Herbst Sleep Appliance

The Herbst appliance for sleep apnea has evolved into one of the most popular choices for snoring and obstructive sleep apnea. The two piece construction is designed for ultimate patient comfort and is desirable for the patient that wants a minimal amount of acrylic to preserve as much tongue space and would like the adjustment capability. The Herbst sleep appliance and lab has PDAC approval for Medicare.

Herbst sleep appliance
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11 day
turnaround time
Class II
FDA approval

Indications for Use

Dandy’s Herbst appliance for sleep apnea is intended to reduce night time snoring and mild to moderate obstructive sleep apnea (OSA) in adults. The device is worn while sleeping and protrudes the lower jaw. The appliance allows for some lateral movement.

Herbst appliance

Mandibular Guidance

Mandibular Opening

Standard mandibular opening for a snoring/sleep apnea device is 3-4 mm between the maxillary and mandibular teeth.

This allows for increased air volume and facilitates airway opening.


Mandibular Advancement

Standard mandibular advancement for a snoring/sleep apnea device is situation dependent. Generally,the mandible is advanced between 5-7mm from the patient’s centric occlusion for proper appliance construction. Typically, the forward mandibular position will cause increased air volume in the patient’s pharyngeal space.

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Herbst Appliance Best Practices

Inserting the Herbst Appliance

Place the upper device in your mouth. Press up on the device with both thumbs to ensure that it fits securely and comfortably.

Herbst Appliance Position

Generally it is good to start the device in the starting position, or the smallest level of protrusion. In some cases, the device may need to be titrated forward (adjust forward) to further open the airway. The device can be adjusted over time based on patient comfort and what is effectively treating the sleep apnea.

Removal of Herbst Appliance

Always remove the lower device first. Using your thumbs on both sides, gently pull the lower device in an upwards motion to remove. Using both your index fingers and thumbs, gently pull the upper device down and forwards to remove.

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Herbst Appliance for Sleep Apnea FAQ

What are the side effects of the Herbst device?

Your patients may experience some temporary side effects, such as sore jaw joints, increased salivation, dry mouth, sore teeth, irritation of the soft tissues in the mouth and/or a slight change in your bite. These possible side effects should diminish within an hour of removing the device. If any of these side effects continue, have your patient contact you immediately.

What are some reasons to select the Herbst over other sleep appliances?

The Herbst sleep appliance is covered by Medicare, allows for more excursive and lateral movements and has a thinner material that’s more comfortable on the cheeks. Other appliances can lock patient’s arches together,  limiting essentially all  movement vertically and horizontally. This can be very uncomfortable for the patient; it may be particularly troublesome for patients who have bruxism. Cheaper appliances depend on acrylic notches and rubber bands; which has been found to be less durable.

Does the Herbst appliance come with elastics?

Yes – all Herbst sleep appliances come with complimentary elastics. They are 3/16 inch and medium force.

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