Sleep Apnea Mouth Guards

How Mouth Guards Treat Sleep Apnea

Oral appliances for sleep apnea address underlying structural factors that contribute to obstructive sleep apnea, such as a small lower jaw or a tongue that falls back into the throat. These physical features can obstruct a person’s airway, resulting in sleep-disordered breathing symptoms. Most commonly, sleep apnea mouth guards move the lower jaw forward, opening up the airway, although some adjust the tongue’s position forward instead.

Types of Sleep Apnea Mouth Guards

Sleep apnea mouth guards come in different designs and materials. They are often custom-fitted, so the same type may look different depending on the person it was made for. However, there are three main types.

Mandibular Advancement Devices (MADs)

Also known as a mandibular repositioning device (MRD) and mandibular advancement splint (MAS), a mandibular advancement device moves the lower jaw into a forward position. The word mandibular refers to the lower jawbone.

Some MADs have a one-piece design, while others have a two-piece design, with upper and lower guards that are connected. One-piece designs fix both the upper and lower jaw in place, which some people find restrictive Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source . Because two-piece designs have separate pieces for the upper and lower jaw, they allow for more movement and opening of the lower jaw, which some people may find more comfortable. However, oral appliances that allow more movement may not be ideal for people who sleep on their backs Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source .

Tongue-Retaining Devices (TRDs)

Tongue-retaining devices keep the tongue in a forward position so it does not collapse back into the airway. These somewhat resemble a pacifier, except that you stick your tongue outward into the device, which is held in place by suction. Some people consider TRDs to be less comfortable than MADs.

Soft Palate Lifters

Soft palate lifters raise the soft palate and the uvula. The aim is to reduce vibrations from the soft palate, but their effectiveness has not been proven.

Researchers and manufacturers continue to innovate and test new designs for sleep apnea mouth guards, with the goal of improving comfort and effectiveness. For example, one newer design that combined a MAD and a TRD was shown to be more effective in reducing respiratory events than the MAD alone.

Benefits of Sleep Apnea Mouth Guards

Research has found that sleep apnea oral appliances can provide the following benefits Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source for people with obstructive sleep apnea:

• Reduce the number of pauses in breathing (apneas) or episodes of shallow breathing (hypopneas)
• Significantly improve blood oxygen levels
• Decrease the frequency and volume of snoring
• Reduce daytime sleepiness

After a few years of treatment, sleep apnea mouth guard usage is associated with improvements in diastolic and systolic blood pressure, as well as continued improvement in quality of life and decreased daytime sleepiness.

Sleep apnea oral appliances can be a safe and effective alternative for the large number of people with OSA who do not respond well to CPAP therapy. As many as 46% to 83% of people Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source do not continue with CPAP therapy due to discomfort or another reason. If people find mouth guards more comfortable, they may be more likely to follow through with their treatment as directed.

Studies show that people who use an oral appliance to treat OSA may use it one more night per week, on average, than people who use CPAP, and nearly two hours longer per night. As a baseline, sleep experts recommend using either a mouth guard or CPAP machine for at least four hours per night for OSA therapy. Only 43% of people using CPAP meet this recommendation, compared with 76% of those using a mouth guard.x

Risks of Sleep Apnea Mouth Guards

While oral appliances are a good option for some, they are not always as effective in treating OSA as CPAP. Nearly twice as many people completely treat OSA with CPAP than with a mouth guard. Research also suggests that CPAP therapy contributes to a further reduction in respiratory events during sleep and a larger improvement in blood oxygen levels. And for about one-third of people, mouth guards do not significantly improve their symptoms Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source .

Although some people find oral appliances Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source more comfortable than CPAP, not all do. One small survey found that more than half of the respondents had stopped using their mouth guard within a year due to discomfort. However, those who continued wearing the mouth guard reported better sleep quality, with less snoring and daytime sleepiness.

Sleep apnea mouth guards can also cause changes in teeth position or bite. In some cases these changes can actually be beneficial, such as reducing overbite or overjet, which is when the upper teeth bend forward at an angle over the bottom teeth. Often, these changes are barely noticeable, but they may appear within six months of starting treatment.

Are Sleep Apnea Mouth Guards Safe?

Generally, sleep apnea mouth guards are considered safe, but they can have side effects. It is important to work closely with your health care provider when selecting and using a sleep apnea mouth guard.

Side effects are most common in the first two months and usually go away as a person gets used to the device. Side effects may include:

• Drooling
• Dry mouth
• Gum irritation
• Headaches
• Tooth pain
• Temporomandibular joint (TMJ) discomfort

For some people, TMJ pain may be more acute initially, though it typically decreases over time and resolves in most cases within 6 to 12 months.

Talking to Your Doctor About Mouth Guards for Sleep Apnea

If you are interested in learning more about mouth guards, talk to a primary care provider, sleep specialist, and dentist. After your initial exam and fitting, schedule regular follow-up appointments with your dentist and sleep physician to ensure the mouth guard still fits well and is effectively treating your sleep apnea.