I have been using a Narval appliances for mild OSA for 9 months. I had an AHI of 12.7 prior to treatment. After the first initial 3 months a sleep study was repeated showing my AHI was 8.6 but not where it needed to be. The length of the connectors on my Narval was 28 mm with this sleep study. My sleep specialist asked the dentist to advance the device to achieve additional mandibular protrusion. So my dentist lengthened the connector rods by 2 mm and within 1-2 days I was in considerable agony with headaches and extreme sensitivity to my right upper teeth. I went back to see my dentist and she dropped me back to 28 mm where I was prior to headaches starting. I do have a history of TMJ disorder which rarely bothered me until adjustments began to the Narval. She then began lengthening the connectors by 0.5 mm every 2 weeks. I would have mild issues with jaw tightness on the right side for 2 days with each adjustment and then it would dissipate. It took 4-5 months but eventually she had moved the connectors from 28-30.5 mm. Then a sleep study was repeated which showed a marked worsening of my OSA with an AHI of 16.1! I then started doing my own research on the Narval device to see how using this could have possibly worsened my sleep apnea as there were no other variables that had changed between sleep studies. That’s when I discovered that mandibular protrusion is achieved by shortening the connectors and not lengthening them. The fact that the connectors on my Narval were lengthened completely explains the worsening sleep apnea. I incidentally also read that the connectors should never be adjusted by more than 1 mm at a time. Clearly my dentist must not be well versed in the Narval appliance. While I am frustrated that I’ve lost 6 months in my journey to treat my OSA with the Narval and suffered needless pain with inappropriate adjustments of the device I do still remain committed to making this appliance work if at all possible. So now my dentist is having me shorten the connectors by 0.5 mm every 2 weeks until I get it down to 25 mm. This will take a number of months to achieve. She gave me all the connectors and is having me do all the adjustments. I do not even know if having the patient do their own adjustments is an acceptable treatment plan. She did become a little defensive bordering on passive aggressive trying to shift the blame to my sleep specialist when we discussed what I had found about shortening connectors to achieve mandibular protrusion. I was as non confrontational as I could be but I did need to advocate for myself. At this point I just want this to work. Since moving my connectors from 30.5 mm to 30 mm and then to 29.5 mm in two weeks I have been experiencing quite constant intense headaches that I associate with my TMJ. My masseter muscles are tender and more inflamed on the right side. I just saw an acupuncturist today and will have a massage in 5 days. What would you suggest as any ways to help ease these headaches and TMJ tension experienced with the connector adjustments? Is there any benefit of adding magnesium supplements? I would welcome any and all suggestions as I really feel I am in this on my own at this point.