Oral Appliances for Sleep Apnea – Pros & Cons of Using Them

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Written by Jill Zwarensteyn, Editor

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What is Obstructive Sleep Apnea?

Obstructive Sleep Apnea¹ – or OSA – is a disorder in which your throat muscles relax to a point where they close off your air supply. This causes you to repeatedly stop breathing while asleep¹ .

Your brain, which senses the air blockage, briefly wakes you up to resume breathing. While you may not be entirely conscious when this happens, it does interfere with your sleep. Additionally, snoring and gasping for air are several of the noisy symptoms of OSA that may also prevent your partner from getting quality rest¹.

OSA is the most common form of sleep apnea. The other two types are central and complex².

While OSA occurs when a part of your body doesn’t work as it’s supposed to, central sleep apnea is characterized by a neurological condition in which the brain doesn’t send the proper signal to breathe². Complex apnea is a combination of obstructive and central sleep apnea².

What Causes Obstructive Sleep Apnea?

As mentioned, obstructive sleep apnea is caused by the throat muscles relaxing too much and blocking airflow¹. The following are risk factors associated with obstructive sleep apnea¹.

Older age
Diabetes
Smoking
Asthma
Family history of sleep apnea
High blood pressure
Being overweight
Having a narrow airway
Consistent nasal congestion

While some of these risk factors are genetic and cannot be changed, you are able to control some of them, such as frequency of smoking and your weight.

What are the Symptoms of Obstructive Sleep Apnea?

The symptoms someone with OSA experiences vary from person to person, but here are the most common symptoms of obstructive sleep apnea¹:

Periods of stopped breathing while sleeping
Loud snoring
Insomnia
Irritability or changes in mood
Heightened blood pressure
Decreased sex drive
Daytime sleepiness
Waking up with a headache, sore throat, or dry mouth
Difficulty paying attention

What are the Effects of Obstructive Sleep Apnea?

Obstructive sleep apnea has serious consequences and can even lead to death. Some other effects of OSA are¹:

Daytime fatigue – Daytime fatigue can lead to drowsy driving and other dangers.
High blood pressure – High blood pressure, which could also lead to a heart attack.
Sleep-deprived partners – If you share a bed with someone, your snoring and periods of not breathing will likely disrupt your partner’s rest.
Eye problems – Conditions like glaucoma have been linked to OSA

Dental Devices for Sleep Apnea

Mouth Guards

Mouth guards keep your jaw and tongue in place so your airway stays open. The two types of mouth guards used for sleep apnea are the mandibular advancement device (MAD) and the tongue-retaining mouthpiece.

Mandibular Advancement Devices

The goal of dental devices is to keep the airways unobstructed by opening up the jaw and preventing the tongue from collapsing back into the throat. One of the most popular tools used for OSA is a mandibular advancement device³ (MAD).

A MAD device looks like a mouth guard, but it has custom springs and adjustments that push the lower jaw and tongue forward³. This, in turn, opens up the mouth and airway, keeping you breathing peacefully through the night³.

Not only should mandibular advancement devices reduce sleep apnea symptoms, but they also work to strengthen the muscles of the tongue and surrounding mouth muscles³. When these muscles become stronger, the prevalence of apnea tends to decrease.

Tongue-Retaining Mouthpieces

A tongue-retaining mouthpiece⁴ is more straightforward than a MAD and resembles a pacifier.

A tongue retaining mouthpiece works by holding the tongue forward. You insert your tongue into the device, and it keeps it in a prominent position, away from the back of your throat⁴.

View Our Guide: Best-Rated Snoring Mouthpiece

Rapid Maxillary Expansion

Rapid maxillary expansion⁵ (RME) is a method used to treat sleep apnea that uses and expander on the roof of your mouth. The expander works to correct narrowness, providing more space for the tongue which thereby opens up the airway⁵. AN RME is typically used for children with OSA⁶.https://1591f7df5f9e5ff204a50a547a9db3e9.safeframe.googlesyndication.com/safeframe/1-0-40/html/container.html

Do Oral Appliances Work for Sleep Apnea?

Research, including a 2019 study⁷, has found that oral appliances have comparable results to CPAP devices when treating obstructive sleep apnea. However, depending on the severity of your sleep apnea, a CPAP device may be more effective in reducing your symptoms.

Dr. Randal Silver, DMD of Sleep Matters Clinic, agrees with the findings of this study, saying that oral appliance therapy is effective in keeping the airway open and reducing symptoms of sleep apnea.

Make sure your consult with a dentist and sleep expert to help you find the appropriate device for you.

Pros and Cons of Oral Appliance Therapy

Benefits

Cost-Effective

An oral appliance can cost anywhere from around 1,500 to 3,500 dollars⁸, while a CPAP machine is typically more expensive. Your health insurance provider may cover the cost of an oral appliance because of the severity of sleep apnea8.

Compact and Portable

Mouthpieces are significantly smaller and easier to transport than CPAP devices, making them more convenient for storage and travel.

Quiet

One of the possible side effects of sleep apnea is snoring, and if you’re concerned about disrupting your partner’s slumber, you don’t want your treatment to be equally disruptive. While less obtrusive than snoring, a CPAP can still be noisy⁹. However, a mouth appliance should not make any sounds.

Energy Efficient

CPAP machines run on electricity, which means they use up more energy and increase your electric bill. On the other hand, mouth devices don’t need to be plugged in, and therefore, are more environmentally friendly and cost-effective.

Easy to Use

Dr. Silver explains that another advantage of using an oral appliance is that they are really easy to use, without any set-up. With this convenient treatment option, all you have to do is put the device in your mouth at night.

Non-invasive

Dr. Silver also believes that oral devices are a great, non-invasive device because they “are small and discreet, making them a comfortable and non-invasive treatment option. They do not require any surgical procedures and have a minimal risk of complications.”

Risks

Bite Changes

Since these products force the jaw into a forward angle, they have the potential to change the position of your bite¹⁰.

Pain

Oral appliances may also cause pain and discomfort¹¹ in the jaw, teeth, and temporomandibular joint (TMJ).

Excessive Saliva or Dry Mouth

Individuals who typically breathe through their mouth may experience drooling or dry mouth¹¹.

Loosening of Dental Restorations

Another risk is that these items could cause dental work such as bridges or crowns to loosen over time¹². In this case, it is important to consult with your dentist, who can make any necessary adjustments and monitor your previous dental work for changes.

May Not Help People with Other Types of Sleep Apnea

While oral devices are a great treatment option for obstructive sleep apnea, Dr. Silver emphasizes that people with central and complex sleep apnea likely won’t benefit from these devices as much.

What Questions to Ask Your Doctor or Dentist About Oral Appliances for Sleep Apnea

Here are some questions you may want to ask your doctor or dentist before beginning oral appliance therapy:

How much will my oral appliance cost?
Will my insurance cover oral appliance therapy?
After starting oral appliance treatment, how long will it be until I notice a difference in my sleep apnea symptoms?
How long will I use this device until I need a replacement?
How often will I need to see a doctor or dentist to check up on my oral appliance treatment?

Frequently Asked Questions

How do I get a sleep apnea mouthpiece?

To get a mouthguard, you will need to see a dentist specializing in this treatment, who will then evaluate you and create a custom-made device.

While some oral appliances are sold online, a custom-made device will likely be more effective. Again, consult your doctor or dentist.

Are oral appliances better than the CPAP machine?

No, oral appliances are not better than the CPAP machine. CPAP machines are still the most popular treatment of sleep apnea, but each device has its advantages and disadvantages that you will need to consider when seeking treatment for your sleep apnea⁷.

What is the most effective appliance for sleep apnea?

The most effective appliance for sleep apnea is the CPAP machine, as it can not only treat obstructive sleep apnea, but it can also help refuse symptoms of central and complex sleep apnea⁷. However, that doesn’t mean oral appliances don’t work; many people with sleep apnea prefer using these devices.

Are oral appliances for sleep apnea covered by Medicare?

Oral appliances for sleep apnea may be covered by Medicare, depending on the device and the severity of your sleep apnea. Consult your doctor or dentist and Medicare professionals to learn more.

Jill Zwarensteyn

Editor

About Author

Jill Zwarensteyn is the Editor for Sleep Advisor and a Certified Sleep Science Coach. She is enthusiastic about providing helpful and engaging information on all things sleep and wellness.

Combination Sleeper

References:

“Obstructive sleep apnea”. Mayo Clinic. Last modified July 14, 2024. https://www.mayoclinic.org/diseases-conditions/obstructive-sleep-apnea/symptoms-causes/syc-20352090.
“Sleep Apnea”. Mayo Clinic. Last modified April 6, 2024. https://www.mayoclinic.org/diseases-conditions/sleep-apnea/symptoms-causes/syc-20377631.
Raghavendra Jayesh, S., Manzoor Bhat, Wasim. “Mandibular advancement device for obstructive sleep apnea: An overview”. Journal of Pharmacy and BioAllied Sciences. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4439678/. 2015.
Lazard MD, Diane S., Bluemen MD, Marc., et. al. “The Tongue-Retaining Device: Efficacy and Side Effects in Obstructive Sleep Apnea Syndrome”. Journal of Clinical Sleep Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2762714/. 2009.
Agarwal, Anirudh., Mathur, Rinku. “Maxillary Expansion”. International Journal of Clinical Pediatric Dentistry. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4993819/. 2010.
Tsuiki, Satoru., Maeda, Keiko., Inoue, Yuichi. “Rapid Maxillary Expansion for Obstructive Sleep Apnea: A Lemon for Lemonade?”. Journal of Clinical Sleep Medicine. https://jcsm.aasm.org/doi/10.5664/jcsm.3464#:~:text=Since%20expansion%20of%20the%20upper,role%20of%20future%20OSA%20development. 2014.
Dieltjens, Marijke., Vanderveken, Olivier M. “Oral Appliances in Obstructive Sleep Apnea”. Multidisciplinary Digital Publishing Institute. https://www.mdpi.com/2227-9032/7/4/141?ref=zadbajoswojezdrowie.com. 2019.
“Cost of Sleep Apnea Treatment”. New Jersey Sleep Apnea Solutions. Webpage accessed August 1, 2024. https://www.newjerseysleepapneasolutions.com/sleep-apnea-treatment-options/cost-of-sleep-apnea-treatment/.
“CPAP machines: Tips for avoiding 10 common problems”. Mayo Clinic. Last modified October 27, 2021. https://www.mayoclinic.org/diseases-conditions/sleep-apnea/in-depth/cpap/art-20044164.
Tsolakis, Ioannis A., Palomo, Juan Martin, et. al. “Dental and Skeletal Side Effects of Oral Appliances Used for the Treatment of Obstructive Sleep Apnea and Snoring in Adult Patients—A Systematic Review and Meta-Analysis”. Journal of Personalized Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8949347/. 2022.
Patel DDS, Mayoor. “Exploring TMJ Symptoms as a Result of MAD for Sleep Apnea”. Dental Sleep Practice. https://dentalsleeppractice.com/exploring-tmj-symptoms-result-mad-sleep-apnea/#:~:text=Side%20effects%20disrupt%20care,and%20morning%2D%20after%20occlusal%20changes. 2017.
Ngiam, Joachim., Cistulli MD, Peter A. “Think Before Sinking Your Teeth into Oral Appliance Therapy”. Journal of Clinical Sleep Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4237521/. 2014.