Botox for TMJ: Helpful, But Not the Whole Story

Great Sleep Dental • August 1, 2025

Temporomandibular disorders (TMD) are much more than just jaw pain or a clicking sound when you chew—they represent a complex condition that can impact many aspects of your life, from speaking and eating to your overall well-being. TMJ disorders involve a variety of musculoskeletal issues affecting the jaw joint, surrounding muscles, and associated structures. In fact, TMJ disorders are considered the second most common cause of orofacial pain after dental problems and are the most common type of non-dental related orofacial pain.

Recent studies have shown that common painful temporomandibular disorders (TMD) are multifactorial, where no individual factor alone leads to the condition. Because of the complex etiology of TMJ disorders, effective treatment often requires a multidisciplinary approach. Today, a range of conservative treatments are being utilized, which include self-management strategies, behavioral therapy, physical therapy, pharmacotherapy, and, in some cases, surgery as a last resort. However, for those patients who do not respond well to conservative treatment options, Botox has become an emerging therapeutic alternative.

What is Botox

Botulinum toxin A, commonly known as Botox, is a neurotoxin that works by blocking the release of Acetylcholine at the neuromuscular junction. Once Acetylcholine is blocked, muscle contraction is prevented, leading to muscle relaxation. When Botox is injected into hyperactive jaw muscles- such as the masseter- it reduces the excessive contraction of your jaw muscles, helping to ease your muscle pain, tension, tightness, clenching, bruxism, and even headaches.

While Botox can be an effective therapeutic alternative in reducing muscle hyperactivity and its related symptoms, it is important to remember that TMJ disorder is never caused by a "Botox deficiency.” Botox is just one part of a broader, multidisciplinary treatment approach (e.g., oral appliances, physical therapy, stress management). Botox is a therapeutic adjunct and not a cure or a preventative solution. It does not address the underlying causes of TMJ disorders, but only provides symptomatic relief. It must always be utilized in conjunction with an individualized treatment plan to meet your specific needs and support your overall recovery.

Botox as the sole treatment for TMJ disorders should be carefully considered, especially when it comes to factors like cost, frequency of treatments, and duration of relief.

Frequency

Botox injections generally need to be repeated every 3 to 4 months to maintain their therapeutic effect. This means patients may require multiple sessions throughout the year. The need for repeated Botox treatments may potentially impact patient compliance and cause additional expenses. According to the American Academy of Neurology, the effects of Botox generally last about 3 months, highlighting the importance of follow-up injections to sustain symptom relief.

Cost

The cost per Botox session can vary widely, typically ranging from a hundred to over a thousand dollars, depending on the extent and dosage. This would definitely pose a heavy financial burden, especially for those patients diagnosed with chronic conditions like TMJ disorders.

Duration of Relief

Since Botox works only as a therapeutic agent, its duration of relief can only last an average of about 3 to 4 months. This means that Botox cannot be considered a permanent solution, but rather a recurring treatment in managing TMD symptoms.

Bruxism and Airway Instability

Bruxism refers to repeated clenching and grinding of the teeth, often occurring during sleep. While commonly viewed as a harmful habit, some individuals may unconsciously grind their teeth at night as a way to keep their airway open. When the tongue falls backward or the soft palate collapses, it can partially block the airway, causing a drop in oxygen levels. In response, the brain may trigger jaw clenching or grinding to help reopen the airway and restore proper breathing.

Because of this potential connection, some believe that bruxism might serve as a protective mechanism against airway instability during sleep. As a result, one should be careful about using Botox in order not to "paralyze" these clenching/grinding muscles before an airway assessment and treatment. If the grinding is helping you breathe better at night, weakening those muscles too soon could make things worse.

Conclusion

Botox is only effective as a temporary symptomatic relief for TMJ disorders, but it does not address the underlying structural issues or the root causes of TMJ disorders. Since TMD is associated with a lot of factors, the best clinical practice is to use Botox as an adjunct alongside other comprehensive treatments- such as oral appliances, physical therapy, muscle conditioning, stress management, and behavioral modifications- that address the root causes directly.

Remember, while TMD can be challenging, a personalized and comprehensive treatment plan can help you regain comfort and significantly improve your quality of life. It is strongly recommended to work closely with your healthcare providers to explore all available options and develop a plan that best supports your long-term relief and comfort.

REFERENCES:

1. BreatheWorks.Bruxism, teeth grinding, and alignment: The postural connection. https://breatheworks.com/bruxism-teeth-grinding-and-alignment-the-postural-connection/#:~:text=Many%20people%20treat%20bruxism%E2%80%94or,of%20compensation%2C%20not%20just%20tension.

2. Kapos, F. P., Exposto, F. G., Oyarzo, J. F., & Durham, J. (2020). Temporomandibular disorders: a review of current concepts in aetiology, diagnosis and management. Oral surgery, 13(4), 321–334. https://doi.org/10.1111/ors.12473

3. Kim, S. R., Chang, M., Kim, A. H., & Kim, S. T. (2023). Effect of Botulinum Toxin on Masticatory Muscle Pain in Patients with Temporomandibular Disorders: A Randomized, Double-Blind, Placebo-Controlled Pilot Study. Toxins, 15(10), 597. https://doi.org/10.3390/toxins15100597

4. Mayo Clinic. (n.d.). Botox injections: Risks. Mayo Clinic. Retrieved fromhttps://www.mayoclinic.org/tests-procedures/botox/about/pac-20384658

5. Okeson, J. P. (2019). Management of temporomandibular disorders and occlusion (8th ed.). Elsevier.https://www.wiley.com/en-us/Management+of+Temporomandibular+Disorders+and+Occlusion%2C+8th+Edition-p-9780323693950

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GLP-1 Medications and Sleep Apnea: What You Need to Know

By Great Sleep Dental • August 1, 2025

What are GLP-1 Receptor Agonists? In recent years, GLP-1 (Glucagon-like Peptide 1) receptor agonists—drugs initially developed to treat type 2 diabetes—have gained attention as a potential medication in combating obesity. Medications such as semaglutide (popular brand names such as Wegovy and Ozempic ) are now widely recognized not only for promoting weight loss but also for providing significant metabolic benefits. Recent studies show that these medications might also significantly help reduce symptoms of obstructive sleep apnea (OSA), a prevalent and frequently overlooked condition strongly associated with obesity. In fact, in December 2024, the U.S. Food and Drug Administration approved a GLP‑1 receptor agonist drug, specifically tirzepatide ( Zepbound ), for the treatment of moderate to severe obstructive sleep apnea (OSA) in adults with obesity. This medication should be used alongside a reduced-calorie diet and increased physical activity. Why GLP-1 Agonists Aren’t a Standalone Treatment for OSA GLP-1 receptor agonists are not a primary treatment for Obstructive Sleep Apnea. These medications do not directly treat the airway obstruction, but can help reduce excess weight that contributes to airway collapse. Studies show that patients taking these drugs often see improvements in their apnea–hypopnea index (AHI), an important indicator of OSA severity, mainly due to the reduction in excess body fat. However, these medications should not be treated as substitutes for CPAP, oral appliances, or other primary treatments for OSA, especially in moderate to severe cases. Rather, they serve as an adjunctive treatment of a broader OSA management, particularly beneficial for obese patients. Things to Consider Cost and Insurance Coverage GLP-1 receptor agonist medications cost $900–$1300 per month without insurance. Due to its high cost, insurance companies have implemented strict prior authorization requirements to determine which patients are eligible for coverage. (Note: A prior authorization is a process where a provider secures approval from the insurance before prescribing drugs or rendering treatments to ensure the service or medication will be reimbursed by insurance.) As a matter of fact, insurance companies primarily use Body Mass Index (BMI) to determine whether a patient will be covered for GLP-1 medications for weight loss. Initially, coverage was approved for individuals with a BMI of 30 or higher. However, some insurers have since raised that threshold, now requiring a BMI of 32 or even 35 for a patient to be eligible. In addition to BMI, new restrictions have been introduced, such as the need to first try and must fail with non-GLP-1 weight-loss drugs, the presence of comorbidities such as uncontrolled high blood pressure (above 140/90), or mandatory participation in a weight-loss program. Safety and Risks Because of the rising patient interest in GLP-1 RA drugs, drug manufacturers have experienced difficulty in keeping up with the demand. This has resulted in the FDA releasing a medication shortage declaration on these drugs. Consequently, this has eased certain federal restrictions, allowing pharmacies to legally produce compounded versions. These compounded GLP-1 medications can be obtained without a provider's prescription, reducing access barriers and often serving as an alternative in cases when insurance denies coverage. Patients must consider that, unlike standard drugs, compounded medications do not go through the rigorous FDA approval process, so they are not officially FDA-approved. A recent study by McCall et al. concluded that compounded GLP-1 receptor agonists may have a higher chance of side effects, safety issues, and quality problems compared to non-compounded drugs. This means doctors should be careful when prescribing them and perform close patient supervision. GLP-1 Medications + Resistance Exercise GLP-1 receptor agonists have emerged as a promising and effective option for reducing excess weight loss. While they reliably support weight reduction, these medications do not specifically preserve muscle mass, emphasizing the importance of combining medication treatment with resistance or weight-bearing exercise to help preserve muscle during the process. Common Side Effects of GLP-1 Receptor Agonist Drugs 1. Nausea and Digestive Upset Nausea and other digestive issues are among the most common side effects when starting GLP-1 medications, affecting up to 70% of patients, especially during the initial phase of treatment. These symptoms improve over time as your body adjusts to the medication. If you experience persistent or severe symptoms, it's important to discuss them with your healthcare provider, who can offer strategies to manage these effects. 2. Fatigue and Dizziness Some patients may experience tiredness or lightheadedness. These symptoms can be related to changes in blood sugar levels or dehydration. It is important to stay well-hydrated and maintain regular meals to help manage these effects. 3. Risk of Muscle Loss Although GLP-1 receptor agonists help reduce excess fat, they can sometimes cause a loss of muscle mass if you do not pair them with strength exercises or eat enough protein. Why GLP-1 RAs Are Not a Quick Fix GLP-1 receptor agonists are very helpful for weight loss, but they are not magic pills. Lasting results come from combining the medication with lifestyle changes, such as a healthy diet, physical activity, and behavioral changes. Many studies have shown that people get the most benefits when they combine these lifestyle changes with medications. Why Airway Treatments Still Matter When Using GLP-1 RAs GLP-1 receptor agonists can help you lose weight, which may improve some factors related to obstructive sleep apnea. However, they do not directly treat the airway obstruction itself. Obstructive sleep apnea is actually a mechanical problem- repeated collapse of the airway during sleep. This is why it is important to keep using proven treatments for OSA that address airway health directly, even when under GLP-1 medications. These treatments help keep your airway open so you can breathe safely during sleep. Common options include: CPAP (Continuous Positive Airway Pressure): This is the most effective treatment for moderate to severe OSA. It uses gentle air pressure through a mask to keep your airway open at night. Oral appliances: These are custom-made devices that move your jaw or tongue slightly to prevent your airway from collapsing. They are often used for mild to moderate OSA. Surgery: In some severe cases, procedures like hypoglossal nerve stimulation or Inspire can help reduce airway blockages. Relying only on weight loss and stopping these treatments too soon can lead to persistent sleep issues, daytime sleepiness, heart risks, and other serious health issues related to untreated OSA. Conclusion In summary, GLP-1 receptor agonists provide a hopeful strategy for reducing the impact of obstructive sleep apnea by promoting weight loss, but mechanical airway support like CPAP or oral appliances still holds the vital role for individuals in maintaining airway patency during sleep. REFERENCES: 1. McCall, K. L., Mastro Dwyer, K. A., Casey, R. T., Samana, T. N., Sulicz, E. K., Tso, S. Y., Yalanzhi, E. R., & Piper, B. J. (2025). Safety analysis of compounded GLP-1 receptor agonists: a pharmacovigilance study using the FDA adverse event reporting system. Expert opinion on drug safety , 1–8. Advance online publication. https://doi.org/10.1080/14740338.2025.2499670 2. U.S. Food and Drug Administration. (2024, December 20). FDA approves first medication for obstructive sleep apnea [Press release]. https://www.fda.gov/news-events/press-announcements/fda-approves-first-medication-obstructive-sleep-apnea 3. Viercinski, R., & Snively, D. (2025, March 26). Glucagon-like peptide-1 receptor agonists: A pharmacy perspective on insurance coverage and medication access . Harvard Medical School Center for Primary Care. https://info.primarycare.hms.harvard.edu/perspectives/articles/glp-1-pharmacy-perspective 4. Wilding, J. P. H., Batterham, R. L., Calanna, S., Davies, M., Van Gaal, L. F., Lingvay, I., McGowan, B. M., Rosenstock, J., Tran, M. T. D., Wadden, T. A., Wharton, S., Yokote, K., Zeuthen, N., & Kushner, R. F., for the STEP 1 Study Group. (2021). Once-weekly semaglutide in adults with overweight or obesity. The New England Journal of Medicine , 384 (11), 989–1002. https://doi.org/10.1056/NEJMoa2032183 5. Yang, R., Zhang, L., Guo, J., Wang, N., Zhang, Q., Qi, Z., Wu, L., Qin, L., & Liu, T. (2025). Glucagon-like Peptide-1 receptor agonists for obstructive sleep apnea in patients with obesity and type 2 diabetes mellitus: a systematic review and meta-analysis. Journal of translational medicine , 23 (1), 389. https://doi.org/10.1186/s12967-025-06302-y

Inspire Therapy: Is It Right for You?

By Great Sleep Dental • August 1, 2025

Hypoglossal nerve stimulation therapy—commonly known as Inspire Therapy—is an FDA-approved, surgically implanted device for obstructive sleep apnea (OSA)that monitors your breath and stimulates your airway muscles during sleep. How It Works The Inspire therapy works by stimulating the hypoglossal nerve, which innervates the movement of your tongue and airway muscles. This mild stimulation causes your tongue and airway muscles to move out of the way, ensuring a patent airway during sleep. Inspire requires the patient to undergo a surgical procedure. The procedure involves two small incisions under the skin: one in the upper right chest and another under the chin at the location of the hypoglossal nerve. Through these incisions, the surgeon implants a small nerve stimulator and battery pack. One electronic lead connects the device to the hypoglossal nerve, while the other lead is connected to a space in the ribs close to the diaphragm. Once connected, the patient’s breathing patterns are monitored. During sleep, it delivers signals to the tongue with each breath to help keep the airway open and allow for proper oxygen flow. The Inspire therapy system consists of 3 components: the implant, a handheld remote, and a software application. The implant is surgically placed in the upper chest. Patients use the small remote control to turn on the device before bed and turn it off upon waking up, as well as to adjust the level of stimulation. To help track sleep goals and share data seamlessly with the care team, patients can also use the Inspire software application. Who is a Good Candidate for Inspire? Age 18 or older Body Mass Index (BMI) of less than 35 Diagnosed with moderate to severe OSA CPAP-intolerant and/or unable to get consistent benefit from CPAP Where to get Inspire Therapy? 1. Sleep Surgeons and ENT Specialists Inspire is typically performed by ENT surgeons trained specifically in hypoglossal nerve stimulation implantation. In some cases, sleep medicine-trained neurosurgeons may also perform the procedure. 2. Major Hospital Systems and Sleep Medicine Centers Many large hospital centers and accredited sleep centers offer comprehensive evaluation and surgical implantation of the Inspire device. 3. Inspire’s “Find a Doctor” Tool Patients can also use the “Find a Doctor” tool on Inspire’s official website ( https://www.inspiresleep.com/en-us/find-a-doctor/ ) to locate an Inspire-trained doctor in their area by entering their ZIP code or state. Pros Inspire Therapy is an effective option for suitable candidates and has emerged as an alternative to CPAP by offering a fully internal solution—no masks, hoses, or noisy machines. This makes it more comfortable and helps improve patient compliance compared to CPAP. The device is also easy to use: once implanted, patients only need a handheld remote to turn Inspire on before sleep and off upon waking. Additionally, Inspire therapy can be customized, allowing the patient or doctor to modify the stimulation levels according to individual needs. Studies have demonstrated that Inspire therapy reduces the severity of sleep apnea by an average of 79%, while also significantly decreasing symptoms like snoring and daytime sleepiness. A 2022 study by Baptista et al. found that for patients with moderate to severe obstructive sleep apnea (OSA) who cannot tolerate or opt out of CPAP therapy, hypoglossal nerve stimulation (HNS) using the Inspire device significantly improves quality of life. However, those unable to access the device continue to experience a reduced quality of life. Cons While Inspire Therapy presents as a promising alternative for treating moderate to severe obstructive sleep apnea (OSA), one must understand that it is not recommended for everyone. Patients must meet specific criteria to qualify and be willing to undergo a surgical procedure under general anesthesia. Inspire Therapy requires a post-operative activation and titration period. Post-surgical healing period takes about 30 days, during which the device remains off to allow proper healing of the internal components and incision sites. After this healing period, the patient has to return to the surgeon for device activation. Using a handheld remote, the surgeon sets initial stimulation parameters for the device. The patient, on the other hand, is instructed on how to use the remote. Over the following weeks or months, a titration period is necessary to find the optimal stimulation setting that best helps the patient in terms of minimizing airway collapse during sleep. While Inspire Sleep Therapy is generally regarded as a safe and effective alternative to CPAP, it does come with certain disadvantages. In one clinical trial, up to 40% of participants using Inspire reported discomfort while using the device. Additionally, a 2020 database review by Bestourous et al. found that approximately 42% of users required a second surgery to either reposition or remove the device. Other potential risks of Inspire Sleep Therapy include infection and nerve damage. Non-Invasive Alternatives Although Inspire has gained attention as a promising option for CPAP-intolerant patients with moderate to severe OSA, it is important to take into consideration that Inspire is not the only alternative to CPAP. Despite its effectiveness, Inspire is invasive, relatively costly, and not universally accessible, limiting its availability to some patients. There are more conservative non-surgical treatment options that can effectively improve sleep apnea, such as oral appliance therapy and even as simple as lifestyle modifications. Oral appliance devices work by repositioning the lower jaw to keep the airway open during sleep. It is often preferred by patients who have difficulty using CPAP machines or who wish to avoid invasive procedures. They are also portable, less expensive, and generally well-tolerated, making them a popular option for many. In addition, lifestyle modifications are another key approach in managing OSA. Although these lifestyle changes require long-term effort and motivation, they address underlying risk factors and improve overall health, offering broad benefits that extend beyond just sleep apnea relief. REFERENCES: 1. Baptista, P., Di Frisco, I. M., Urrestarazu, E., Alcalde, J., Alegre, M., Sanchez, I., O’Connor-Reina, C., & Plaza, G. (2022). Quality of Life Impact of Hypoglossal Nerve Stimulation with Inspire® Device in Patients with Obstructive Sleep Apnea Intolerant to Continuous Positive Airway Pressure Therapy. Life , 12 (11), 1737. https://doi.org/10.3390/life12111737 2. Bestourous, D. E., Pasick, L. J., Benito, D. A., & Zapanta, P. E. (2020). Adverse events associated with the Inspire implantable hypoglossal nerve stimulator: A MAUDE database review. American Journal of Otolaryngology, 41 (6), 102616. https://doi.org/10.1016/j.amjoto.2020.102616 3. Bongo Rx. (n.d.). Inspire sleep apnea device: Treatment overview . Bongo Rx. Retrieved from https://bongorx.com/inspire-sleep-apnea-device-advantages-and-disadvantages/ 4. Inspire Sleep. (n.d.). How Inspire therapy works . Inspire Sleep. Retrieved from https://www.inspiresleep.com/en-us/how-inspire-therapy-works/ 5. South Shore Health. (n.d.). Inspire therapy: Treatment for obstructive sleep apnea . South Shore Health. Retrieved from https://www.southshorehealth.org/services-care/neurology/sleep-medicine/inspire-therapy-treatment-obstructive-sleep-apnea 6. Strollo PJ Jr, Soose RJ, Maurer JT, et al. Upper-airway stimulation for obstructive sleep apnea. N Engl J Med. 2014;370(2):139–49. https://doi.org/10.1056/NEJMoa1308659 . 7. The University of Kansas Health System. (n.d.). Inspire therapy . The University of Kansas Health System. Retrieved from https://www.kansashealthsystem.com/care/treatments/sleep-apnea-surgery/inspire-therapy 8. Verywell Health. (2018, October 17). Sleep apnea treatment costs: Inspire therapy, CPAP machines, and more . Verywell Health. https://www.verywellhealth.com/how-much-do-different-sleep-apnea-treatments-cost-4177858

Create your Ultimate Sleep Playlist for Deeper Sleep!

By Great Sleep Dental • May 2, 2024

Many of us resort to different methods and devices in an attempt to fall asleep. Making a sleep playlist with relaxing music like pink noise, white noise, and other calming frequencies is one such efficient technique. Let's explore the science underlying these noises and see how you might use them to enhance your sleep experience. Understanding the Science of Sleep Sounds Before we explore the components of an ideal sleep playlist, let's take a moment to understand the science behind these sleep-inducing sounds. White Noise: White noise consists of a blend of all audible frequencies, creating a consistent sound similar to static or the hum of a fan. This steady sound can help mask background noises that might otherwise disrupt your sleep, promoting a more peaceful environment. Pink Noise: Pink noise is similar to white noise but with a slightly different frequency distribution, emphasizing lower frequencies. Studies suggest that pink noise may have a more natural, soothing effect on the brain, potentially improving sleep quality and memory consolidation. Brown Noise: Brown noise, also known as red noise, features even lower frequencies than pink noise, with a deeper and more soothing rumble. Its gentle oscillations mimic the natural sounds of wind or rustling leaves, creating a sense of serenity and tranquility conducive to sleep. Nature Sounds: The gentle rustle of leaves, the rhythmic pattern of rain, or the serene sounds of ocean waves can evoke feelings of relaxation and tranquility. Incorporating nature sounds into your sleep playlist can create a calming ambiance reminiscent of the great outdoors. Binaural Beats: Binaural beats involve playing two slightly different frequencies in each ear, causing the brain to perceive a third tone. This phenomenon is believed to influence brainwave activity, potentially inducing states of relaxation or deep sleep. Crafting Your Perfect Sleep Playlist Now that we've explored the science behind sleep sounds, it's time to curate your ultimate sleep playlist. Here's how to get started: Choose Your Sounds: Experiment with different types of sleep sounds, including white noise, pink noise, nature sounds, and binaural beats. Select the ones that resonate most with you and evoke feelings of relaxation. Consider Your Preferences: Some people prefer the steady hum of white noise, while others find solace in the gentle sounds of nature. Listen to various options and determine which sounds best suit your personal preferences and sleep environment. Adjust the Volume: It's essential to find the right balance when it comes to volume. Your sleep sounds should be audible enough to mask background noises but not so loud that they become disruptive. Aim for a volume level that is soothing and conducive to sleep. Create a Routine: Incorporate your sleep playlist into your nightly routine to signal to your body that it's time to unwind and prepare for sleep. Listen to your chosen sounds consistently, ideally starting about 30 minutes before bedtime. The Benefits of Sleep Sounds Adding sleep sounds to your nightly routine can offer a myriad of benefits, including: Improved Sleep Quality: Sleep sounds can help create a more conducive environment for sleep, leading to deeper and more restful slumber. Reduced Stress and Anxiety: The soothing sounds of nature or white noise can help calm the mind and alleviate feelings of stress and anxiety, making it easier to relax and fall asleep. Enhanced Focus and Concentration: Quality sleep is essential for cognitive function and mental clarity. By promoting better sleep, sleep sounds can contribute to improved focus and concentration during waking hours. Conclusion Incorporating white noise, pink noise, nature sounds, and binaural beats into your sleep routine can be a powerful tool for enhancing your sleep quality and overall well-being. Experiment with different sounds, adjust your playlist to suit your preferences, and enjoy the tranquil serenity of a restful night's sleep. Sweet dreams!

Emotional Ties with Sleep

By morningdovemarketing • March 15, 2024

Given the critical function sleep plays in both our mental and general well-being, the emotional connections to sleep can be complicated and varied. The following are some emotional components of sleep.

Treatments for Sleep Apnea

By morningdovemarketing • March 3, 2024

There is no doubt that better sleep makes you excel in life. Some amazing effects of a good night's sleep are as follows.

Better Sleep; Better Life!

By morningdovemarketing • February 27, 2024

There is no doubt that better sleep makes you excel in life. Some amazing effects of a good night's sleep are as follows.

We Are Meant to Breathe Through Our Noses

By morningdovemarketing • February 13, 2024

OAT is used commonly for treating mild to moderate obstructive sleep apnea (OSA), as well as severe OSA when CPAP cannot be tolerated. It is a well-tolerated and minimally invasive therapy and a great option to treat sleep disordered breathing. The treatment essentially consists of gently holding the jaw forward while you sleep. It is a non pharmacological and nonsurgical option that is easy to use and transport.