Integration of SOT cranial therapy with an occlusal splint for the
treatment of obstructive sleep apnea: A case report.

Thomas Bloink, DC, Mamal Rahimi, DDS, and Charles L. Blum, DC
Sacro Occipital Technique Organization - USA

Purpose and Background
Obstructive sleep apnea (OSA) relates to an obstruction to the
continuum of airway expressed as sleep-disordered breathing
associated with multiple co-morbidities and societal implications1,2.
With untreated sleep apnea patient the risk of automobile accidents
are approximately 8-times more likely than that of a normal sleeper
and in the work arena likewise productivity and safety suffer1.

The combination of SOT cranial therapy with a flat
plane mandibular occlusal splint appeared to help
resolve this patient’s apnea and accompanied
symptoms. This intervention was minimally invasive,
less costly than a CPAP, and only required a 3-4
week treatment program. Splint type therapy has
been found to be helpful for OSA patients and one
prospective randomized study found “that a dental

Following the 6-office visits the patient reported
significant reduction of all symptoms. Follow-up
polysomnogram was performed one-month following
prior study and with the dental appliance in her
mouth. RDI and AHI were both reduced to 2.9 and
lowest Sa02 was 92% during sleep. The patient had
significantly reduced TMJ pain and the chronic
myofascial neck and shoulder pain had gradually
resolved over the 3-4 weeks of care. Due to her
increased ability to sleep and increased oxygenation,
she had less daytime fatigue and greater function.
Common treatments for OSA
usually start with a continuous
positive airway pressure (CPAP)
machine and can progress to
surgery to facilitate airway
expansion and/or increase
function. Surgery is costly and
invasive and patient compliance
with CPAP machines is
estimated at only 40%2.
A 56-year-old female patient
presented for chiropractic and
dental care with persistent
symptoms of sleep apnea,

appliance could be an alternative treatment for some
patients with severe OSA5.”
Ascending and descending kinematic postural
influences have been found between posture and
occlusion, condylar position, and airway space --
suggesting that the treatment of TMJ disorders and
sleep apnea may be an opportunity for dental and
chiropractic collaboration6-8. Clinically, chiropractors
and dentists are realizing a relationship between
posture and the OSA, supporting the need for
interdisciplinary efforts8.

The persistent nature of the patient’s apnea, the pre
and post-sleep study objective findings, and the
patient’s significant reduction in pain and improved
function are compelling features of this case.
Greater study is needed to identify the subset of
apnea patients that could benefit from this approach.

1. Al Lawati NM, Patel SR, Ayas NT. Epidemiology, risk factors, and consequences of obstructive sleep apnea and short sleep duration. Prog Cardiovasc Dis. 2009 Jan-Feb;51(4):285-93.
2. Kapur VK. Obstructive sleep apnea: diagnosis, epidemiology, and economics. Respir Care. 2010 Sep;55(9):1155-67.
3. Monk R. Sacro Occipital Technique Manual. Sacro Occipital Technique Organization – USA: Sparta, NC, USA. 2006: 91-126.
4. Monk R, Blum CL. SOT Cranial Level Two Manual: TMJ Technique. Sacro Occipital Technique Organization – USA: Sparta, NC, USA. 2004.
5. Walker-Engström ML, Ringqvist I, Vestling O, Wilhelmsson B, Tegelberg A. A prospective randomized study comparing two different degrees of mandibular advancement with a dental appliance in
treatment of severe obstructive sleep apnea. Sleep Breath. 2003 Sep;7(3):119-30.
6. Sakaguchi K, Mehta NR, Abdallah EF, Forgione AG, Hirayama H, Kawasaki T, Yokoyama A. Examination of the relationship between mandibular position and body posture. Cranio. 2007 Oct;25(4):237-49.
7. Maeda N, Sakaguchi K, Mehta NR, Abdallah EF, Forgione AG, Yokoyama A. Effects of experimental leg length discrepancies on body posture and dental occlusion. Cranio. 2011 Jul;29(3):194-203.
8. Blum CL. TMD Functional Integrative Approach: Dental and Chiropractic Approach to Forward Head Posture. Journal of the American Academy of Craniofacial Pain. Fall 2009; 22(2):18,31,39.
Cranial-dental exam revealed a dental class II, narrow arches and
premature anterior contacts with evidence of clenching and
bruxism. The sleep study revealed a Respiratory Disturbance
Index (RDI) of 17.1 and Apnea Hypopnea Index (AHI) of 16.3,
with the lowest oxyhemoglobin saturation (SaO2) of 89% during
sleep. Six-treatments over a 3-4 week period of time consisted of
sacro-occipital technique (SOT) care3, cranial-dental treatments
incorporating SOT intra-oral cranial adjustments4, and sphenomaxillary
cranial care. Dental care was provided in conjunction
utilizing occlusal balancing by a mandibular flat plane dental
excessive daytime sleepiness,
short-term memory loss, foggyheadedness,
joint (TMJ) pain, chronic
myofascial neck and shoulder
pain, fatigue, and vertigo.