Oral Appliance Therapy for Obstructive Sleep Apnea

What are oral appliances for sleep apnea?

Oral appliances for sleep apnea are dental devices, or mouthpieces, that you wear in your mouth to keep your airway open while you sleep. Healthcare providers use them to treat obstructive sleep apnea (OSA).

With OSA, your upper airway is blocked partly or completely when you’re sleeping. The reduced airflow triggers your brain to wake you up just enough to keep breathing. The cycle of restricted airflow, waking and falling asleep again, continues throughout the night. These episodes stop you from sleeping soundly and prevent your vital organs from getting enough oxygen. Untreated, OSA can lead to serious health conditions and is potentially fatal.

Oral appliances, also called oral appliance therapy, treat OSA. They hold your mouth in a position that makes sure you get enough airflow. They help you breathe better and reduce how often OSA wakes you up.

Types of oral appliances used to treat obstructive sleep apnea (OSA)

There are two main types of dental appliances for treating OSA: mandibular advancement devices (MADs) and tongue-stabilizing devices (TSDs).

Mandibular advancement devices

Mandibular advancement devices (MADs) are the most common oral appliance for treating OSA. They’re also called mandibular advancement splints, mandibular advancement appliances or mandibular repositioning appliances.

MADs work by pulling your lower jaw (mandible) forward. Moving your jaw forward also pulls your tongue forward, creating more space for airflow in the back of your throat. MADs fit over your teeth. Most come in two parts, one for your top teeth and one for your bottom. Screws, hinges and adapted rubber bands connect the top and bottom, allowing you to pull the lower part of the device that controls your jaw forward. Others have independent interchangeable arches.

MADs vary in terms of:

• Size.
• The materials they’re made of (how firm or soft they are).
• How the top and bottom pieces connect (in two-piece models).
• How much your teeth touch when you close your mouth.
• How far the device moves your jaw.

Tongue-stabilizing devices

Tongue-stabilizing devices (TSDs) are also called tongue-retaining devices. They treat OSA by pulling your tongue forward using suction. A suction bulb on the device holds your tongue in place while you sleep. The tip of a TSD stays outside of your mouth. Like MADs, TSDs open your airway by moving the base of your tongue forward.

TSDs aren’t as popular as MADs, but they may be an option for people with OSA who want to try an oral appliance but can’t use MADs. For example, people whose teeth aren’t strong enough to hold a MAD in place may use a TSD instead. These are also available over the counter.

What is the most effective oral appliance for sleep apnea?

The most effective oral appliances are custom-made to fit your mouth. You can buy oral appliances without a prescription, including “boil and bite” models that make an impression of your teeth. These types may provide benefits, but research shows that custom-made oral appliances offer the best results for OSA.

How does oral appliance therapy work to treat obstructive sleep apnea?

Oral appliances pull the base of your tongue forward, creating more space in the back of your throat. Some types latch onto your tongue and pull it forward. Most pull your lower jaw forward while your tongue remains in place.

You put the device in before you go to sleep and wear it throughout the night. You remove it in the morning when you wake up.

Who are oral appliances for OSA best for?

Oral appliances work best for people with mild to moderate OSA who can’t use a CPAP (continuous positive airway pressure) machine. A CPAP is a machine that attaches to your airway through a tube and mask you wear at night that sends pressurized air through your airways, keeping them open.

While CPAP is the best treatment for improving airflow for people with sleep apnea, many find it challenging to use night after night. Over time, they stop. Oral appliance therapy isn’t as effective as CPAP, but it does improve symptoms in some people.

Other people use oral appliances and CPAP together. For example, you may use a CPAP machine at home but an oral appliance when traveling. You may use an oral appliance with a CPAP machine to decrease the amount of pressurized air you’re getting from the CPAP.

Who shouldn’t use an oral appliance for sleep apnea?

Oral appliances aren’t for everyone, including:

• People with central sleep apnea: Central sleep apnea happens when signaling problems in your brain cause breathing pauses. Oral appliances can’t treat this type of apnea.
• Children: Children with breathing issues often need different treatments than adults. Only use an oral appliance if your child’s healthcare provider recommends it.
• People with severe OSA: Attempting to manage severe OSA with only an oral appliance can be dangerous. Follow your healthcare provider’s guidance on when it’s safe to use an oral appliance and when it isn’t.

How do I get an oral appliance for obstructive sleep apnea?

You’ll need a sleep study to diagnose your OSA. If your sleep specialist decides an oral appliance is a good option, you’ll need a referral to a dentist.

To fit you for a MAD (the most common type of oral appliance), the dentist will:

1. Take an impression of your teeth or a 3D scan and a bite relationship.
2. Send it to a manufacturer, who’ll follow your dentist’s custom design so the device fits your teeth.
3. Fit you for the device during a return visit. The dentist will ensure it fits comfortably and won’t slip out of place while you sleep.
4. Provide instructions on how to clean and care for your appliance.

The dentist may recommend you have a sleep test after you get your MAD to see how the appliance is working. Based on the results, you may need further adjustments to your appliance.

How long does it take to get used to an oral appliance?

It takes about two to four weeks to adjust. It may feel odd at first to have a mouthpiece when you sleep. Try wearing it for only a few hours at first and gradually extending how long you have it in. For most people who use them, wearing an oral appliance eventually becomes part of their nighttime routine.

What are the side effects of oral appliance therapy for OSA?

You may notice side effects during the first week or two while you’re adjusting. Symptoms usually improve once you get used to wearing your appliance.

Short-term side effects include:

• Salivating (producing more spit) while you have the appliance in.
• Pain in your jaw, teeth and temporomandibular joint (TMJ).
• Dry mouth.
• Gum irritation. 

Long-term side effects are uncommon with a properly fitted appliance. When issues occur, they include:

• Changes in your bite.
• Teeth movement or loose teeth.
• Changes in your jaw muscles or TMJ.

Visit a dentist regularly so they can check for changes in your dental health and make corrections as needed. They’ll also ensure your device remains in good shape. Bring your device with you to all future dental appointments.

What are the benefits of oral appliance therapy for obstructive sleep apnea (OSA)?

Oral appliance therapy:

• Can improve symptoms of OSA, including daytime sleepiness and concentration issues.
• Some people experience deeper sleep with fewer disruptions.
• Can reduce or eliminate snoring.
• Offers another option for people who can’t use a CPAP.
• Is easy to take along when traveling.

Your response depends on the shape of your mouth and how severely OSA affects you. Some people with mild to moderate OSA find an oral appliance completely resolves their symptoms. Other people don’t notice an improvement and need different treatments.

Your dentist will explain all the potential benefits. They can explain the pros and cons of using an oral appliance for obstructive sleep apnea.

What questions should I ask my healthcare provider about an oral appliance to treat obstructive sleep apnea?

• How much does oral appliance therapy cost?
• Will my insurance cover the costs of oral appliance therapy?
• How many visits will getting an oral appliance require?
• How many sleep tests will I need to take?
• What kinds of side effects should I look for while using my device?
• How long will the device last?