Oral Appliance Therapy for sleep apnea: How do they work?

Oral appliance therapy is a treatment for snoring and sleep apnea. It involves wearing a removable oral appliance in your mouth when you sleep. The device fits much like a sports mouth guard or orthodontic retainer.

An oral appliance prevents your airway from collapsing by either holding the tongue or supporting the jaw in a forward position. You must be custom fitted for an oral appliance for it to work properly. Over-the-counter devices are not recommended as a treatment option for snoring or sleep apnea.

Sleep apnea

Sleep apnea is a serious sleep disorder that occurs when a person’s breathing is interrupted during sleep. People with untreated sleep apnea stop breathing many times during sleep, sometimes hundreds of times during the night.

There are three types of sleep apnea: obstructive, central and mixed. Obstructive sleep apnea (OSA) is the more common of the three. Obstructive sleep apnea occurs when the upper airway is blocked either partly or completely during sleep. During an apnea episode, the diaphragm and chest muscles work harder as the pressure increases to open the airway. Breathing usually resumes with a loud gasp or body jerk. These episodes can interfere with sound sleep, reduce the flow of oxygen to vital organs, and cause heart rhythm problems.

In central sleep apnea, the airway is not blocked but the brain fails to signal the muscles to breathe due to instability in the respiratory control center. Central apnea is related to the function of the central nervous system and not treated by oral appliance therapy. Mixed sleep apnea is a combination of both obstructive and central sleep apnea.

Symptoms of sleep apnea

Symptoms of sleep apnea

The signs and symptoms of obstructive and central sleep apneas overlap, sometimes making it difficult to determine which type you have. The most common signs and symptoms of obstructive and central sleep apneas include:

  • Loud snoring
  • Episodes in which you stop breathing during sleep — which would be reported by another person
  • Gasping for air during sleep
  • Awakening with a dry mouth
  • Morning headache
  • Difficulty staying asleep (insomnia)
  • Excessive daytime sleepiness (hypersomnia)
  • Difficulty paying attention while awake
  • Irritability

Oral appliance therapy to treat sleep apnea

Oral appliance therapy to treat sleep apnea

An oral appliance or mandibular advancement device is similar in appearance to a mouth guard or retainer and is worn during sleep. The appliance is custom made by a dentist trained in sleep medicine. It works by moving and holding the lower jaw slightly forward. The main purpose of the oral appliance is to keep the airway open during sleep, thereby preventing it from collapsing and blocking the normal flow of air during breathing.

Advantages of oral appliance therapy

Oral appliance therapy is an effective, non-invasive treatment that fits easily into your lifestyle. Patients like oral appliance therapy because it is:

  • Easy to wear
  • Quiet
  • Portable
  • Convenient
  • Comfortable
  • Easy to care for

Three main categories of dental devices for OSA

Three main categories of dental devices for OSA

Mandibular advancement devices

The most widely used mouth device for sleep apnea, MADs look much like a mouth guard used in sports. The devices snap over the upper and lower dental arches and have metal hinges that make it possible for the lower jaw to be eased forward. Some, such as the Thornton Adjustable Positioner (TAP), allow you to control the degree of advancement.

Tongue retaining device

Used less commonly than MAD, this device is a splint that holds the tongue in place to keep the airway open.

For people with mild to moderate sleep apnea, particularly those who sleep on their backs or stomachs, dental devices may improve sleep and reduce the frequency and loudness of snoring. Also, people are more likely to use their dental appliances regularly than CPAP.

Mouth guards

Similar to mandibular advancement devices, these devices also help reposition your lower jaw, although to a lesser degree. These mouth guards can also help reduce the grinding of the teeth (bruxism) which can reduce the risks of TMJ disorder and chipping your tooth.

Risks of oral appliance therapy for sleep apnea

The risks of oral appliance therapy include:

  • Bite changes
  • Loose teeth
  • A need for dental work replacement
  • Excessive drooling
  • Mouth dryness


How do I order an oral appliance for sleep apnea?

If you and your doctor decide that an oral device is a good option, you will need a referral to an appropriate dentist to have an evaluation. The dentist will decide if you are a candidate for this treatment and make an impression of your teeth. The dentist will make the device and call you back for a fitting. You will also be given a morning repositioner to realign your bite after the appliance is removed. He or she will also give you instructions on how to use and clean the appliance. You might also have to go back to the dentist for further custom adjustments to optimize care. Once care is completed, it is recommended that have another sleep test to see how the appliance is working for you. Further adjustments may be necessary.

What are the complications of sleep apnea?

If left untreated, obstructive sleep apnea can result in a number of health problems including hypertension, stroke, arrhythmias, cardiomyopathy (enlargement of the muscle tissue of the heart), congestive heart failure, diabetes, and heart attacks. In addition, untreated sleep apnea may be responsible for job impairment, work-related accidents, and motor vehicle crashes as well as academic underachievement in children and adolescents.

Does insurance cover oral appliance therapy?

Because Sleep Apnea is a medical condition, the claim is filed through your medical insurance provider. Most medical insurances cover the costs of oral appliance therapy.

How long does an oral appliance for sleep apnea last?

Sleep apnea dental appliances can last up to two years with continual wear. Some patients may need a replacement as early as six months, but that is rarely the case. After two years, the mouth guard may get worn down and become less effective.

Can sleep apnea be cured?

While CPAP and oral appliances work well, they’re not cures for sleep apnea. The only sure way to rid yourself of the condition for good is to either lose weight or have surgery to remove excess tissue from the palate or throat.

Does sleep apnea worse with age?

Yes, aging may make your sleep apnea worse. Just as you lose muscle tone in your arms and legs, you similarly may lose muscle tone within your airway. This may compromise its ability to stay open.