Oral appliances can work wonders for people with sleep apnea. These devices are far more comfortable than wearing a mask, they’re portable so you can take them with you while traveling, and you can talk and drink water while wearing one. And, of course, they don’t involve surgery.
In this article, I explain how oral appliances work as well as a lot of the most common questions I get about oral appliance therapy.
My aim is to make this page a complete resource for people with questions about oral appliances.
If your question is NOT answered here, please let me know in the comments below so I can answer it for you and everyone else who reads this article — everyone benefits!
The Main Advantage of an Oral Appliance
An oral appliance fits like a retainer. It works by keeping your jaw and tongue in a forward position so that they can’t block your airway even after your airway muscles fully relax in deep sleep.
Imagine a doorway that wants to close shut. To prevent the door from slamming shut, you can:
- Surgically widen the doorway opening so that, even when the door slams shut, air can pass through the doorway.
- Keep the door propped open by pushing air through with a high-powered fan in front of the door.
- Prop the door open with a doorstop.
In the same way a doorstop props open a door, an oral appliance props open the airway during sleep. This is why the oral appliance therapy can work great on its own, together with a CPAP machine, or instead of surgery.
How Oral Appliances Work to Keep Your Airway Open
It’s fairly simple: The device clamps onto your upper and lower teeth, much like a retainer. The upper and lower portions are connected via a piston and tube which only let the jaw retrude so far.
As the muscles relax in deep sleep, the tubes bottom out and your chin is kept forward and the tongue can’t block the back of the airway.
With the jaw and tongue pushed forward, the airway is kept open, keeping you breathing during a full cycle of deep stage sleep even though all the muscles in your body are completely relaxed.
How Oral Appliances Treat Bruxism
These devices not only treat sleep apnea, they also cure grinding. Grinding is the instinctual response by the body when you stop breathing at night.
The back and forth motion of grinding is an effective way of reopening a collapsed airway. Even though grinding is what saves us, it comes at a cost. Not only does grinding slowly destroy your teeth, but if you’re grinding, you’re being aroused out of deep sleep because you can’t breathe. Therefore, you treat the root cause — the sleep apnea — and you take away the need for the body to grind the teeth.
Many of the patients I’ve treated with oral appliance therapy are shocked when they stop grinding and clenching. They suffered from headaches, neck aches, TMD symptoms, and jaw popping because they were always told that they would grind due to stress — not because of their small airway.
As a side note: if you grind your teeth, your dentist has likely prescribed a night guard for you to protect the teeth. I no longer will make night guards without first ruling out sleep apnea, since it’s always better to treat the root cause of an ailment. Not only this, but a night guard can make grinding worse by further obstructing the airway, leading to more grinding and worse sleep quality.
What to Know About Oral Appliance Therapy
They’re for mild or moderate sleep apnea only. If you have severe sleep apnea, an oral appliance is not recommended since it may not be enough support for a compromised airway. If you have severe sleep apnea and can’t stand the CPAP, there’s still hope. I’ve treated patients with severe sleep apnea because the oral appliance allows the patient to better tolerate the APAP machine, blowing less and more timely because the airway is presenting with less resistance.
They can cure grinding and clenching. Since we grind and clench while we sleep in order to reopen a collapsed airway, sleeping with an oral appliance can eliminate your need to grind and eventually your TMD symptoms. A nightguard will protect the teeth from the forces of grinding, but can increase grinding by increasing the blockage in the airway. An oral appliance treats the root cause — the sleep apnea — thereby taking away the need to grind in the first place.
You should only get a Medicare-approved appliance. There are hundreds of different oral appliances out there. The devices on the Medicare-approved list have stood the test of time and have demonstrated clinical efficacy. Of course there are many effective appliances that should be on the Medicare list that aren’t yet, but at least the list is a good starting point and ensures you don’t get hooked up with the wrong device.
Can I go straight to the oral appliance and skip the CPAP?
This is a common question. Assuming that you have had your sleep study and you know that you have mild to moderate sleep apnea, there’s no reason you shouldn’t do this. The only reason you might not want to skip the CPAP and go straight to the oral appliance is that your insurance company wants you to try the CPAP first. Whatever you decide to do, make sure that you verify your sleep ability with a proper sleep study — peace of mind is also an important part of the sleep equation.
Is an over-the-counter oral appliance just as effective?
No. It could even make things worse. They’re crudely made. They might put the jaw in a worse position for the airway. These devices allow people to treat themselves, which could potentially be very harmful. Use these at your own risk because you may be making things worse. Only a sleep medicine trained sleep apnea dentist can tell you if it’s working properly. Sometimes, to hold these devices in place, you have to clench. There’s also no professional supervision with these devices.
If I grind or clench, can I still get an oral appliance?
Absolutely! You grind your teeth at night because your airway is collapsing at night. An oral appliance can treat the root cause of your grinding, which is obstructive sleep apnea.
Not all doctors or even dentists are up to speed on the evidence-based fact that sleep apnea causes grinding and clenching. You may have to search for a professional who is up to speed.
What do I do if my doctor or dentist tells me oral appliance therapy is contraindicated because I grind?
Seek out someone who’s more up to date. Check localsleepdentist.com to find a dentist an American Academy of Dental Sleep Medicine (AADSM) dentist in your zip code. And, sometimes the patient has to educate the doctor — bring in the studies. Here are some links to clinical studies to print out to bring in.
Is a Herbst/SUAD/Mandibular Advancement Device the same thing?
Yes, these are all the same names for the same thing. To make sure you’re getting the right one, use the term “mandibular advancement device.” That is the generic term for what the device does. Mandibular refers to your mandible (jaw), so this is the term that I think keeps things the least ambiguous.
Unfortunately, there are so many different names for this device, it can be quite confusing, even for healthcare professionals.
Mark Burhenne DDS