exiting the mouth other than through valve 14 or the nose and it serves to help retain device 10 in the mouth during sleep in another embodiment 13 may reside outside of the mouth and bite surfaces 11 and 12 may be fitted to the teeth as with many mandibular advancement devices to help hold device 10 in the mouth valve 14 in one embodiment can be a simple one way purge valve with a silicon flap such as one might find employed at the base of a snorkel tube the role of valve 14 is typically to freely allow a substantial quantity of air into the mouth as desired by the patient as quietly as possible valve 14 further is intended to restrict the egress of air from the mouth another embodiment would provide for the adjustment of the valve to allow customizable restricted oral exhalation and inhalation fig3 illustrates an embodiment showing the usage of optional piece 16 illustrated in detail in fig4 fig4 illustrates an optional and adjustable piece 16 intended to further restrict the egress of nasal exhalation adjustable piece 16 can flex toward or away from the nose on adjustable hinge 17 16 can also be adjusted to be nearer to the nose by virtue of shortening or elongating the adjustable length shaft 18 19 is a replaceable soft cushion that rests near or touching the patient nose 16 in general can quickly move to accommodate nose blowing other embodiments can be envisioned such as one that pushes the nostrils closed slightly or one that is not even attached to device 10 further embodiments could provide.