Oral Appliances for Sleep Apnea

Key Takeaways

• Oral appliances are a non-CPAP treatment option for obstructive sleep apnea that work by repositioning the jaw or tongue to keep the airway open during sleep.
• They're often recommended for people with mild to moderate sleep apnea who cannot tolerate CPAP therapy due to discomfort, claustrophobia, or other issues.
• Custom dental devices fitted by a qualified dentist tend to be more effective and comfortable than over-the-counter options, and professional fitting can reduce side effects.

How Oral Appliances for Sleep Apnea Work

Obstructive sleep apnea occurs when the muscles around the upper airway relax and tissues in the throat or mouth collapse, blocking air flow. Oral appliances treat OSA by holding the mouth in a position that keeps the upper airway open while a person sleeps.

While CPAP therapy uses pressurized air flow regulated by a machine to maintain an open airway during sleep, oral appliances reposition the jaw, tongue, or both to prevent obstruction of the airway without the use of a machine or other equipment.

Oral appliances show a great deal of promise as an effective treatment for people with mild or moderate cases of obstructive sleep apnea. Specifically, custom-fit mandibular advancement devices can reduce snoring and the number of breathing disruptions a person has per night, an important signifier of effectively managed OSA. They're also considered easy to use.

Types of Oral Appliances for Sleep Apnea

There are two main types of oral appliances for treating sleep apnea: mandibular advancement devices and tongue-retaining devices. Other devices are available, but they're still undergoing research and aren't as widely used.

Personal preference can have a major role in determining which device may be right for you. Likewise, your mood, lifestyle, and social support can impact your decision to use oral appliances or another treatment option.

Mandibular Advancement Device

Mandibular advancement devices (MADs), also called mandibular repositioning mouthpieces or mandibular advancement splints, can reduce the severity of obstructive sleep apnea. These are the oral appliances that are most commonly used for treating OSA.

Mandibular advancement devices fit around the upper and lower teeth and are worn only while sleeping. They enlarge the airway by pulling the lower jaw forward, preventing the tongue and other tissue from relaxing into the throat.

When worn regularly, a MAD may cause a progressive repositioning of the lower jaw and gradually relieve symptoms of OSA.

Experts recommend using custom-made mandibular advancement devices for treating OSA. A health care provider creates custom-made MADs by having a person bite into a dental cast. Regular follow-up visits are usually necessary to make adjustments to the device, both for comfort and to monitor the position of the jaw.

Some characteristics can make certain people better candidates for mandibular advancement devices. Studies suggest that young female users with mild to moderate OSA, low body mass, and a small neck circumference are more likely to find success with a MAD.

Tongue-Retaining Device

Tongue-retaining devices (TRDs), also called tongue-stabilizing devices, use suction to pull the tongue and hold it out of the mouth during sleep. The suction and positioning prevents the tongue from blocking the airway.

While studies of these devices are limited, TRDs are generally considered effective at improving sleep apnea. One study found that tongue-retaining devices can reduce breathing disruptions during sleep by 53%. People who use these devices also report improved quality of life and less daytime sleepiness.

Tongue-retaining devices can be alternatives to mandibular advancement devices, especially for people who cannot use MADs. They're more accessible and can be purchased without a prescription. But people are less likely to regularly use TRDs than MADs, mainly due to discomfort from the suction action and difficulty keeping the device in place.

Rapid Maxillary Expansion

Rapid maxillary expansion (RME) is an orthodontic treatment that gradually widens the upper jaw using a custom-made device called an expander. The expander is designed to fit along the roof of the mouth and attach to the back upper teeth, and it’s typically worn full-time for a period determined by an orthodontist.

RME is most often recommended for children with obstructive sleep apnea who have a narrow upper jaw, a crossbite, or persistent OSA after having their tonsils and adenoids removed. By gently separating the bones of the upper jaw over time, the treatment can increase the space in the nasal passages and upper airway, which may help improve breathing during sleep.

Tongue Muscle Stimulation Device

One of the newest types of oral appliances for treating obstructive sleep apnea, this device delivers mild electric pulses to the tongue, stimulating the muscles and improving muscle tone. Over time, muscles grow stronger, supporting the tongue and preventing it from falling back into the airway during sleep.

Instead of being worn throughout the night like other oral appliances, a tongue muscle stimulation device is used during the day for a short period of time. For the first six weeks of treatment, a person wears the device for 20 minutes per day. Thereafter, they should use the device for a 20 minute session once per week.

Currently, doctors may prescribe tongue muscle stimulation devices to people with mild OSA and people who snore. Early research shows that the devices can reduce breathing disruptions by 48%. Researchers continue to investigate whether stimulation devices are a safe and effective treatment option for people with other types of sleep apnea.

Pros and Cons of Oral Appliances for Sleep Apnea

Oral appliances can be an effective alternative to CPAP therapy for some people with obstructive sleep apnea, but they aren’t the right solution for everyone. Like any treatment, these devices come with both benefits and limitations related to comfort, effectiveness, cost, and long-term use.

Benefits of Oral Appliance Therapy

Oral appliance therapy offers several benefits for people with obstructive sleep apnea, particularly those with mild to moderate symptoms or who have difficulty tolerating CPAP therapy. These devices are compact, quiet, and easy to travel with, making them a convenient option for many users. Because oral appliances don’t require a machine, tubing, or electricity, some people find them easier to use consistently.

People who use MADs report less daytime sleepiness and improved cognitive function and quality of life. Additionally, MAD therapy can also have long-term positive effects on a person’s heart health, lowering blood pressure and reducing the risk of heart-related events.

Risks of Oral Appliance Therapy

Oral appliance therapy can have both short-term and long-term side effects. In most cases, side effects from OSA are temporary and go away within a few weeks after regular use and properly fitting the appliance.

People undergoing oral appliance therapy commonly report mild side effects, including:

• Dry mouth
• Increased saliva
• Discomfort in the teeth
• Tender muscles
• Jaw pain
• Irritated gums
• Shifting of teeth

Sometimes the side effects of oral appliances can be more severe and become progressively uncomfortable, causing some people to stop treatment.

Long-term side effects of treatment with oral appliances can include changes in a person’s overbite or the repositioning of their upper teeth. Some of these skeletal and dental changes can be permanent. However, most people don’t notice dental changes, and many report that the benefits of oral appliance therapy outweigh the side effects.

How to Get an Oral Appliance for Sleep Apnea

Before using an oral appliance to treat sleep apnea, you need an accurate diagnosis. Oral appliances are meant to treat mild to moderate sleep apnea and require a prescription.

Diagnosis typically involves a sleep study, either in a sleep lab or at home, to confirm the presence and severity of sleep apnea. Once diagnosed, a healthcare provider can determine whether an oral appliance is an appropriate treatment option and write a prescription if needed.

Sleep Doctor can help streamline this process by facilitating home sleep apnea testing, connecting you with licensed healthcare providers, and offering access to oral appliance options designed specifically for sleep apnea treatment.

Where Can I Buy an Oral Appliance for Sleep Apnea?

Sleep Doctor offers a curated selection of oral appliances designed to treat obstructive sleep apnea and snoring, making it easier to find an option that fits your needs. These devices are intended for people who have already been evaluated for sleep apnea or who are working with a healthcare provider to determine the right treatment approach.

While some oral appliances are available over the counter, such as boil-and-bite mandibular advancement devices or tongue-retaining devices sold online, these options are typically less precise and may be less comfortable or effective. 

How Much Do Oral Appliances for Sleep Apnea Cost?

The cost of oral appliances for sleep apnea can vary widely, depending on the type of device.

• Over-the-counter oral appliances are generally the least expensive ($50 to $200) but may offer limited effectiveness and comfort.
• Medical-grade oral appliances typically cost more ($200 to $1,300 or more) due to higher-quality materials and design.
• Custom-fitted oral appliances made by dental specialists are often the most expensive option ($1,500 to $4,500), but they also tend to be the most effective and comfortable.

Will Insurance Cover the Cost of an Oral Appliance for Sleep Apnea?

Insurance coverage for oral appliances varies by plan. Some health insurance policies cover oral appliances for sleep apnea when they're prescribed by a physician and deemed medically necessary, particularly for people who cannot tolerate CPAP therapy.

Coverage often applies to custom-fitted oral appliances provided through a qualified dental or medical provider. Because coverage rules differ, it’s important to check with your insurance company to understand what documentation is required and whether prior authorization is needed.

When to Talk to a Doctor

About 80% of people with sleep apnea are undiagnosed. If you struggle to fall asleep at night or experience excessive daytime sleepiness, reach out to a health care provider to get the proper diagnosis and treatment recommendations.

It’s very important to get treatment if you have obstructive sleep apnea. OSA can affect your health, resulting in disrupted sleep, daytime sleepiness, and increased blood pressure. It can also impair your mental functioning and increase your risk of workplace accidents and car crashes.

If you've been diagnosed with mild to moderate obstructive sleep apnea and struggle with using CPAP, consider asking your doctor about alternative treatment options, such as oral appliance therapy. Your doctor can assess what treatment options are best for your lifestyle and needs.

Frequently Asked Questions

Does an oral appliance work as well as CPAP?

Both CPAP therapy and MADs improve the symptoms of OSA, with most users reporting less daytime sleepiness and lower blood pressure. However, CPAP therapy is better at lowering the rate of disrupted breathing events per hour, an important measurement for determining the severity of a person’s sleep apnea.

Nearly half of people who use CPAP machines find it difficult to follow the guidelines necessary for effective treatment. Many people find the equipment to be uncomfortable and the noise to be disruptive. This can lead them to stop CPAP after only a few hours or not use it at all on some nights, making treatment less successful.

Because sleep apnea is a chronic condition, using a treatment consistently is key to the treatment’s effectiveness. Several studies have reported that people are more likely to use oral appliances on a regular basis, making them an appropriate alternative treatment for mild or moderate obstructive sleep apnea when CPAP therapy doesn’t work.