US20080173312A1 - System and method for treating a patient with obstructive sleep apnea - Google Patents

Abstract

A method for treating obstructive sleep apnea includes providing MAD therapy via an adjustable mandibular advancement device structured to advance the position of the patient's lower jaw, providing CPAP therapy via a mask system structured to deliver a supply of pressurized air to a patient, and selectively adjusting the mask system and/or the mandibular advancement device to alternate and/or balance between CPAP therapy and MAD therapy.

Description

CROSS-REFERENCE TO APPLICATION
• This application claims the benefit of U.S. Provisional Application No. 60/881,156, filed Jan. 19, 2007, which is incorporated herein by reference in its entirety.
FIELD OF THE INVENTION
• The present invention relates to a system and method for treating a patient with obstructive sleep apnea.
BACKGROUND OF THE INVENTION
• Obstructive sleep apnea (OSA) is a common sleep-related respiratory disorder, and many obstructive sleep apnea therapies have been developed to treat the disorder. One such therapy is a mandibular advancement device (MAD) that is used to adjust the position of the patient's lower jaw, e.g., bringing it forward, in an attempt to keep the patient's airway open.
• The present invention provides alternative arrangements of MADs to enhance the treatment of OSA.
SUMMARY OF THE INVENTION
• One aspect of the present invention relates to a mandibular advancement device including a first anchor provided to one or more of a patient's lower teeth, a second anchor supported at a position spaced from the first anchor, and a biasing arrangement to couple the first and second anchors and provide a biasing force to advance the position of the patient's lower jaw.
• Another aspect of the present invention relates to a method for treating obstructive sleep apnea including providing a pillow and positioning the pillow behind the patient's neck to tilt the patient's head back to a position that opens the patient's airway to facilitate breathing.
• Another aspect of the present invention relates to a method for treating obstructive sleep apnea including providing a mask system with an air delivery conduit that extends over the patient's head, fitting the mask system to the patient's head, and adjusting the mask system to promote opening of the patient's upper airways.
• Another aspect of the present invention relates to a method for treating obstructive sleep apnea including providing MAD therapy via an adjustable mandibular advancement device structured to advance the position of the patient's lower jaw, providing CPAP therapy via a mask system structured to deliver a supply of pressurized air to a patient, and selectively adjusting the mask system and/or the mandibular advancement device to alternate and/or balance between CPAP therapy and MAD therapy.
• Another aspect of the present invention relates to a pillow for treating obstructive sleep apnea. The pillow includes a main body adapted to be positioned behind the patient's neck to tilt the patient's head back to a position that opens the patient's airway to facilitate breathing in use.
• Another aspect of the present invention relates to a system for treating obstructive sleep apnea. The system includes a mask system adapted to deliver a supply of pressurized air to a patient and an adjustment mechanism provided to the mask system and adapted to promote opening of the patient's upper airways in use.
• Another aspect of the present invention relates to a system for treating obstructive sleep apnea. The system includes an adjustable mandibular advancement device to provide MAD therapy, a mask system to provide CPAP therapy, and a control system to selectively adjust the mask system and/or the mandibular advancement device to alternate and/or balance between CPAP therapy and MAD therapy.
• Other aspects, features, and advantages of this invention will become apparent from the following detailed description when taken in conjunction with the accompanying drawings, which are a part of this disclosure and which illustrate, by way of example, principles of the invention.
BRIEF DESCRIPTION OF THE DRAWINGS
• The accompanying drawings facilitate an understanding of the various embodiments of this invention. In such drawings:
• FIG. 1 is a schematic view of a mandibular advancement device including a spring or elastic arrangement according to an embodiment of the present invention;
• FIG. 2 is a schematic view of a mandibular advancement device including a spring or elastic arrangement according to another embodiment of the present invention;
• FIG. 3 is a schematic view of a mandibular advancement device including a magnetic arrangement according to an embodiment of the present invention;
• FIG. 4 is a schematic view of a pillow according to an embodiment of the present invention;
• FIG. 5 is a schematic view of a pillow including jaw pushers according to an embodiment of the present invention;
• FIG. 6 is a schematic view of a pillow according to another embodiment of the present invention;
• FIG. 7 is a schematic view of a mandibular advancement device incorporating a football-type helmet according to an embodiment of the present invention;
• FIG. 8 is a schematic view of clamping locations for a mandibular advancement device according to an embodiment of the present invention;
• FIGS. 9A and 9B illustrate a mask system including an Adam's Circuit according to an embodiment of the present invention;
• FIG. 9C illustrates a half brace according to an embodiment of the present invention;
• FIGS. 10A and 10B are schematic views of a mask including a pivotally mounted lower section according to an embodiment of the present invention;
• FIG. 11 is a schematic view of a mask including a portion that extends into the patient's mouth according to an embodiment of the present invention; and
• FIG. 12 is a schematic view of a control system to alternate the balance between CPAP and MAD therapy according to an embodiment of the present invention.
DETAILED DESCRIPTION OF ILLUSTRATED EMBODIMENTS
• One aspect of the present invention relates to the way in which a mandibular advancement device may be used in the treatment of obstructive sleep apnea. For example, the mandibular advancement device may be used as a stand-alone device and adjust the position of the patient's lower jaw in an attempt to keep the patient's airway open. Alternatively, the mandibular advancement device may be used in conjunction with a mask system, e.g., nasal mask, full-face mask, nasal and mouth mask, nasal prongs, to enhance the treatment of obstructive sleep apnea. That is, the mandibular advancement device may adjust the position of the patient's lower jaw while the mask system delivers a supply of pressurized air. The mandibular advancement device may be selectively or incrementally adjusted during and/or after a treatment period (e.g., based on apnea severity), and the adjustment of the mandibular advancement device may be coordinated with the mask system (e.g., adjustment coordinated with the pressure level of the mask system).
• The following includes descriptions of several embodiments of the present invention, which may share common characteristics and features. It is to be understood that one or more features of any one embodiment may be combinable with one or more features of the other embodiments. In addition, each single feature or combination of features in any of the embodiments may constitute an additional embodiment.
1. Mandibular Advancement Device
• A mandibular advancement device is structured to advance the position of the patient's lower jaw in an attempt to keep the patient's airway open. For example, the mandibular advancement device may be an internal device that is provided within the patient's mouth, e.g., dental insert, in order to advance the position of the patient's lower jaw. Alternatively, the mandibular advancement device may be an external device that is provided outside the patient's mouth, e.g., engaged with patient's neck and external jaw, in order to advance the position of the patient's lower jaw.
1.1 Internal Device
• An “internal” mandibular advancement device includes a portion provided within the patient's mouth to advance the position of the patient's lower jaw. The internal mandibular advancement device may be a fixed device having a fixed magnitude of advancement or an adjustable device having an adjustable magnitude of advancement. Adjustment of the device may be manual and/or automatic, and may be continuously controlled for a patient during changing sleep conditions as needed.
1.1.1 Constant Displacement
• Exemplary embodiments of “internal” mandibular advancement devices are disclosed in PCT Application No. PCT/AU2006/001095, filed Aug. 2, 2006, the entirety of which is incorporated herein by reference. In the exemplary embodiments, the mandibular advancement device includes upper and lower members that are fitted to respective upper and lower jaws of the patient. The upper and lower members include flanges (which may be adjustable) that engage one another to advance the position of the patient's lower jaw. Thus, the position of the patient's lower jaw is advanced by a constant displacement.
1.1.2 Constant Force
• Instead of constant displacement, constant force may be used to advance the position of the patient's lower jaw. For example, a spring arrangement, an elastic arrangement, and/or a magnetic arrangement may be used to force the position of the patient's lower jaw.
• FIG. 1 is a schematic view of a mandibular advancement device including a spring orelastic arrangement10 according to an embodiment of the present invention. As illustrated, the spring orelastic arrangement10 includes alower anchor12 provided to the patient's lower teeth (e.g., anchor attached to one or more lower teeth), anupper anchor14 provided to the patient's upper teeth (e.g., anchor attached to one or more upper teeth), and a spring or elastic member16 (e.g., rubber band) provided or attached between the lower andupper anchors12,14. In use, the spring orelastic member16 provides a biasing force to advance the position of the patient's lower jaw.
• In an alternative embodiment, as shown inFIG. 2, the spring orelastic arrangement10 may include alower anchor12, anexternal anchor15 provided outside the patient's mouth, and a spring orelastic member16 provided or attached between thelower anchor12 and theexternal anchor15. In use, the spring orelastic member16 provides a biasing force to advance the position of the patient's lower jaw.
• FIG. 3 is a schematic view of a mandibular advancement device including amagnetic arrangement20 according to an embodiment of the present invention. As illustrated, themagnetic arrangement20 includes a dental insert ormouthpiece22 provided to the patient's lower teeth and anexternal device24 provided outside the patient's mouth. Thedental insert22 is magnetically coupled to the external device such that the external device magnetically “pulls” and/or “pushes” thedental insert22 and hence the patient's lower jaw outwardly to advance the position of the patient's lower jaw. That is, the magnetic coupling may be provided by magnets with unlike poles that are attracted to one another to “pull” the dental insert outwards at the front of the patient's jaw and/or magnets with like poles that are repelled from one another to “push” the dental insert from behind the patient's jaw. The magnetic arrangement provides an arrangement that is non-invasive and non-mechanical.
• An advantage of constant force over constant displacement is that constant displacement may cause a tremendous amount of force on a patient's jaw if the patient's muscles are tight. But, if the muscles are tight, then the patient's oral soft tissue will probably not be blocking the airway, so little to no jaw advancement may actually be necessary.
1.2 External Device
• An “external” mandibular advancement device is provided outside the patient's mouth to advance the position of the patient's lower jaw. For example, the “external” mandibular advancement device may engage the patient's head, neck, face, and/or external jaw to advance the position of the patient's lower jaw.
1.2.1 Pillow
• In an embodiment, as shown inFIG. 4, the mandibular advancement device may be in the form of apillow30 that is positioned, e.g., behind the patient's neck, to tilt the patient's head back. Similar to tilting a patient's head back for administering CPR, thepillow30 tilts the patient's head back in order to open the patient's airway to facilitate breathing.
• In an alternative embodiment, as shown inFIG. 5, thepillow30 may incorporate one or more protrusions32 (e.g., jaw pushers) that are adapted to push up against the back of the patient's jaw in order to advance the position of the patient's lower jaw.
• In either embodiment, the pillow may have a crescent or wave shape that extends between the shoulders and the base of the patient's skull (e.g., as viewed from the top of the pillow). The pillow can also be formed with an upper portion to effectively cradle the patient's head. For example,FIG. 6 illustrates apillow70 having a crescent or wave shape and an upper portion orcradle72. As illustrated, thepillow70 may include aninflatable bladder74 such as that described below in section 1.2.3.
• 1.2.2 Neck Brace with Jaw Pushers
• In an embodiment, the mandibular advancement device may be in the form of a neck brace that includes one or more protrusions or jaw pushers adapted to push up against the back of the patient's jaw in order to advance the position of the patient's lower jaw.
1.2.3 Inflatable Mechanism
• In an embodiment, the mandibular advancement device may be in the form of an inflatable mechanism that is adapted to inflate and force the patient to be in a specific position. For example, the inflatable mechanism may be an inflatable pillow that is adapted to inflate and force the patient to tilt his/her head back, roll on his/her side, etc.
• 1.2.4 Helmet with Mouth Guard
• In another embodiment, as shown inFIG. 7, a mouth guard ordental insert40 may be provided to the patient's lower teeth and coupled with theface mask42 of a football-type helmet44 to “pull” the patient's lower jaw forward. Themouth guard40 may be fixed to theface mask42 or may include a spring, elastic, and/or a magnetic arrangement with theface mask42 such as the arrangements described above in section 1.1.2.
• 2. Mandibular Advancement Device Used in Conjunction with Mask System
• In some mask systems, e.g., full-face masks, portions of the mask system may push against the patient's lower jaw which may cause obstructions. An aspect of the present invention relates to a mandibular advancement device used in conjunction with a mask system in order to advance the position of the patient's lower jaw and/or counteract any potential obstructions caused by using the mask system. The mandibular advancement device may be incorporated into any suitable mask system, e.g., full-face, nasal, nasal prongs, mouth mask and nasal prongs, etc.
• The mandibular advancement device may be permanently or removably attached to the mask system, e.g., selectively attachable. In an embodiment, the mask system and mandibular advancement device may be formed separately from another and then connected with a lanyard. Also, the mandibular advancement device may be controlled, at least in part, by the mask system, e.g., mask pressure used to operate mandibular advancement device.
• In an embodiment, the combination of a CPAP mask system with a mandibular advancement device may allow a reduced CPAP pressure to be used for treatment. For example, a CPAP mask system alone may deliver pressurized gas at about 12 cmH₂O for treatment, and a CPAP mask system used with a mandibular advancement device may deliver pressurized gas at about 10 cmH₂O for treatment.
2.1 External Clamp
• In an embodiment, the mandibular advancement device may be in the form of an external clamp adapted to clamp or clasp the rear of a patient's jaw (as indicated by arrow R inFIG. 8) or the front of a patient's jaw (as indicated by arrow F inFIG. 8). For example, the external clamp may be coupled to the mask system, e.g., attached to the mask frame and/or mask headgear, and be configured to clamp the rear of a patient's jaw to “push” the patient's chin forward or clamp the front of a patient's jaw to “pull” the patient's chin forward. Preferably, the clamp pushes or pulls outside of the patient's jowls near the temporomandibular joint.
2.2 Tilt Head Back
• In an embodiment, the mask system may include a component (e.g., air conduit or delivery tube) that extends over the patient's head, e.g., Adam's Circuit, to promote opening of the patient's upper airways, e.g., by tilting the patient's head back and/or forcing the mask system away from the patient's lower jaw. This prevents the mask system from pushing down against the patient's lower jaw which may cause obstructions.
• For example, a mask system including an Adam's Circuit80 (e.g., a Puritan Bennet Adam™ Interface System) may be provided to a patient's head to tilt the patient's head from a first position (shown inFIG. 9A) to a second position (shown inFIG. 9B) to prevent the mask system from pushing down against the patient's lower jaw and/or to open the patient's airway to facilitate breathing. As illustrated, the Adam'sCircuit80 may tilt the patient's head such that the patient interface (e.g., prongs, cushion, cannula, etc.) translates over a distance d, which may be sufficient to straighten the upper airways, e.g., to thereby clear an occlusion or fold82 within the patient's airway if the patient's neck is awkwardly angled. In an embodiment, the Adam's Circuit may have a first length that is reduced, e.g., by an adjustment mechanism, to a second length in order to tilt the patient's head from the first position (shown inFIG. 9A) to the second position (shown inFIG. 9B).
• In another embodiment, the air delivery tube may be movably positionable relative to the headgear. If the patient is slouching and the neck is bent, the tube may be pulled upwardly relative to the patient and the headgear, thus forcing the patient to raise his/her head in order to properly engage the patient interface. In the process, the patient's upper airways are straightened, thus potentially reducing the chances for airway collapse. In this and other embodiments, it may be helpful to provide a fixed reference point on the patient to which the headgear and/or Adam's Circuit are positioned. In one example, the headgear simply has a fairly rigid, depending member braced against the back of the head and the neck and/or shoulders of the patient to maintain the neck at a predetermined angle. In an alternative embodiment, the member could be built into clothes or constitute a separate member (e.g., in a neck brace). For example,FIG. 9C illustrates ahalf brace85 that is open in the front of the patient's neck and extends below the patient's jaw line and up behind the back of the patient's head. As illustrated, thebrace85 may includeside portions87 to prevent wobbling of the patient's head in use.
• In another embodiment, a mandibular advancement device in the form of a pillow, pillow with jaw pushers, or neck brace with jaw pushers (as described above) may be provided to tilt the patient's head back.
2.3 Facial Support
• In embodiments, the mask system may be supported by portions of the patient's face to prevent the mask system from pushing down against the patient's lower jaw. For example, the mask system may clamp onto sides of the patient's mid-bridge, e.g., like a G-clamp, or use the patient's ears as support.
2.4 Inflatable Mechanism
• As noted above, the mandibular advancement device may be in the form of an inflatable mechanism that is adapted to inflate and force the patient to be in a specific position. In an embodiment, the inflatable mechanism may be incorporated into the headgear of the mask system. For example, the headgear may include an inflatable portion or bladder that is adapted to inflate and force the patient to tilt his/her head, roll on his/her side, roll over, etc. The pressure to inflate the bladder may be provided by the flow generator of the mask system.
2.5 Magnetic Arrangement
• As noted above, a magnetic arrangement may be provided to “pull” and/or “push” the patient's lower jaw. In an embodiment, the mask, e.g., full-face mask, may be magnetically coupled to the headgear such that the headgear magnetically “pulls” and/or “pushes” the mask to adjust the position of the patient's lower jaw, e.g., mask provided with magnetic attraction and headgear provided with magnetic repulsion.
2.5.1 Electromagnetic Arrangement
• In an alternative embodiment, an electromagnetic arrangement may be provided for force advancement of the patient's lower jaw. The electromagnetic arrangement may include a permanent magnet, e.g., provided to the mask, and an electromagnet, e.g., provide to the headgear, to allow the headgear to “pull” and/or “push” the mask to adjust the position of the patient's lower jaw. The electromagnet allows adjustment of the force.
2.6 Updated Mask Structure
• The mask, e.g., full-face mask, may include structure to allow movement and/or counteract any potential obstructions to movement of the patient's lower jaw.
• For example, the lower jaw region of a full-face mask may be structured to allow movement of the patient's lower jaw. In an embodiment, as shown inFIGS. 10A and 10B, the mask may include a pivotally mountedlower section50 to allow movement of the patient's lower jaw in use. Thelower section50 may be spring biased. For example, thelower section50 may incorporate one ormore springs52, with the attachment points P for headgear straps positioned above thesprings52. Thesprings52 may be arranged to bias thelower section50 towards the patient's face to provide a sealing force but allow sufficient movement of the patient's lower jaw in use. Alternatively, thesprings52 may be arranged to bias thelower section50 away the patient's face to allow sufficient movement of the patient's lower jaw in use.
• In another exemplary embodiment, as shown inFIG. 11, amask60, e.g., mouth mask, may support aportion62 that extends into the patient's mouth and provides adistal end64 adapted to engage the patient's lower jaw and/or lower teeth to push the patient's lower jaw forward. As illustrated, theportion62 has no contact with the upper jaw and/or upper teeth of the patient in use. In an embodiment, theportion62 may be supported by a frame of the mask.
• In another embodiment, a mouth guard or dental insert may be provided to the patient's lower teeth and coupled with the back of the patient's head and/or headgear of the mask system to “push” or “pull” the patient's lower jaw forward.
• In another embodiment, a portion of the pressurized gas may be used to force the patient's lower jaw forward, e.g., inflatable bladder to force patient's lower jaw forward.
• 2.7 Coordinated with Mask Pressure Level
• In an embodiment, displacement provided by the mandibular advancement device may be coordinated with the pressure level of the mask system. That is, a control system may be provided to alternate and/or balance between CPAP therapy provided by the mask system and MAD therapy provided by the mandibular advancement device.
• For example, a pressure level of 12 cmH₂O provided by the mask system may be suitable with 8 mm of advancement provided by the mandibular advancement device, and a pressure level of 20 cmH₂O provided by the mask system may be suitable with 12 mm of advancement provided by the mandibular advancement device. However, other suitable relations between the pressure level and MAD setting may be provided, e.g., depending on the patient and/or required treatment. It should be appreciated that controlling the alternation and/or balance may be manual and/or automatic, e.g., automatically changed during the night.
• FIG. 12 is a schematic view of a control system to alternate and/or balance between CPAP and MAD therapy. As illustrated, thecontrol system90 is communicated withblower92 to control and/or receive feedback regarding the delivery of pressurized air to mask94 for CPAP therapy. Thecontrol system90 is also communicated withMAD96 to control and/or receive feedback regarding MAD therapy. Based on the patient and/or required treatment, thecontrol system90 may automatically update and/or recommend suggested settings to alternate and/or balance between CPAP therapy provided by the mask system and MAD therapy provided by the MAD.
3.0 Improvements to Prior Art Masks
• One or more of the above-described embodiments of mandibular advancement devices may be adapted for use and/or incorporated into the masks described in PCT Publication WO 01/95965, which is incorporated herein by reference in its entirety. For example, an inflatable mechanism, e.g., inflatable pillow, may be adapted for use with the disclosed masks.
• While the invention has been described in connection with what are presently considered to be the most practical and preferred embodiments, it is to be understood that the invention is not to be limited to the disclosed embodiments, but on the contrary, is intended to cover various modifications and equivalent arrangements included within the spirit and scope of the invention. Also, the various embodiments described above may be implemented in conjunction with other embodiments, e.g., aspects of one embodiment may be combined with aspects of another embodiment to realize yet other embodiments. Further, each independent feature or component of any given assembly may constitute an additional embodiment. In addition, while the invention has particular application to patients who suffer from OSA, it is to be appreciated that patients who suffer from other illnesses (e.g., congestive heart failure, diabetes, morbid obesity, stroke, barriatric surgery, etc.) can derive benefit from the above teachings. Moreover, the above teachings have applicability with patients and non-patients alike.

Claims (43)

1. A mandibular advancement device, comprising:

a first anchor provided to one or more of a patient's lower teeth;

a second anchor supported at a position spaced from the first anchor; and

a biasing arrangement to couple the first and second anchors and provide a biasing force to advance the position of the patient's lower jaw.

2. The mandibular advancement device according toclaim 1, wherein the biasing arrangement includes a spring or elastic member.

3. The mandibular advancement device according toclaim 1, wherein the first anchor is attached to one or more of the patient's lower teeth.

4. The mandibular advancement device accordingclaim 1, wherein the second anchor is attached to one or more of the patient's upper teeth.

5. The mandibular advancement device according toclaim 1, wherein the second anchor is an external anchor provided outside the patient's mouth.

6. The mandibular advancement device according toclaim 1, wherein the biasing arrangement includes a magnetic arrangement.

7. The mandibular advancement device according toclaim 6, wherein the first anchor is a dental insert or mouthpiece and the second anchor is an external device provided outside the patient's mouth, the dental insert being magnetically coupled to the external device.

8. A system for treating obstructive sleep apnea, comprising:

a mask system adapted to deliver a supply of pressurized air to a patient; and

a mandibular advancement device according toclaim 1.

9. The system according toclaim 8, wherein the mask system includes a nasal mask, full-face mask, nasal and mouth mask, and/or nasal prongs.

10. A method for treating obstructive sleep apnea, comprising:

providing a pillow; and

positioning the pillow behind the patient's neck to tilt the patient's head back to a position that opens the patient's airway to facilitate breathing.

11. The method according toclaim 10, further comprising:

providing one or more protrusions to the pillow; and

positioning the pillow so that the one or more protrusions push up against the back of the patient's jaw in order to advance the position of the patient's lower jaw.

12. The method according toclaim 10, further comprising providing an upper portion or cradle to the pillow to effectively cradle the patient's head in use.

13. The method according toclaim 10, further comprising providing an inflatable bladder to the pillow and inflating the pillow to force the patient to a specific position.

14. The method according toclaim 10, further comprising delivering CPAP therapy to the patient.

15. A method for treating obstructive sleep apnea, comprising:

providing a mask system with an air delivery conduit that extends over the patient's head;

fitting the mask system to the patient's head; and

adjusting the mask system to promote opening of the patient's upper airways.

16. The method according toclaim 15, wherein adjusting the mask system includes adjusting the mask system to tilt the patient's head back.

17. The method according toclaim 16, further comprising reducing the length of the air delivery conduit that extends over the patient's head to tilt the patient's head back.

18. The method according toclaim 15, wherein adjusting the mask system includes forcing the mask system away from the patient's lower jaw.

19. The method according toclaim 15, further comprising adjusting the position of the patient interface to cause the angle of the patient's neck to change.

20. The method according toclaim 19, further comprising raising the patient interface to cause the upper airway to open.

21. A method for treating obstructive sleep apnea, comprising:

providing MAD therapy via an adjustable mandibular advancement device structured to advance the position of the patient's lower jaw;

providing CPAP therapy via a mask system structured to deliver a supply of pressurized air to a patient; and

selectively adjusting the mask system and/or the mandibular advancement device to alternate and/or balance between CPAP therapy and MAD therapy.

22. The method according toclaim 21, wherein selectively adjusting includes manual and/or automatic adjustment.

23. The method according toclaim 21, wherein selectively adjusting includes selectively adjusting the position of the patient's lower jaw provided by the adjustable mandibular advancement device based on the delivery pressure provided by the mask system.

24. The method according toclaim 21, wherein selectively adjusting includes selectively adjusting the delivery pressure provided by the mask system based on the position of the patient's lower jaw provided by the adjustable mandibular advancement device.

25. A pillow for treating obstructive sleep apnea, comprising:

a main body adapted to be positioned behind the patient's neck to tilt the patient's head back to a position that opens the patient's airway to facilitate breathing in use.

26. The pillow according toclaim 25, wherein the includes one or more protrusions, the one or more protrusions adapted to push up against the back of the patient's jaw in order to advance the position of the patient's lower jaw in use.

27. The pillow according toclaim 25, wherein the pillow includes an upper portion or cradle adapted to effectively cradle the patient's head in use.

28. The pillow according toclaim 25, wherein the pillow includes an inflatable bladder that is inflatable to force the patient to a specific position in use.

29. A system for treating obstructive sleep apnea, comprising:

a mask system adapted to deliver a supply of pressurized air to a patient; and

a pillow according toclaim 25.

30. The system according toclaim 29, wherein the mask system includes a nasal mask, full-face mask, nasal and mouth mask, and/or nasal prongs.

31. A system for treating obstructive sleep apnea, comprising:

a mask system adapted to deliver a supply of pressurized air to a patient; and

an adjustment mechanism provided to the mask system and adapted to promote opening of the patient's upper airways in use.

32. The system according toclaim 31, wherein the mask system includes a nasal mask, full-face mask, nasal and mouth mask, and/or nasal prongs.

33. The system according toclaim 31, wherein the mask system includes an air delivery conduit that extends over the patient's head.

34. The system according toclaim 33, wherein the adjustment mechanism is coupled to the air delivery conduit, the adjustment mechanism structured to reduce the length of the air delivery conduit to tilt the patient's head back.

35. The system according toclaim 31, wherein the adjustment mechanism is structured to adjust the mask system to tilt the patient's head back.

36. The system according toclaim 31, wherein the adjustment mechanism is structured force the mask system away from the patient's lower jaw.

37. The system according toclaim 31, wherein the adjustment mechanism is structured to adjust the position of the mask system to cause the angle of the patient's neck to change.

38. The system according toclaim 37, wherein the adjustment mechanism is structured to raise the mask system to cause the upper airway to open.

39. A system for treating obstructive sleep apnea, comprising:

an adjustable mandibular advancement device to provide MAD therapy;

a mask system to provide CPAP therapy; and

a control system to selectively adjust the mask system and/or the mandibular advancement device to alternate and/or balance between CPAP therapy and MAD therapy.

40. The system according toclaim 39, wherein control system provides manual and/or automatic adjustment.

41. The system according toclaim 39, wherein the control system is structured to selectively adjust the position of the patient's lower jaw provided by the adjustable mandibular advancement device based on the delivery pressure provided by the mask system.

42. The system according toclaim 39, wherein the control system is structured to selectively adjusting the delivery pressure provided by the mask system based on the position of the patient's lower jaw provided by the adjustable mandibular advancement device.

43. The system according toclaim 39, wherein the mask system includes a nasal mask, full-face mask, nasal and mouth mask, and/or nasal prongs.

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