How Does a Sleep Apnea Oral Appliance Work?

Oral appliances can work wonders for people with sleep apnea. Here's how to know if an oral appliance is right for you.

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sleep apnea

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!

Disclosure:
Ask the Dentist is supported by readers. If you use one of the links below and buy something, Ask the Dentist makes a little bit of money at no additional cost to you. I rigorously research, test, and use thousands of products every year, but recommend only a small fraction of these. I only promote products that I truly feel will be valuable to you in improving your oral health.

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:

  1. Surgically widen the doorway opening so that, even when the door slams shut, air can pass through the doorway.
  2. Keep the door propped open by pushing air through with a high-powered fan in front of the door.
  3. 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.

sleep apnea oral appliance

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

Read Next: The Complete Guide to At-Home Sleep Tests, Plus My Favorite Way to Track Sleep

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22 Comments

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  1. Debbie Zamiska says:

    My son is 13 yrs old and has been diagnosed with sleep apnea. The lung dr. has recommended having his tonsils/adenoids removed but when we went to the ENT they said his are small. If they were slitty enlarged I would be alright with the surgery but they aren’t so I’m not comfortable putting my son through it. I know this is a common surgery but it still is surgery.
    I’m hoping we could try this oral appliance to see if it will work for him. Do they make them for teenagers?

  2. It all depends on the rseoan for the nasal surgery. Some people do have a deviated septum or other major rseoans for nasal blockage. In some cases the nasal airway blockage will actually make using cpap more difficult due to nasal congestion and such. On the other hand the palate surgery is not always the best option. This is not an absolute cure for OSA. Almost all patients who have the surgery wind up on Cpap anyways. The success rate is very poor and it almost never works. Also very painful. An ENT is generally going to want to perform the surgery. I agree with the person who says you should see a board certified sleep specialist on this matter. He may give you a different outlook on your situation. Good luck in whatever your outcome may be.

  3. I have a Somnomed sleep appliance. (CPAP tried and found it intolerable/ felt like I was suffocating with mask on). I DO prefer the sleep appliance to CPAP, however, now I wake up 5 or 6 times every night with an extremely dry mouth! I bought Biotene mouth spray, and it works temporarily, but I’m still waking up repeatedly with the dry mouth symptoms. Kind of negates the whole reason for getting the sleep appliance, to get better sleep.
    On the positive side, my headaches are gone as well as dreams that I’m underwater and can’t get to the surface for air.

    • Sarah Macken says:

      I use a partial denture in the daytime and a Somnomed appliance at night. I know the gums need to rest from appliances that cover them. How long do the gums need to rest in a day? and how do I get the required rest period with both devices?

  4. I wear an Invisalign retainer at night. Can i use an oral device?

    • I was wondering the same thing!

  5. Katherine Rollins says:

    Can it be used if you don’t have teeth?

  6. I use a night guard not an oral appliance due to cost. Usually within a month of use the night guards start showing signs of chewing or grinding. Last year I changed from a feather pillow to a buckwheat hull pillow. Since then my night guards show no sign of of chewing or grinding. Could it be that the pillow resolved my night grinding?

    • Hi Linda:

      It’s interesting and possible that the different more supportive pillow had an effect on your airway. The firmer pillow kept your head and neck in a position that did not allow the airway to “kink”. much like what we try to do when giving CPR. Especially if you are a side sleeper.

      However, don’t assume all is well until you have verified your sleep ability with a true sleep study.

      Thanks for that comment. I do make a recommendation for pillows in the appendix of my book (http://amzn.to/1PAT6wO) as most of us sleep on a pillow that is not supportive enough.

  7. Theresa Greenlee says:

    Just over 17 mos ago, I was diagnosed with severe sleep apnea. Rather than snore, I stop breathing for periods up to about 80 seconds. My doctor tried CPAP therapy, but I was intolerant. My insurance denied the pre-authorization for an OAT 15 mos ago. I knew I had to do something because this is a life or death issue for me. As it is, I have already developed heart arrhythmias which are inoperable because they occur both in the top and bottom of my heart. Additionally, about seven months ago, my dentist did a frenectomy as I had a slight ‘tongue tie’.

    I do not fit the typical apneic. I am a woman. small in stature, average weight and I am active, walking 15-30 miles per week. I work in healthcare and am in a fast paced office.

    This past week, I took delivery on my OAT from my dentist. The device seems a little loose, so I will be returning to the dentist to have it adjusted. I am concerned after reading your article that the OAT may not be the best therapy for me, but I do not know what else to do since I could not tolerate CPAP. What is your recommendation?

    Thank you for your help, Theresa Greenlee

    • Theresa: Sorry about the diagnosis of severe OSA. Oral appliances are contraindicated for treating severe OSA, as the device may not be enough to open the airway and would give the patient (and dentist) a false sense of security, leading to further decline in health, potentially deadly.

      However, I’d recommend getting one anyway and then trying an APAP (CPAP that is more adjustable to your needs) in conjunction with the oral appl. I’ve treated many such severe patients this way, and have found that the oral appl make the APAP more tolerable (as its able to work at lower pressures due to less of a collapsed airway).

      It’s called combination therapy, and it can work extremely well! Good luck and please let me know what happens.

      DrB

  8. Annika Larson says:

    My husband may have sleep apnea. I did not realize that these symptoms could be affected by different dental appliances and practices. As you mentioned, oral appliance therapy can help open the airway to help with the APAP machine. We will have to talk to our dentist about this. Thanks for sharing!

  9. If you get fitted for a MAD device and then need dental work such as a crown done will you need a new device made?

    • Good question. Usually when I do one crown, I can adjust it on the spot. If extensive work is done or orthodontic work, then it gets sent back to the lab for a repair and small fee. The worst part is waiting fort the device for up to two weeks!

      DrB

  10. Tess Van Wiele says:

    Are oral appliances only effective for people who sleep on their back? What about side-sleepers? I was recently diagnosed with severe sleep apnea, both obstructive and central. My CPAP machine is on order. My doctor recommends both a CPAP and an oral appliance used together. I sleep on my side so I don’t see how an oral appliance would help me. Is it also effective for side-sleepers?

    • Tess:

      Oral appliances work in any sleep position. The mandible can retrude even when sleeping sideways. Using both an oral appliance and and a CPAP is a great idea and can be more effective than one or the other used alone.

      Good luck with all of this!

      DrB

  11. Christopher Janney says:

    Dr B,
    Thank you for all the great information here. I’m just about done with your book. I’ve gotten a sleep study done and have moderate APNEA.

    Question is if I’m able to get an oral appliance made that is sufficient enough to remediate the APNEA could I simultaneously use a chin strap instead of ‘mouth taping’, as I’m bearded and forced to sleep supine due to two injured shoulders and know as soon as I relax the jaw opens up.

    Thanks for all you do!

    Cheers,
    Christopher J

  12. Anne Sheridan says:

    Thank you very helpful
    But I live in UK can you recommend any dentists with your expertse in UK?
    I grind teeth have daytime sleepiness and some swallowing issues
    I use mouth guard hasn’t helped and think what you’ve said in your article is the way to go. ….

  13. I recently went to a AADSM
    Dentist who told me first of all nothing would fix my Tmj because once the ligaments around it are stretched they’re never going to tighten the way a muscle would. She still offered the device but cautioned that the device can make my Tmj worse. The whole reason I sought her out to begin with because I wanted something to at the very least stop my clenching so my Tmj won’t get worse. It just seems like too much of a gamble. I don’t know if there is a device on the list proven to not make tmj worse. Also where can I find that list of approved appliances? I do have moderate sleep apnea currently going to be set up with a cpap but the appliance sounds like it would cover both issues. In other words, kill 2 birds with 1 stone. I’m so hoping this article is true and that once I get the apnea under control perhaps the clenching will stop. It does make sense.

  14. I have a Herbst device and have been cleaning it with dish soap and water, occasionally soaking in a denture cleaner for a few minutes. I just found out that leaving it out on the counter all day after getting up is a bad idea. Can I put it in the box it came in with a 50/50 mixture of white vinegar upon getting up in the morning? Thank you!

  15. Amanda Drew says:

    My husband always wakes up in the middle of the night gasping, and we think that he has sleep apnea. Thanks for letting us know that you should find out your actual sleep ability with a doctor before choosing the appliance that you’ll use. We’ll have to ask and find the right sleep apnea appliance that will work for my husband.

  16. Hi. I was recently diagnosed with mild sleep apnea. Wondering if there is an accountability to wearing the oral appliance as there is with a CPAP? I am a teacher and a school bus driver and I have to prove that I am using my CPAP for at least 4 hours a day in order to continue to drive the bus. I have much difficulty with the CPAP and am looking into an oral appliance, but don’t want to spend the money if my doctor will say there’s no way for him to know if I’m using it.

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