08/15/2025
Honored to work alongside Dr. Doris Ferres, DMD PA
Submitted by: Doris A Ferres, DMD, AMD, D-ASBA
Practice Name: Ferres Dentistry/Airway and Sleep Solutions
Date: 7/22/25
Patient: Laura Starkweather, Female, Adult
Condition: Obstructive Sleep Apnea (OSA), chronic pain secondary to multiple back surgeries
Appliance: HERBST Sleep Appliance
Fabricated by: Gergen’s Orthodontic Lab
Lab Contact: David Gergen, Owner
Clinical Background:
Laura is a patient diagnosed with Obstructive Sleep Apnea (OSA) and a complex medical history including multiple spinal surgeries resulting in persistent, often debilitating chronic pain. Conventional CPAP therapy has been challenging for her, both in terms of compliance and comfort. Seeking an alternative approach that could manage her OSA while minimizing discomfort, she was fitted with a custom HERBST sleep appliance fabricated by Gergen’s Orthodontic Lab.
Night One: Immediate Positive Response
Following the initial fitting, Laura wore the HERBST appliance on the first night without simultaneous use of her CPAP. She did not alter any other aspect of her nighttime routine or medication protocol. Despite being in extreme discomfort earlier in the day, she experienced the following:
Significant reduction in night wakings: Woke only twice, compared to her usual fragmented sleep.
Complete absence of pain: Reported waking up pain-free for the first time in memory.
Discontinued pain medication: Remarkably, she did not require any pain medication the entire day following the first use.
Sustained comfort: Throughout the following day, even during periods of prolonged sitting (typically painful), she remained free of discomfort.
“Despite not changing anything else about my nighttime routine, other than wearing the appliance, I only woke up twice last night... but my utter shock — I was not in pain. I haven’t taken any pain medication today — NONE!!”
Night Two: CPAP Reintroduction & Setback
The second night, Laura used both the HERBST appliance and her CPAP concurrently. Unfortunately, she experienced:
Neck pain and a migraine upon waking
Return of discomfort, in stark contrast to her experience with the appliance alone
Immediate rejection of CPAP: She proactively contacted her sleep provider and Lincare to discontinue CPAP therapy based on this negative experience
Despite the return of upper body pain, her hip pain remained absent, which she described as a tremendous relief.
“After waking up so miserable this morning, it was glaringly obvious that CPAP is not for me… The good news is my hips still don’t hurt — for which I am incredibly grateful.”
Summary & Clinical Significance:
Laura’s experience with the HERBST sleep appliance has been nothing short of transformative in just two nights of use:
Dramatic reduction in chronic pain symptoms
Improved sleep quality
Elimination of dependency on pain medications (at least temporarily)
Clear preference for the appliance over CPAP due to comfort and therapeutic effect
Her case exemplifies the broader systemic benefits of airway-centered dental therapy and the potential of mandibular advancement appliances, not only to manage OSA but also to positively impact chronic pain syndromes in select patients.
This testimonial underscores the real-world efficacy of the HERBST appliance and highlights its value as a primary therapy for patients who are CPAP-intolerant or who present with complex comorbidities.
Doris A Ferres, DMD, AMD, D-ASBA
Feres Dentistry/Airway & Sleep Solutions
