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Oral appliances work by keeping your lower jaw and tongue in a forward position. This way, the tongue won’t block your airway even after your airway muscles fully relax while you’re asleep. This means you can breathe easy at night.
What is an oral appliance? An oral appliance is a device that fits like a retainer and looks like a mouth guard. It supports your jaw and tongue to maintain an open upper airway. Research shows that oral appliances can effectively treat sleep apnea.
Obstructive sleep apnea (OSA) describes the interruption of breathing while asleep. OSA affects 22 million Americans, yet most cases go undiagnosed.
OSA symptoms include:
- Daytime sleepiness
- Loud snoring
- Morning headaches
- Dry mouth
- Increased blood pressure (AKA hypertension)
- Low-quality sleep
- Teeth grinding
But you don’t have to be scared of OSA. Sleep apnea oral appliances offer a simple sleep apnea treatment option. There are over 100 FDA-approved oral appliances.
In this article, I explain the advantages of oral appliances, and I answer a lot of the most common questions I get about oral appliance therapy. Look at this page as a complete resource for people with questions about oral appliances.
Advantages of an Oral Appliance
According to many sleep apnea patients and practitioners, oral appliances have advantages over alternative treatments for sleep apnea.
Do oral appliances really work for sleep apnea? Yes, oral appliances work for sleep apnea by bringing your jaw and tongue forward, opening up your airway so you can breathe at night.
What are the advantages of an oral appliance?
- Oral appliances are far more comfortable than wearing a mask, like that of a CPAP machine.
- They are portable, so you can take them with you while traveling.
- You can talk and drink water while wearing an oral appliance.
- An oral appliance may help you avoid surgery by addressing one of the major root causes of sleep-disordered breathing.
In the same way a doorstop props open a door, an oral appliance props open the airway during sleep. This is why oral appliance therapy can work great on its own or with a CPAP machine.
Oral appliance therapy has clear advantages over CPAP therapy.
CPAP therapy (continuous positive airway pressure) is the most common treatment for sleep apnea. CPAP works by creating a continuous stream of air pressure that allows individuals with sleep disorders to breathe at night.
However, the continuous pressure makes it difficult for some to exhale. And even custom-fit CPAP masks can be uncomfortable to wear while you’re asleep. Many sleep apnea patients complain that wearing a mask is embarrassing.
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How Oral Appliances Work to Keep Your Airway Open
Oral appliances clamp onto your upper and lower teeth, much like a retainer. The upper and lower portions of the oral device are connected via a piston and tube, which only let the jaw go back so far.
As the muscles relax in deep sleep, the tubes bottom out and your chin is kept forward so the tongue can’t block the airway.
With the jaw and tongue pushed forward, the airway is kept open. This keeps you breathing during a full cycle of deep stage sleep, while still allowing all the muscles in your body to completely relax.
How Oral Appliances Treat Bruxism
Oral appliances not only treat sleep apnea. These oral devices can also cure a root cause of nighttime teeth grinding (AKA bruxism). Grinding is the body’s natural response when you stop breathing at night (called an “apnea”).
Oral appliances fix the root cause of bruxism — sleep apnea.
The back and forth motion of grinding wakes you up, allowing you to reopen a collapsed airway. Even though grinding is what saves you, it comes at a cost.
Grinding slowly destroys your teeth. Also, if you’re grinding, you’re being aroused out of deep sleep because you can’t breathe. This reduces the quality of your sleep.
Don’t get me started on the importance of high-quality sleep on your whole-body health!
Many of the patients I’ve treated with oral appliance therapy are shocked when they stop grinding and clenching. Many misinformed doctors tell them that stress triggered their grinding, but it is often sleep apnea.
Teeth grinding symptoms that oral appliances may stop include:
- Worn-down teeth
- Neck aches
- Facial pain
- TMJ disorder symptoms
- Jaw popping
- Interruptions in sleep
- Low-quality sleep
- Sleep disruption for your bed partner
If you grind your teeth, your dentist likely prescribed a night guard for you to protect the teeth. I no longer prescribe night guards without first ruling out OSA, since it’s always better to treat the root cause of an ailment than just the symptoms.
Not only this, but a night guard can make grinding worse by further obstructing the airway. This can lead to more grinding and worse sleep quality.
Side Effects of Oral Appliances
Oral appliances have a few side effects, but they are minor compared to the effects of sleep apnea and teeth grinding.
Potential oral appliance side effects:
- Dry mouth
- Excessive salivation
- Tooth/jaw discomfort
- Temporary changes in your bite
Is oral appliance therapy right for you?
Oral appliances are for mild or moderate sleep apnea only.
If you have severe sleep apnea, an oral appliance is not recommended. It may not open up your airway enough.
If you have severe OSA and can’t stand CPAP, there’s still hope outside surgery on the soft tissues in your throat. An oral appliance allows patients to better tolerate the APAP machine (automatic positive airway pressure) when used in conjunction with one another.
Oral appliances can cure grinding and clenching.
Since we grind and clench our teeth while we sleep in order to reopen a collapsed airway, sleeping with an oral appliance can eliminate your need to grind and eventually your TMJ (temporomandibular joint) disorder symptoms.
A night guard 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 — sleep apnea — thereby taking away the need to grind in the first place.
You should only get a Medicare-approved oral 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 sleep apnea dental appliances that should be on the Medicare list that aren’t yet. At least the list is a good starting point and ensures you don’t get hooked up with the wrong device.
What is the most effective oral appliance for sleep apnea?
The most effective oral appliance is the mandibular advancement device (MAD). It is the most widely used oral appliance for a reason. MADs are effective for mild to moderate sleep apnea.
DNA adjustable oral appliances are another approach to treating OSA by altering the structure of your mouth, allowing more room for your tongue to occupy without blocking your upper airway. DNAs reportedly cure sleep apnea by safely and painlessly restructuring the arches of your teeth.
The 6 most common sleep apnea oral appliances are:
- Mandibular Advancement Devices (MAD)
- Mandibular Advancement Splints (MAS)
- Mandibular Repositioning Appliances (MRA)
- Tongue Retaining Devices (TRD)
- Daytime-Nighttime Appliance (DNA)
- Mandibular Repositioning Nighttime Appliance (mRNA)
How much does an oral appliance for sleep apnea cost?
The average cost of oral appliances for sleep apnea is $1800 to $2000, according to the American Sleep Association.
Most insurance plans cover oral appliances as medical equipment for sleep apnea. Some insurance plans require you to try CPAP therapy first, even if your dentist or doctor recommends going straight to an oral appliance.
Can I go straight to the oral appliance and skip the CPAP?
Yes, you can skip CPAP and start oral appliance therapy to address sleep apnea. If you’ve already started CPAP therapy, then you may benefit from doing both together, since you’re used to CPAP.
Assuming that you have had a sleep study and you know that you have mild to moderate sleep apnea, there’s no reason you shouldn’t start with oral appliances for your sleep apnea.
The only reason you might not want to skip CPAP is if your insurance company wants you to try the CPAP first. Insurance companies often determine treatment plans, even if they are based on outdated science.
Whatever you decide to do, make sure that you have a proper sleep study performed to correctly diagnose your sleep apnea, as well as the severity.
Is an over-the-counter oral appliance just as effective?
No, an over-the-counter oral appliance could make your sleep-disordered breathing worse.
They are crudely made and might put the jaw in a worse position for the airway. Sometimes, to hold an OTC oral device in place, you have to clench, which is counterproductive. There’s also no professional supervision with these devices.
These devices allow people to treat themselves, which could potentially be very harmful. Use these at your own risk because they may make your sleep apnea and/or bruxism worse.
Only a sleep medicine trained sleep apnea dentist or sleep doctor can tell you if an oral appliance is working properly.
How long does an oral appliance for sleep apnea last?
Oral appliances for sleep apnea are not designed to last forever. Most oral appliances lose their effectiveness after a year or two.
Replacing your oral appliance every 12-24 months can definitely increase lifetime cost, and should factor into your and your orthodontist/dentist’s decision.
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 well-informed 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 — specifically, a functional dentist.
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. Oral appliance therapy prevents teeth grinding.
And, sometimes the patient has to educate the doctor — bring in the studies.
Is a Herbst/SUAD/Mandibular Advancement Device the same thing?
Yes, these are all the same names for the same oral device.
To make sure you’re getting the right one, use the term “mandibular advancement device” (MAD). Mandibular refers to your mandible (jaw), so this is what 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.
Are oral appliances the same as dental devices?
Yes, “oral appliances” are sometimes called “dental devices”.
Other names for oral appliances:
- Oral devices
- Dental appliances
- Dental devices
- Marklund, M. (2017). Update on oral appliance therapy for OSA. Current Sleep Medicine Reports, 3(3), 143-151. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5592194/
- Singh, G. D., Griffin, T. M., & Cress, S. E. (2016). Biomimetic oral appliance therapy in adults with severe obstructive sleep apnea. J Sleep Disord Ther, 5(227), 2167-0277. Full text: https://www.researchgate.net/publication/297007618_Biomimetic_Oral_Appliance_Therapy_in_Adults_with_Severe_Obstructive_Sleep_Apnea