in making and using aspects and embodiments of this invention , one skilled in the art may employ conventional techniques and components available to one skilled in the art . furthermore , one of skill in the art may rely upon and use documents and available commercial or research products to make and use aspects of this invention , including the selection of polymer layers of the bite forms . patent and other documents referred to in this disclosure are specifically incorporated herein by reference and the teachings therein can be used for the purpose of making certain embodiments of the invention . to manufacture the device of the invention , impressions are taken of a patient &# 39 ; s dentition and maxillary and mandibular master casts are fabricated from these impressions . the master casts are then mounted to an articulator , which is adjusted to establish the proper closed position of the two master casts . as will be appreciated by those skilled in the art , this may be accomplished with proper bite registration techniques , which allows the determination of the proper , predetermined position of the mandibular cast with respect to the maxillary cast and the minimum vertical spacing between the casts . typically , a george gauge can be used for accurate bite registration . vent holes may then be drilled into these casts . a dual laminate material may then be attached ( with heat ) to the dentition of the master casts such that the harder layer of the laminate is on the outside . in a preferred embodiment , a triple - laminated appliance is constructed . the first two layers comprise a dual - laminated blank or rigid vinyl , which is pressure formed over the model of the patient &# 39 ; s mouth . a third and outer layer of ethylene acrylic is then used by heat curing the pressure packed thermoplastic material . the buttons can be easily placed at the desired positions into this outer layer while it is setting . in operation , a user whose dentition is mirrored by the bite forms inserts each bite form in his mouth and bites down . the user closes his mouth and attaches the top and bottom buttons on each side with an elastic band . this prevents mouthleaks and helps to alleviate snoring and sleep apnea when used with available positive airway pressure or continuous positive airway pressure ( cpap or pap ) devices . the maximum intercuspal distance spacing of the bite forms described will make the use of negative pressure or suction in the oral cavity unnecessary , and there is no requirement to retain or hold the tongue in position to achieve beneficial results . one method to determine beneficial effects in using the devices of the invention is to record the respiratory disturbance index ( rdi ), as known in the art . the rim can be measured in patients , for example male patients , during three separate conditions : 1 ) while wearing a cpap device alone at prescribed pressure ; 2 ) while wearing a cpap at prescribed pressure with the simultaneous use of a chin strap ; and 3 ) while wearing a cpap at prescribed pressure with the simultaneous use of the intraoral mouth closure device of the invention . in the data of fig1 , the results show the rdi obtained from six patients ( mean ± 1 sd ). the first bar shows the cpap only treatment , with an rdi of 16 . 1 ± 9 . 66 . a significant reduction in values of rdi occurs when the intraoral mouth closing device of the invention ( cpap + iomcd ) is fitted and worn in conjunction with the cpap ( from 16 . 1 ± 9 . 66 to 8 . 72 ± 7 . 81 , p = 0 . 033 , paired samples t - test ). there was no difference between rdi values recorded when the cpap is used alone versus when the cpap is used with the elastic chin strap ( cpap + cs ) simultaneously ( 16 . 1 ± 9 . 66 versus 15 . 5 ± 10 . 0 , p = 0 . 919 ). clearly , the use of the mouth closing device of the invention improves over other available methods and devices . the mouth closing devices of the invention are also more comfortable to use with cpap , perhaps because the vertical dimension is not altered and rather is designed to be the maximal intercuspal distance of the patient . in addition , the devices of the invention do not require the use of negative pressure in the mouth . furthermore , the devices have an open palate and are not designed to hold , interfere with , or impede the movement of the tongue . the connection points , or in some embodiments the buttons , as shown in the figures are designed to be placed in positions that maintain a space substantially equal to the maximum intercuspal distance or space when the connection points between maxillary and mandibular bite forms are attached . in some circumstances , the comfort of the patient may also dictate the position or dictate some movement of the connection point placement . in addition or in the alternative , connection points of the maxillary bite form can be approximately interproximal to the cuspid and 1st bi - cuspid , and placement of the connection points on the mandibular bite form can be approximately below the maxillary connection points and not more than one tooth width away from directly below the maxillary connection point . more than one connection point may be used on each side of each bite form if desired , and the bite forms need not take the form of the buttons shown in the drawings . multiple sized connection points or different shapes of forms of connection points can also be used . while a standard dental rubber or elastic band can generally be used to connect the mandibular and maxillary connection points , other or more rigid devices can be used . for example , wires or coated wires , springs or coated springs , and polymeric bars or rods can be used to attach the connection point , or a subset of the connection point used in two bite forms of the invention . preferably , the devices used to attach connection points are flexible or elastic . in addition , or in the alternative , one or more connection points may be in the interior ( lingual ) side of the bite forms rather than all being placed on the exterior ( facial ) side as shown in the drawings . accordingly , one of skill in the art has many options in positioning the connection points on the bite form in order to achieve the one or more advantages of the invention . any of the embodiments described or exemplified can be used in conjunction with a cpap treatment and in methods to treat disorders in breathing during sleep . thus , the invention specifically includes methods to improve an existing or available cpap treatment device or the treatment of breathing disorders during sleep . generally , the use of the devices of the invention is associated with improved cpap results , higher satisfaction , and patient compliance levels than the prior or existing methods or devices . the examples presented above and the contents of the application define and describe examples of the many products and methods for using them according to the invention . none of the examples and no part of the description should be taken as a limitation on the scope of the invention as a whole or of the meaning of the following claims .
the invention relates to devices designed to be used in conjunction with continuous positive airway pressure devices in order to improve the performance of the positive airway pressure in treating a disorder in breathing during sleep . in one embodiment , connection points on each side of both a maxillary and mandibular bite form are connected in order to maintain a space between the teeth substantially equal to the maximum intercuspal distance or space . used with available continuous positive airway pressure devices , the invention can substantially improve obstructive sleep apnea or similar treatments with lower failure or patient non - compliance rates .