Sleep Herbst

The Herbst is not a new idea. It has been used in orthodontic and TMJ therapy since 1909. In the 1980s Dr. Gene Williamson applied it to TMJ treatment, and Dr. Ed Spiegel adapted it for obstructive sleep apnea — which is where most of our sleep work with it begins today.

The mechanism is bilateral: two telescoping rod-and-tube arms connect the upper and lower arches, with nothing joining them across the midline. That matters for the patient. The jaw still moves laterally, the mouth still opens, and speech is possible with the appliance in. A design that locks the mandible in one position is a design that gets left in the bedside drawer.

Advancement is made at the protrusion collar. One full turn moves the mandible forward in 1/8 mm increments, up to 4 mm from the position we built it to — so titration happens in your chair, with no return trip to the bench.

We chose this appliance deliberately. It had to hold fit and finish to the standard we are willing to put our name on, let the patient move and speak, adjust in the increments dental sleep medicine practice calls for, tolerate the normal variation in impression technique that comes through the door, and meet the requirements for insurance reimbursement. The Herbst does all five.