How to Titrate Your Oral Appliance

Not one size or type of device fits all. BlueSleep recommends the best, FDA-approved devices and helps you adjust or “titrate” them, so you get the right fit for comfort, affordability, and effectiveness.

How to Start

The first time using your oral appliance, insert it one hour before bedtime. After an hour, if you’re not having sensitivity or pain, attempt sleeping with the appliance in place. If it’s too sensitive, remove and try again the next night. Repeat this process until you’re able to comfortably wear the appliance for one hour before falling asleep. Then reduce the amount of time to 15 minutes before bedtime. You may not be able to wear the appliance all night long the first night. Each night increase the amount of time you use the appliance until it can be worn all night long.

How to Evaluate Your Sleep

After using the appliance for one week while sleeping, evaluate your sleep. Use an app called SnoreLab or ask your bed partner. If you’re still snoring, waking at night, or have other symptoms from sleep apnea, then titrate the appliance.

How to Titrate Your Oral Appliance

Follow these easy instructions to get a comfortable and effective fit to stop your snoring and sleep apnea.
Photo of a Prosomnus EVO™ mandibular oral device

ProSomnus® EVO®

You will be given numerous advancement arches and will wear one on the lower teeth, and one on the upper teeth. Each arch is numbered. The first set of arches you will use are U0 and L0 (Upper 0 and Lower 0).

If you are still symptomatic (snoring, waking up at night, not feeling well rested) then change out the arches every 7-14 days according to the chart below.
U0 + L0
U0 + L1
U2 + L0
U2 + L1
U4 + L0
U4 + L1
Photo of Prosomnus PH mandibular oral device

ProSomnus® [PH]

Using the tool provided, turn the hex nut in the direction of the “up” arrows etched on the side of the Herbst arm. Each 90 degree equals 0.1 mm of movement. Make up to five 90 degree turns per side each week. Make sure to adjust the right and left side evenly.
A ruler is etched on to the wrench handle to assist in measuring how far you have adjusted.
To reduce the advancement, rotate downwards in the opposite direction of the etched arrow.
Photo of a Dynaflex Herbst mandibular oral device

Dynaflex Herbst

Please follow the directions in this YouTube video and contact us if you have any questions.
Photo of a Glidewell Silent Nite mandibular oral device

Silent Nite

Your appliance was accompanied by a blue tree pack of connectors. Two connectors will already be installed on your appliance and missing from the pack of connectors. If you need to titrate further, remove the connectors and install the next shorter size. Make sure the same size is installed on the left and right side of the appliance. Wait 1-2 weeks before each switch to shorter connectors in order to slowly titrate to the shortest set of connectors you can comfortably tolerate. You may not need all the rods on the tree pack. Always use the same length connector on both sides and keep the previous longer connectors to revert to if pain appears.
Photo of a Panthera Classic mandibular oral device


Your appliance was accompanied by many different size rods. If you need to titrate further, remove the rods and install the next shorter size. Wait 1-2 weeks before changing to shorter rods in order to slowly titrate to the shortest set of rods you can comfortably tolerate. You may not need all the rods provided. Always use the same length rod on both sides and keep the previous longer rods to revert to if pain appears.
Photo of an EMA mandibular oral device


Included with the appliance is a wide selection of yellow bands and blue bands.  Use the yellow bands first, going down in size until you stop snoring. The yellow bands are softer than the blue bands, and used for “titrating” (adjusting) to the right size. Once you’ve reached the right size, switch to the blue bands, which last longer and stretch less. If you find the blue bands are uncomfortable, then shift back to the yellow bands.

How to Clean Your Appliance

Cleaning your device is quick and easy.

EMA, Herbst, Silent Nite, ProSomnus® EVO®, ProSomnus® [PH]

When you wake up, remove the appliance and clean it with a toothbrush and a mild cleanser such as antibacterial hand soap. Rinse thoroughly with cold water only, dry, and place in the case.


Using a soft bristle toothbrush, gently brush under running cold water. Soak all day in Novadent original appliance cleanser. Before inserting, rinse thoroughly under running cold water. Change the cleaning solution weekly.

For Panthera, once a week you may also use Arm & Hammer whitening toothpaste mixed with a little water to form a paste, brush with a soft bristle toothbrush and let it sit for 30 minutes. Rinse thoroughly.

How to Manage Discomfort

If you’re having any pain, rest your jaw and eat soft foods. Warm, wet compresses and massage can alleviate the dull, aching sensation while getting accustomed to the appliance.

How to Realign Your Bite

Fifteen minutes after removing your appliance, insert the bite plate (AM aligner) and gently close together lining up your teeth. Hold until your bite feels normal, roughly 10 minutes.

How to Contact BlueSleep

If you have any questions or concerns, please contact [email protected].