My doctor said paying the amount of money for the appliance was outrageous. He suggested using tongue depressors stacked together with a rubber band. He suggested I stack as many as I can fit in my mouth and exercise 3 times a day and then the 4th time, at bedtime, increase one tongue depressor. I can't say I do the excercises often due to the pain which I was told to work through the pain. The doctors are happy to give the depressors to me when I visit. Hope that helps anyone who does not have insurance or a huge deductible to save a lot of money. Sincerely, Mary