Snoring is more than just a loud annoyance for suffering sleepers who are looking into an oral appliance for sleep apnea. For many people, it can be a sign of Obstructive Sleep Apnea (OSA). OSA is a widespread sleep disorder where your airway repeatedly collapses or becomes blocked while you’re asleep.
This stops or slows your breathing for short periods, interrupting your sleep, reducing the oxygen reaching your body, and potentially leading to serious long-term health problems like high blood pressure, heart issues, memory problems, and feeling excessively tired. It’s a common condition, estimated to affect a large number of individuals globally – and here in the United States.
Treating OSA is important for your health. While the most commonly prescribed treatment is Continuous Positive Airway Pressure (CPAP) therapy, which uses a mask to provide air flow to keep your airway open, it’s not the right solution for everyone. Many patients find the masks bothersome, the machine noisy, or the process inconvenient, making it hard to use CPAP consistently every night.
Because so many individuals struggle with CPAP adherence, there’s a need for alternatives. This is where Oral Appliance Therapy (OAT) comes into play.
“Sleep-related breathing disorders comprise a variety of diagnoses, including snoring, upper airway resistance syndrome, central sleep apnea, hypopnea, and obstructive sleep apnea (OSA),” states the American Dental Association. “OSA is the most prevalent form of sleep apnea, accounting for over 80% of sleep-disordered breathing cases in the U.S.”
Oral Appliance for Sleep Apnea: A Different Way
An oral appliance for sleep apnea is a custom-made device, similar in appearance to a sports mouthguard or orthodontic retainer. Its main goal is straightforward: to prevent your airway from collapsing.
By keeping the airway open, this appliance helps reduce or stop breathing pauses and shallow breathing that define Obstructive Sleep Apnea. This improves your oxygen levels during the night and significantly minimizes or eliminates snoring.
Most oral appliances work by gently holding your lower jaw forward. These are called Mandibular Advancement Devices (MADs). By moving your jaw forward, the base of your tongue is pulled away from the back of your throat, and the surrounding tissues are tightened.
This simple mechanical action creates more open space in your airway for air to flow easily. A less common type, called a Tongue Retaining Device (TRD), works by holding just the tongue forward using suction. This can be an option for people who don’t have enough teeth for a MAD.
It’s important to understand that the most effective oral appliances recommended by medical and pain management experts are custom-fitted and adjustable. A qualified lab creates these devices precisely for your mouth based on detailed molds or digital scans of your teeth.
Make sure you take note of the adjustability. It allows your doctor to focus exactly on how far forward your jaw is positioned to get the best results for your breathing and comfort.
You might see non-custom devices sold online or in stores, but these are generally not recommended for treating sleep apnea. They don’t fit precisely, are not truly adjustable enough to treat your condition, and using one could mean your sleep apnea is not being properly treated.
For safe and effective treatment, a custom, adjustable appliance from a qualified pain management or other specialist is necessary.
The Steps Involved in Getting Your Mouth Piece
To pick the right oral appliance for sleep apnea, you need to collaborate closely with your pain management specialist, doctor, and dentist, all of whom have special training in sleep treatment.
It all starts with a diagnosis of sleep apnea from your doctor. A sleep study usually takes place first, which measures your breathing problems. Based on the results of how many breathing events you have per hour while asleep, your doctor will determine the severity of your sleep apnea.
If your doctor decides an oral appliance is the best treatment option for you, it means you have mild to moderate Obstructive Sleep Apnea, or even a more severe case of OSA. In addition, many patients haven’t been able to use CPAP successfully. If this is you, your specialist will give you a prescription or referral for a custom-made mouth device.
Your next step is finding a dentist specifically qualified in dental sleep medicine. This is a specialized area, and not all dentists have the necessary training. Organizations like the American Academy of Dental Sleep Medicine (AADSM) offer credentials and maintain lists of qualified dentists who understand sleep disorders, how oral appliances work, and how to manage potential dental and jaw-related issues.
Once you’ve found a qualified dentist, a thorough examination of your mouth, teeth, gums, and jaw joint will be made to make sure you’re a good candidate. Specialists will take impressions or digital scans of your upper and lower teeth and record how your jaws relate to each other.
This detailed information is sent to a specialized dental laboratory, which uses it to fabricate your custom oral appliance. Advanced manufacturing techniques are used to make sure a precise and comfortable fit is created just for you.
Adjusting Your Oral Appliance for Sleep Apnea
When your oral appliance for sleep apnea is ready to pick up, your specialist will make sure it fits securely and comfortably, showing you how to put it in and take it out. You’ll also be given detailed instructions on how and when to wear your appliance, which is typically every night, and how to keep it clean.
After you start wearing your mouthpiece, you’ll enter the adjustment period, often called “titration.” Over several weeks or months, you’ll work closely with your specialist, doctor, or dentist to gradually adjust the forward position of the lower jaw held by the appliance. These adjustments are made in small increments.
“Optimal titration is important to maximise the therapeutic benefits of the MAS device,” states Frontiers. “An advancement of at least 50% of maximum mandibular protrusion is required to have a potential therapeutic outcome while minimising adverse side effects. International guidelines recommend a progress diagnostic sleep study following titration to assess the efficacy of the device.”
The goal is to find the specific position that’s most effective at keeping your airway open while still being comfortable. Living with an oral appliance means incorporating its use into your nightly routine and committing to long-term care. Sleep apnea is oftentimes chronic, so ongoing management is necessary.
This includes regular follow-up appointments with both your sleep doctor and possibly a dental-sleep medicine dentist. The dental visits are important for monitoring the condition of your appliance, checking for any potential side effects like changes in your bite or tooth position, and making any necessary adjustments.
Your appliance will require daily cleaning, as well as proper storage when not in use. Custom appliances are built to be durable and last for several years, though they may eventually need replacement due to wear or changes in your mouth.
Oral Appliances Compared to CPAP Treatment
Studies show that a custom-fitted oral appliance for sleep apnea is very effective in improving your sleep apnea. They reduce the number of breathing problems experienced during sleep and improve the amount of oxygen in your blood.
While a Continuous Positive Airway Pressure machine is often considered more effective at normalizing breathing numbers, oral appliances still provide major improvements in a large percentage of users. One of the benefits is a noticeable reduction in snoring. Many patients using oral appliances report that their snoring stops almost entirely.
Additionally, users consistently feel more rested and energetic during the day. They report less daytime sleepiness, less fatigue, better mood, and better concentration.
This brings up an important point when comparing oral appliance therapy versus CPAP: while CPAP might be slightly more effective in terms of raw breathing numbers in a sleep lab setting, oral appliances can achieve similar real-world results. In short, patients tend to use them more consistently.
They are also found to be more comfortable, less intrusive, and easier to live with than CPAP. Users tend to wear their oral appliances for more hours each night on average compared to CPAP users. This consistent use helps make the overall treatment better in improving, or even eliminating, your apnea symptoms.
Nonetheless, while oral appliances offer comfort and convenience advantages over CPAP, they can have their own set of potential side effects. While you’re getting used to the appliance, you might experience some jaw muscle soreness or discomfort, tooth tenderness, changes in saliva, or feel like your bite is temporarily off after taking the appliance out in the morning.
These often lessen over time. In the long term, some patients experience gradual, subtle changes in how their upper and lower teeth fit together. These changes are usually minor but require monitoring.
Oral Appliance for Sleep Apnea and Patient Trends
An oral appliance for sleep apnea is a vital alternative for patients diagnosed with severe sleep apnea who have tried CPAP but found it uncomfortable, couldn’t tolerate it, or refused to use it. Additionally, people who primarily snore but don’t have a major case of sleep apnea may use an oral appliance after getting checked by a doctor to make sure there’s no underlying Obstructive Sleep Apnea.
Patient preference is a major trend driving the use of mouthpieces. Demographically, the typical oral appliance user often reflects the general population of individuals suffering from sleep apnea: usually middle-aged adults, more men than women, and individuals who are overweight.
While some studies have looked into whether factors like age or weight predict how well an oral appliance will work, the findings haven’t been consistent. Individual factors and a person’s comfort and willingness to use the device are usually more important than broad demographic traits in determining successful treatment with an oral appliance.
That being said, the market for oral appliances is growing steadily. While CPAP remains the dominant treatment device, more and more people are using oral appliances as awareness increases and the need for alternatives is recognized.
This growth is supported by manufacturers continuously innovating and producing advanced devices made with new, more comfortable materials and using precise fabrication techniques.
Common Consumer Questions About Mouthpieces
The following are answers to practical questions that patients ask when considering an oral appliance for sleep apnea:
- How much does a custom oral appliance cost, and is it covered by insurance? The initial cost of a custom appliance can be significant, but it’s usually considered a medical device for a diagnosed medical condition (OSA). Because of this, the cost is typically covered by medical insurance, including Medicare, not dental insurance.
- Most commercial medical insurance plans also provide coverage. Your dental sleep medicine dentist’s office staff are usually experienced in working with medical insurance to help you understand your benefits and handle billing.
“Mouthpieces and other oral appliances can help treat mild to moderate sleep apnea and snoring,” according to WebMD. “The average cost for a sleep apnea mouth guard ranges from $1,800 to $2,000. This includes the appliance, dental visits, and follow-ups. Many health insurance companies will cover the expense.”
- How do I find a qualified mouthpiece specialist? It’s important to see a specialist, doctor, or dentist specifically trained in dental sleep medicine. The American Academy of Dental Sleep Medicine’s site has a tool to help you locate these specialists in your area.
- How do I clean and take care of my oral appliance? How long does it last? You’ll receive specific cleaning instructions. Generally, you’ll need to clean it daily using a soft toothbrush and water or a recommended cleaner. Avoid hot water, which can damage the material.
- Always store your appliance in its protective case when not wearing it. Custom appliances are made from durable materials and designed to last for several years, but the actual lifespan can vary based on how well you care for it and any changes in your mouth.
How Your Oral Appliance for Sleep Apnea Works
Some patients are particularly curious about the chances of side effects, like jaw pain or bite changes, when using an oral appliance for sleep apnea. Many people experience some temporary jaw or tooth discomfort when they first start using the appliance, but this often goes away with time and adjustments.
More importantly, patients want to know how long it takes to see results. Many users notice their snoring improves or stops right away on the first night. You might start feeling more energetic or less sleepy during the day within a few weeks.
The full effect in treating your apnea often develops over the weeks or months of the titration process as you find the best setting for your appliance. Below are descriptions, benefits, and a comparison breakout to help:
Aspect | Description / How It Works | Key Benefits or Considerations | Comparison to CPAP & Other Notes |
What It Is | A custom-made device, like a mouthguard or retainer, worn during sleep. | A non-invasive alternative to CPAP therapy. | Different approach than CPAP mask/machine. |
How It Works (MADs) | Most types gently hold your lower jaw slightly forward. | Keeps the airway open by moving the tongue base and tightening soft tissues. Helps reduce apneas, hypopneas, and snoring. | Works mechanically, unlike CPAP’s air pressure. |
How It Works (TRDs) | A less common type that uses suction to hold just your tongue forward. | Can be an option if you don’t have enough healthy teeth for a MAD. | Works directly on the tongue, not the jaw. |
Important Type | Custom-fitted and Adjustable devices made specifically for your mouth by a lab. | Essential for effectiveness, proper fit, comfort, and safety. Can be fine-tuned over time. | Highly recommended over non-custom (“boil-and-bite”) devices. |
Getting Started (Diagnosis) | Requires a medical diagnosis of sleep apnea by a doctor, usually with a sleep study. | Confirms you have OSA and determines its severity, guiding treatment choice. | Physician makes the diagnosis and prescription, not the dentist. |
Getting Started (Provider) | Prescribed by a medical doctor, then requires care from a dentist with special training in dental sleep medicine. | Ensures expertise in fitting, adjusting, and managing the appliance and potential side effects. Look for AADSM or ABDSM credentials. | Collaboration between doctor and dentist is key. General dentists are not typically qualified for this. |
Getting Started (Process) | Includes dental exam, impressions/scans, bite registration, lab fabrication, and initial fitting. | Appliance is made precisely for your mouth for optimal fit. | Involves dental procedures before you get the appliance. |
Using It (Adjustment) | Gradual adjustments to the appliance’s position over weeks/months (called titration). | Optimizes effectiveness for breathing while maintaining comfort. May involve follow-up sleep testing. | Unlike CPAP, where pressure is set, OAT involves a process of finding the best position. |
Using It (Daily & Long-Term) | Worn nightly; requires daily cleaning and storage. Needs regular check-ups with the dentist. | Essential for hygiene, durability, and monitoring for any changes in your bite or appliance fit over time. Appliance lasts several years (often 3+). | Requires daily care similar to retainers. Ongoing dental visits are needed for monitoring potential bite changes. |
Key Benefit: Snoring | Effectively reduces or eliminates snoring. | Often a noticeable benefit very quickly, improving sleep for you and partners. | Highly effective for snoring, often comparable to CPAP. |
Key Benefit: Feeling Better | Improves daytime sleepiness, energy levels, mood, and concentration. | Leads to better quality of life and ability to function during the day. | Improvements in how people feel are often similar to those experienced with CPAP, even if objective numbers differ. |
Comparison: Effectiveness | Significantly reduces breathing events; can improve oxygen levels. | While CPAP may normalize breathing numbers more fully, OAT’s effectiveness in improving symptoms and health outcomes is often comparable in the real world. | CPAP often achieves higher efficacy in clinical tests, but OAT’s higher adherence can make it equally or more effective overall. |
Comparison: Adherence | Patients tend to use OAT more consistently and for more hours per night than CPAP. | Easier to use and more comfortable for many, leading to better nightly use. This drives its real-world effectiveness. | OAT generally has higher patient acceptance and adherence than CPAP. |
Comparison: Side Effects | Primarily dental or jaw-related (soreness, bite changes, tooth tenderness, saliva changes). | Potential side effects require management by a qualified dentist. Long-term bite changes are possible but often minor. | Different profile than CPAP side effects (mask leaks, dryness, noise, claustrophobia). |
Comparison: Comfort/Convenience | Small, portable, quiet, no mask or hoses, no electricity needed. | Generally perceived as more comfortable, easier to travel with, and less intrusive than CPAP. | Often the main reason patients prefer OAT over CPAP. |
Who Uses OAT | Adults with mild to moderate OSA; adults with severe OSA who can’t use CPAP; primary snorers. | A vital treatment option for many, especially those who struggle with CPAP. | Candidacy determined by OSA severity and CPAP tolerance/preference. |
Patient Trends | Increasing use, driven by patient preference and struggles with CPAP. | Patients value comfort, convenience, and symptom relief. High patient satisfaction reported. | Market growing as an alternative to CPAP. |
Cost & Insurance | Custom appliance has an upfront cost. | Typically covered by medical insurance (including Medicare) for diagnosed OSA. Dental office helps with billing. | Considered a medical treatment, not dental. |
Time to See Results | Snoring reduction often immediate. Daytime energy may improve in weeks. Full effect after titration. | Results can be felt relatively quickly for symptoms, but full breathing improvement takes time as adjustments are made. | Symptom relief speed can vary by person. |
Related: Bruxism | Connection between OSA and teeth grinding is common. | Some appliances are designed to help manage both conditions. | An overlap condition that OAT can sometimes help with. |
Related: Combination Therapy | Using an oral appliance with a lower-pressure CPAP machine together. | Can improve comfort and effectiveness for some people, especially with severe OSA. | An option for complex cases where neither therapy alone is sufficient or well-tolerated at necessary levels. |
The Team | Requires collaboration between your sleep doctor (diagnosis/prescription) and a qualified dental sleep medicine dentist (appliance management). | Ensures comprehensive care from diagnosis through long-term treatment. | Both medical and dental professionals are essential for successful OAT. |
The Future of Mouthpieces and Teamwork
The field of sleep medicine and oral appliance for sleep apnea trends continues to evolve. Pain management specialists, doctors, and dentists are playing an increasingly important role by helping identify patients at risk for sleep apnea during regular check-ups. They are uniquely positioned to spot physical signs in your mouth and jaw.
Researchers and manufacturers are also working on new advancements. This includes developing appliances made from even better, more comfortable materials and using cutting-edge digital technology for super-precise fitting.
There’s also growing interest in devices that can treat both sleep apnea and teeth grinding, as these two conditions sometimes occur together. For some individuals, using an oral appliance together with a lower-pressure CPAP machine, called combination therapy, is proving to be an effective way to manage more complex cases.
Getting the best treatment for sleep apnea requires teamwork. A sleep doctor is imperative for diagnosing your condition, and your qualified dental sleep specialist is the key to managing any customized oral appliance.
If you’re dealing with sleep apnea, especially if it’s mild to moderate, or if you’ve had trouble using CPAP, an oral appliance can be a worthwhile treatment option to explore. While it requires commitment to using it nightly and seeing your dental sleep specialist for follow-up care, for many patients, it provides the breakthrough they need to sleep better and live better.
The best way to figure out if it’s right for you is to talk with your sleep apnea or pain specialist.
Wellness and Pain
Personalize your oral appliance for sleep apnea by visiting Wellness and Pain. We offer conservative treatments, routine visits, and minimally invasive quick-recovery procedures. We can keep you free of problems by providing lifestyle education and home care advice.
This enables you to avoid and manage issues, quickly relieving your inhibiting lifestyle conditions when complications arise. We personalize patient care plans based on each patient’s condition and unique circumstances. Wellness and Pain can help improve wellness, increase mobility, relieve pain, and enhance your mental space and overall health.