnus Continuous Advancement Low Profile (CA-LP) oral appliance.
Possible side effects of wearing the Prosomnus CA-LP
The side effects of this device are similar to all other custom dental sleep apnea appliances.
Short-term side effects include an increase in saliva flow for the first 30 minutes after inserting your device. You may also feel slight discomfort in your jaws or teeth during insertion, during removal or after removal of your device. These side effects are often resolved after a few days or weeks of wearing your device.
For more details on potential side effects and how to deal with them, see our article discussing side effects on this link.
Nighttime success tips
Here are some tips to help you establish a routine
- Brush and floss your teeth before inserting your device (very important)
- Apply lip moisturizer (optional)
- Rinse your dental device with cool water before inserting (optional)
- Drink water only – Once inserted, you can swallow easily and usually drink water. Please avoid other beverages.
- Go to sleep!
How to insert your CA-LP device
Most patients like to place the upper tray first.
To do this:
Step 1. Line the tray up along your top teeth and press onto your teeth. Sometimes a slight rocking movement may be necessary
Step 2. Repeat with the lower tray
Step 3. Bring your lower jaw slightly forward and close
Removing your Prosomnus CA-LP sleep device
To remove your oral appliance, always do what feels most comfortable.
Step 1. Lift the back edges of the lower tray with both hands, moving upwards in a rocking motion
Step 2. Repeat for the upper arch using the back areas to start to lift off your teeth
In most cases, the easiest way you will remove your device is usually the best
TIP: Be careful not to drop your device. The Prosomnus device is very strong but can crack when dropped on a hard surface.
Developing a morning routine after removing your Prosomnus CA-LP dental sleep device
There are three areas of routine to consider after removing your oral appliance:
Performing these as recommended will increase the longevity of your dental sleep device, prevent unwanted side effects and increase your comfort level during your oral appliance treatment.
How to clean your oral device
Cleaning your device will help improve longevity, reduce odors and avoid discoloration of your device.
For your specific type of Prosomnus device, you may follow any of the suggestions on our site except for:
- Daily (Part 1) cleaning is recommended only.
- Weekly special cleaning (Part 2) is NOT necessary.
- The Prosomnus company DOES NOT recommend soaking their device in any cleaning tablets/solutions.
- Scrub with soft brushes only using liquid detergents (dishwashing liquid or hand soap)
- Air dry in an open container
- Home ultrasonic units are NOT recommended for Prosomnus devices currently
Minimize bite changes by completing jaw stretches and using a morning aligner
It is normal for your teeth to feel strange after removing your Prosomnus device for up to an hour.
This occurs most commonly from your jaw not being realigned into its regular position. This is commonly experienced.
When do I advance the Prosomnus CA-LP appliance?
The CA-LP Prosomnus oral device has one upper plate with the advancing mechanism and two lower segments marked L0 and L3. Unless directed otherwise by your sleep apnea dentist, you will start with the upper segment and the L-0 tray.
These trays have been preset to have your jaw slightly forward or similar to the jaw position when awake. This is the most effective treatment position for some patients, and you will not need to advance your jaw further. Further jaw protrusion (advancement) is needed for the dental sleep device to be effective for many other individuals.
Here is a review of when it’s best to begin or stop advancing your device
The following is a list of positive effects 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 is or waking up gasping for air is witnessed by the bed partner
- 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.
Once you are comfortable with general wearing but still have noticeable apnea symptoms, it’s time for you to advance your dental sleep device.
When do I STOP advancing the oral sleep device?
It’s time to stop advancing to the next tray if any one of these occurs:
- If pain occurs, you may need to skip a night
- If comfort doesn’t increase over a few days, you may need to return the appliance to the previous comfortable tray combination by decreasing the advancement setting
All symptoms are resolved, and you “believe” the device to be working well
- At this level, snoring reports have stopped, or you might awaken refreshed, no morning headaches, and less sleepy during the day
You reach the last set of trays
- In this case, your dental provider may order more to advance further
The best way to establish that your device effectively treats your sleep apnea and eliminates oxygen desaturations is to perform another sleep test.
This testing can be an at-home sleep test or polysomnography test performed by your sleep apnea medical or dental team.
Your sleep apnea dentist will help guide you to the proper timing of getting a sleep test with your oral appliance inserted.
How to advance the Prosomnus CA-LP
(video coming soon)
Do not adjust the appliance for the first three nights if an adjustment is needed.
Step 1. Insert the key to the small hole adjacent to the yellow or white arrow on the side of the upper part of the appliance.
– You will feel it seat
Step 2. Turn the key in the direction of the arrow until it stops 5 turns (about ½ mm). One turn (90degree) advances the mechanism slightly more petite than .1 millimeter (10 turns =.9mm)
Step 3. Once you have advanced to three millimeters or 34 turns, you will set the appliance back to zero turns and switch to the L3 lower piece if you want to advance further
– This will allow for another 3 millimeters of advancement
Step 4. Continue advancing 5 turns every 3-4 days until all symptoms(snoring, daytime sleepiness, poor sleep, other) have been eliminated or discomfort begins
– You must advance your oral device the same number of turns on each side
The maximum this dental sleep device can be advanced is 3mm or 34 turns. By using the L3 tray, your device may obtain a total span of 6 mm.
If the jaw becomes sore, do not advance the appliance any further until the jaw discomfort has subsided. The appliance can be ‘reversed’ to the most recent comfortable position if necessary. Chart courtesy of Courtesy Prosomnus Tech.
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.
For these circumstances, I recommended using the Snorelab App. Click here to learn more about this helpful app.
What do I do if my mouth drops open when wearing my Prosomnus oral appliance?
Elastic bands can be worn on your Prosmonus Evo and IA device if you experience dry mouth or feel your mouth is popping open during sleep.
Nasal breathing, if possible, is encouraged with oral appliance therapy. Nasal breathing may improve the results of your therapy and keep your mouth free from dryness.
Elastics are also available in non-latex material. If you have a latex allergy, it is important to use non-latex elastics.
If your trays do not have hooks, your sleep apnea dentist may ask the dental lab to accommodate this request. Other suggestions may include using mouth tape.
You may find links to recommended elastics and mouth tape on our resource page. See the dry mouth and nasal breathing help on the Resource Page.
What follow-up appointments are recommended once I start wearing my Prosomus CA-LP?
Several appointments are recommended with your sleep apnea dental team to help you maximize the results of your appliances and to troubleshoot issues that may arise.
NOTE: It is important to follow up with a visit 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 and/or sleep apnea events in many situations. Performing another sleep test with the sleep apnea mouthguard inserted will often be recommended.
Once there is verification that your oral appliance effectively controls your symptoms and apnea events, it is recommended you return to your sleep dentist in 6 months, then annually.
At these visits, your sleep apnea dentist will evaluate the integrity of your oral device and assess you for potential dental or oral side effects.
Please contact your prescribing sleep apnea dentist if you have questions or need help with this.