Oro-Nasal PAP Fusion dotMAD™

• Patients for whom the optimally adjusted MAD has not provided normal sleep physiology, determined by an objective, follow up sleep study. 
• Patients with a Central Sleep Apnea component not resolved by oral appliance therapy alone.
• Severe OSA patients whose EDS or other symptoms are not fully resolved 
• MAD patients who must sleep supine for orthopedic reasons who, as a result have incomplete airway management.
• Impaired nasal airway function which promotes mouth breathing in sleep.
• PAP patients with intolerably high titrated pressure requirements. This is often connected with increased WASO (wake after sleep onset), sleep maintenance insomnia, EDS (excessive daytime sleepiness) and other symptoms of sleep deprivation.  
• PAP patients who unconsciously remove strapped masks.
• Patients with unstable TMJs or unstable dental occlusion may use a conventional TMD appliance for the PAP attachment, or a MAD to stabilize the mandible without or with minimal mandibular advancement. This can eliminate the harmful effects on the TMJs by preventing retrusion of the mandible by the lower straps while lowering the required PAP pressure. This can result in improved compliance and outcome. 
• Patients who are not adaptable to the MAD may use a Maxillary TMD stabilization splint for attachment of the PAP interface.  
• Patients with defeating PAP side - effects, e.g. claustrophobia, skin sensitivities to mask straps, strap induced headaches, mouth leak when jaw drops, and others. 

*Clinical and technical support available at Comfort Acrylics, Inc. Laboratory or Visit www.comfortacrylics.com  

*Contact Dr. Richard Moore, DDS, ABDSM at Comfort Acrylics, Inc., digital division Ph: 360-834-9218

*Patents and trademarks are pending at the USPTO and owned by dotMAD, LLC. All rights reserved.