Mouth Devices for Sleep Apnea

If you have mild to moderate obstructive sleep apnea and can’t tolerate or haven’t been helped by CPAP, oral appliances may be an effective treatment option.

Dental appliances for sleep apnea: Do they work?

Keeping your partner — or yourself — up at night with loud snoring? This might be more than a nuisance. About 25% of men and nearly 10% of women have obstructive sleep apnea (OSA), a serious sleep disorder characterized by explosive snores, grunts, and gasps. Tissue at the back of the throat temporarily obstructs the airway, leading to breathing pauses (apneas) throughout the night. Not only does OSA leave people tired and groggy, but it also puts them at risk for a host of health problems, including high blood pressure, depression, and heart disease.

The most effective and best-studied treatment is positive airway pressure (PAP), a small bedside machine that blows air through a mask to prevent your airway from collapsing. But people with mild or moderate OSA sometimes find PAP challenging to use, and often wonder about alternatives. Dental devices (also known as oral appliances) are an option for some people. But do your homework before going this route, cautions Sogol Javaheri, MD, MPH, MA, a sleep specialist at Harvard-affiliated Brigham and Women’s Hospital.

Who might benefit from a dental device for sleep apnea?

“These devices are supposed to reposition your jaw or tongue to open your upper airway. But they can be really uncomfortable and only work about half the time,” Dr. Javaheri says. It’s hard to predict who might benefit from using an oral device, and people with very mild OSA and few symptoms may not notice any difference. As a result, she generally doesn’t recommend them except for people with mild to moderate OSA or those with severe OSA who can’t tolerate PAP.

Three main categories of dental devices for OSA

Mandibular advancement devices. Made of molded hard plastic, these devices snap over your lower and upper teeth, and also feature metal hinges and screws that can be tightened to push your lower jaw forward. Some dentists make custom mandibular advancement devices, but before you consider buying a custom device, be sure to ask whether your dentist has experience in sleep-related breathing disorders and is certified by the American Academy of Sleep Medicine. Some non-certified dentists simply take a mold of your teeth, send it to a company that makes the device, then sell it to you at a large markup — sometimes totaling $4,000 or more. What’s more, it’s unlikely to be covered by your dental or medical insurance if it’s used for snoring.

Mouth guards. Similar to mandibular advancement devices, these devices also help reposition your lower jaw, although to a lesser degree. Some sleep physicians recommend SnoreRx, which you can purchase online for less than $100. Instead of starting with an impression of your teeth created by a dentist, you use what the company calls the “boil and bite” method. You place the device in a cup of boiling water for a minute and then bite down on the softened plastic so it molds to your teeth.

Just under half – 49% – of Americans get their health insurance through their employer, according to the Henry J. Kaiser Family Foundation. Another 19% of Americans are insured under Medicaid, 14% under Medicare, seven% under non-group plans and two% under other public insurers, while nine% of U.S. citizens remain uninsured.

Tongue-retaining devices. These devices consist of a soft plastic splint placed around your tongue that holds it forward and out of your mouth throughout the night. They tend to make your mouth very dry and can be quite uncomfortable.

Most insurance plans at least partially cover these devices when used for OSA, but not if they’re used for simple snoring. Don’t be tempted to try one unless you’ve been formally diagnosed with OSA, says Dr. Javaheri. And even if you have OSA, be sure to call your insurance company so you understand how much is covered before you have a device made.

About the Author

Julie Corliss is the executive editor of the Harvard Heart Letter. Before working at Harvard, she was a medical writer and editor at HealthNews, a consumer newsletter affiliated with The New England Journal of Medicine. She … See Full Bio

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Mouth Devices for Sleep Apnea

If you have been diagnosed with obstructive sleep apnea — a condition in which relaxation of the muscles around the tongue and throat causes the tissues to block airflow to the lungs while you sleep — there are a number of treatment options to discuss with your doctor. Two of the most widely used and most effective are continuous positive airway pressure (CPAP) and dental appliances, or mouth guards.

CPAP (Continuous Positive Airway Pressure)

The most effective treatment for obstructive sleep apnea, CPAP blows air with continuous pressure down your throat at night to keep your airways open while you sleep. The treatment is done using a CPAP machine, which consists of three main parts:

• Mask that fits over your nose — or your nose and mouth — and is held in place with straps while you sleep
• Motor that blows air
• Large tube called a cannula that connects the motor to the mask

CPAP machines are small, lightweight, and fairly quiet. If you travel, you should take your CPAP with you.

Benefits of CPAP include keeping your airways open while you sleep, easing snoring, improving sleep quality, relieving daytime sleepiness, and lowering blood pressure.

Although you will likely feel better rested and alert once you start CPAP, getting used to the device can take some time. Some people have difficulty sleeping the first few nights of treatment.

Side effects of CPAP use are usually minor and may include:

• Feelings of confinement from the face mask
• Sore or dry mouth
• Nasal congestion, runny nose, sinusitis, or nosebleeds
• Irritation and sores over the bridge of the nose
• Stomachbloating and discomfort
• Discomfort in chest muscles.

If you are having any of these or other problems, call your doctor. An adjustment to your CPAP machine may make it more comfortable. Some CPAP machines have special features such as heated humidifiers to reduce problems such as drying of the airways. Other possible fixes include using a cushioned face mask, chin straps, and nasal saltwater sprays. Your doctor may have additional suggestions.

Mouth Devices

If you have mild to moderate obstructive sleep apnea and can’t tolerate or haven’t been helped by CPAP, oral appliances may be an effective treatment option.

These devices, which must be fitted by a dentist or orthodontist, and worn in the mouth at night include:

Mandibular advancement device (MAD). The most widely used mouth device for sleep apnea, MADs look much like a mouth guard used in sports. The devices snap over the upper and lower dental arches and have metal hinges that make it possible for the lower jaw to be eased forward. Some, such as the Thornton Adjustable Positioner (TAP), allow you to control the degree of advancement.

Tongue retaining device. Used less commonly than MAD, this device is a splint that holds the tongue in place to keep the airway open.

For people with mild to moderate sleep apnea, particularly those who sleep on their backs or stomachs, dental devices may improve sleep and reduce the frequency and loudness of snoring. Also, people are more likely to use their dental appliances regularly than CPAP.

Dental devices have also been shown to control sleep apnea long term compared to uvulopalatopharyngoplasty (UPPP), the standard surgical procedure for apnea, in which the surgeon removes soft tissue from the back of the throat. However, dental devices do have some potential drawbacks, including altered bite, movement of teeth, pain, arthritis of the temporol mandibular joint (TMJ), dry lips, and excessive salivation.

If you are fitted with a dental device you should have a checkup early on to see if it is working and periodic checkups for possible adjustment or replacement. If you experience pain or changes in your bite, your dentist or orthodontist who fitted your device may be able to make modifications to correct the problem.

The best treatment for obstructive sleep apnea depends on a number of factors, including the severity of your problem, the physical structure of your upper airway, other medical problems you may have, as well as your personal preference. You should work with your doctor or sleep specialist to select the best treatment option for you.

Show Sources

The Ohio State University Medical Center: “Obstructive Sleep Apnea (OSA).”

National Heart Lung and Blood Institute: “What Is CPAP?”

MedlinePlus: “Nasal CPAP.”

University of Maryland Medical Center: “Obstructive sleep apnea – Dental Devices.”

American Sleep Apnea Association: “Taking a Bite Out of OSA.”

Academy of General Dentistry: “Breathing Easier.”

American Sleep Apnea Association: “Treatment Options for Adults with Obstructive Sleep Apnea.”

New York University Langone Medical Center: “Continuous Positive Airway Pressure.”