If you or a loved one has Obstructive Sleep Apnea (OSA), you are likely familiar with how it is caused by airway obstructions that are triggered by structural issues within the soft tissues of the throat and upper airway. This condition causes poor sleep and can even increase your risk for chronic illness.
Scientists have done an incredible job developing treatments that can reverse this disorder. Currently, the most common choice is Continuous Positive Airway Pressure (CPAP), but that is not always a perfect solution for everyone. But thankfully, there are viable alternatives to CPAP out there as well for those who need another solution.
One of those solutions, which is what we’ll be covering today in this article, is a sleep apnea mouth guard. In this article, we’ll explore how these oral appliances treat OSA. We will go over the three main types, along with some of the benefits and risks of using such devices. We will discuss how they differ from CPAP and address some things to keep in mind if you are considering this form of treatment. Lastly, we’ll walk you through the process of getting your own mouthguard.
What Is a Sleep Apnea Mouth Guard
Sleep apnea mouthguards are a group of devices that are primarily used to treat Obstructive Sleep Apnea (OSA). Sometimes referred to as oral appliances, these mouthguards involve a method of treatment called Oral Appliance Therapy (OAT). Like Positive Airway Pressure (PAP) machines, the use of oral appliances is considered to be a form of non-invasive treatment for sleep apnea, as they do not involve surgery or airway intubation.
Most providers consider sleep apnea mouthguards to be an alternative to CPAP. They may be most suitable for those who have mild or even some moderate cases of OSA and/or have struggled to tolerate sleeping with a CPAP machine. That said, these devices are very different from any form of PAP treatment, which involves delivering a flow of pressurized air directly through the airway and into the lungs. This pressurized air offers the added benefit of acting as a sort of brace for the soft tissue that lines the upper airway.
On the other hand, oral appliances function more so as a positional aid for the mouth and throat. Specifically, they work by repositioning the jaw and/or tongue so that the airway stays open as you sleep. And while not quite as common as CPAP, oral appliance therapy can be very effective for a number of people.
How Sleep Apnea Mouth Guards Work
While there are multiple types of sleep apnea, these devices are designed to primarily treat the most common one, Obstructive Sleep Apnea. Mouthguards target soft tissue airway obstruction at its source by physically adjusting the structure of the mouth, throat, and upper airway. In order to better understand this process, let’s take a moment to understand how this form of sleep apnea occurs.
Understanding Obstructive Sleep Apnea
OSA occurs when the airway becomes partially or totally blocked due to changes in the soft tissue in the surrounding area. As a result, breathing becomes very shallow and may even temporarily stop altogether. This condition is known for causing excessively loud snoring that may even keep others awake at night.
Airway obstruction can happen in a couple of ways, but ultimately it is triggered when certain muscles in the mouth, throat, and/or upper airway become so relaxed that they collapse, causing a blockage. Most of these events involve the tongue in some way, as it has a tendency to “fall” into the back of the throat.
This type of obstruction is much more likely to occur if you have an anatomical difference in the affected area, such as a large tongue or an abnormally small airway. The risk for OSA is also increased in people who are predisposed to muscle fatigue or muscle weakness in the head and neck area, such as individuals who have neuromuscular conditions or those who are obese.
In some cases, these obstructive events are so bad that they can cause you to stop breathing altogether. When this happens, your brain sends a signal that rouses you from sleep so that you can take a deep breath of air. While you may not always be fully aware of these incidents, they can lead to very poor quality sleep and may even have an impact on your ability to function at your full potential during the day.
Treating Obstructive Sleep Apnea with Oral Appliance Therapy
In the case of Obstructive Sleep Apnea, airway blockages arise due to structural issues within the throat or airway. Therefore, an important feature of OSA treatment involves bracing or supporting the surrounding soft tissue so that it is less likely to collapse. This can be done using a flow of highly pressurized air, like with a CPAP. But it can also be achieved by repositioning specific structures located in this part of the body.
This is where sleep apnea mouthguards come in. These devices can help to position the jaw, tongue, or soft palate in such a way that the airway is held open, even when the surrounding muscles are prone to over-relaxing. Additionally, when using an oral appliance, some muscles may be repositioned in such a way that they are unable to fully relax. This reduces their likelihood of fully collapsing and blocking the airway.
By providing additional support and keeping the airway open, these devices can reduce the number of OSA events, which leads to significant improvements in sleep quality. Mouthguards may also be suitable for those who have not yet been diagnosed with sleep apnea but present with related concerns. For example, they target some of the most common causes of snoring and can even be paired with nasal appliances for a full-spectrum approach.
Types of Sleep Apnea Mouth Guards
Not all forms of Oral Appliance Therapy are created equal. There are three main types of mouthguards. They are categorized based on how they interact with the mouth and throat—some work solely by adjusting jaw placement and thus changing the entire structure of the mouth and throat, while others physically hold the soft tissue in place so that it cannot collapse down into the airway.
Mandibular Advancement Devices (MADs)
Products within this first group are called Mandibular Advancement Devices (MADs), and they are currently the most popular option for individuals who choose this line of treatment. This form of Oral Appliance Therapy uses the structure of the jaw itself to minimize the risk of airway obstructions. The name refers to the bone that makes up the chin, along with the rest of the lower half of the jaw, called the mandible.
These devices look quite similar to the mouthguards that are used in sports or for teeth grinding. They consist of three parts. One attaches to the upper dental arch, while another aligns with the lower arch. They are connected via a set of hinges that are used to position the lower jaw forward. Some products even allow you to adjust these hinges, which gives you the ability to control the exact placement of the mandible.
Moving the jaw forward helps to prevent airway obstruction in the following two ways:
- Creates Muscle Tension: Positioning the jaw with a MAD creates a slight bit of tension in the muscles that make up the tongue and line the throat. This reduces the risk of those muscles relaxing to the point that they collapse into the airway.
- Opens the Airway: Having the jaw placed in a forward position also opens up the airway a bit more. This creates additional space in the throat and airway, making them less susceptible to the blockages that do occur.
These adjustments make it much easier for air to flow into the lungs and reduce the likelihood of total blockages occurring. As a result, you may experience less snoring, plus see improvements in the number of sleep disturbances and, ultimately, your quality of life.
Tongue Stabilizing Devices (TSDs)
As the name suggests, tongue stabilizers are a type of oral appliance that adjusts the position of the tongue as it rests inside the mouth. Some manufacturers referred to them as Tongue-Retaining Devices (TRDs). While less common than the mandibular option, research shows that they are a suitable alternative for mild to moderate cases of OSA. These devices are a great solution for people whose snoring or sleep apnea has been largely attributed to their tongue falling into the back of their throat while they sleep.
TSDs are typically shaped like a sort of pacifier that has an attachment to hold the tongue in a forward position. They consist of a tongue sleeve surrounded by a mouthpiece, which you situate between your lips and teeth. You then place your tongue into the sleeve, where it is held in place using gentle suction.
Sleeping with a tongue retainer can reduce your risk of sleep apnea in the following ways:
- Holds the Tongue in Place: When sleeping on your back, your tongue has a tendency to relax into your throat, thanks to gravity. When this happens in combination with other structural changes, it can trigger OSA. A tongue stabilizing device physically holds the tongue in place so that it stays flat inside the mouth rather than bunching up and/or relaxing into the back of the throat.
- Controls the Muscles of the Tongue: Sticking your tongue out too far can cause its muscles to tense up too much. This can actually lead to the tongue becoming bunched up to the point that it partially blocks the airway. Alternatively, over-relaxation can also lead to obstruction. Tongue stabilizers not only keep the tongue in place, but they also keep it from becoming too tense or too relaxed.
Keeping the tongue from falling into the back of the throat addresses one of the biggest contributors to Obstructive Sleep Apnea. As a result of using a tongue-stabilizing device, you will likely snore less and experience fewer breathing issues as you sleep.
Soft Palate Lifters (SPLs)
Unlike the previous two devices discussed above, this category involves products that act as more of a brace versus a positional tool. They are often referred to as palatal lifters, but there is also a surgical implant option, which is called a palatal implant. This type of sleep apnea mouthguard works by physically bracing the soft palate located towards the back of the mouth/start of the throat.
Soft Palate Lifters resemble a retainer but with an added attachment that extends its reach further toward the back of the throat. Some versions can even be surgically implanted, particularly for individuals who need both CPAP and oral appliance therapy. These devices keep certain parts of the soft palate, which can be prone to collapsing, from causing obstruction of the airway.
Palatal lifters are best for mild to moderate cases of sleep apnea and reduce the risk of airway obstruction by:
- Preventing Collapse of the Soft Palate: Like the tongue, the soft palate is another major culprit for Obstructive Sleep Apnea. When the muscles that line this part of the mouth/throat become too relaxed, they tend to cause the uvula, tonsils, and surrounding tissues to drop down into the throat itself, which blocks the airway. While some SPLs simply brace the soft palate so that it cannot physically collapse into the throat, others actually raise it. This causes just enough tension that the related muscles are unable to fully relax to the point of collapsing.
- Making Additional Room in the Airway: Even when the muscles aren’t fully relaxed, the soft palate can sometimes interfere with the airway. While the effects of this aren’t usually noticeable during the day, they become quite obvious when it leads to sleep apnea. Because of this, raising the soft palate can actually increase the size of the airway. This reduces your risk of being seriously impacted by any obstructions that do arise.
Sleeping with an SPL can reduce the likelihood of your airway becoming significantly blocked by a soft palate collapse. And when the airway is unobstructed, you are able to breathe much more easily without snoring or having your sleep continuously interrupted by episodes of apnea.
Pros and Cons of Sleep Apnea Mouth Guards
If your doctor has diagnosed you with sleep apnea, it is important to follow a treatment plan that works for you. Like other types of effective solutions, managing your OSA with a sleep apnea mouthguard offers many benefits when used appropriately. In fact, studies suggest that sleep apnea events can be reduced by more than 65% when using a Mandibular Advancement Device. That said, this form of treatment does come with a handful of side effects that some individuals may find frustrating.
Benefits of Sleep Apnea Mouth Guards
The positive effects of choosing Oral Appliance Therapy include the following:
- Fewer episodes of apnea (no breathing) and hypopnea (slow or reduced breathing)
- Increased blood oxygen levels while sleeping
- Less snoring
- Improved sleep quality
- Increased feelings of restfulness
- Decreased daytime sleepiness and fatigue
- Improved cognition and mood
- Reduced risk for health conditions such as cardiovascular disease or inflammation
Side Effects of Sleep Apnea Mouth Guards
There are a handful of unpleasant issues that can sometimes arise while sleeping with an oral appliance. These effects tend to resolve themselves over time. They include:
- Jaw pain
- Tooth discomfort
- Excessive drooling
- Dry mouth
- Gum and cheek irritation
- Teeth shifting
Oral Appliance Therapy Versus CPAP Therapy
CPAP therapy is often considered to be the gold standard for sleep apnea treatment. It has proven to be an effective solution for many types of sleep apnea and can even provide additional respiratory support for other conditions as well. That said, this level of respiratory support isn’t always necessary, and sleeping with a CPAP machine can be difficult to adjust to. According to the National Library of Medicine, more than one-third of all people who sleep with a CPAP machine choose to discontinue it within the first year.
Advantages of Oral Appliance Therapy
The benefits of treating mild to moderate cases of OSA with a sleep apnea mouth guard include:
- Less Noise: CPAP machines can sound incredibly loud and may even disrupt your sleep further when you are first getting used to yours. Oral appliances have the benefit of creating no additional noise.
- Greater Portability: While some CPAP brands claim to be portable, they are still known for being bulky and requiring access to an outlet nearby. Sleep apnea mouthguards are small and can fit into small personal bags.
- Easy to Use: It can take some time to understand the ways in which a CPAP machine functions. And because they involve quite a bit of technology, some people find them confusing and rather daunting. Mouthguards are much more simple, as you simply put them in your mouth, and that’s it.
- Cost-Effective Options: CPAP therapy can be very expensive, even with a good insurance plan in place. Oral appliances tend to be offered at a range of pricing options— from under $100 to thousands of dollars. Also, OA therapy typically does not require you to buy additional parts, as you do with CPAP.
- No Hassle Cleaning: Oral appliances can be cleaned quickly and easily by suspending them in an oral-safe cleaning solution. On the other hand, CPAP parts require you to regularly clean your mask, hoses, and filters.
- No Electricity Needed: Obstructive Sleep Apnea affects people of every sex, race, background, etc. Despite being one of the most common ailments on the planet, its main treatment, CPAP therapy, is not as widely accessible. Mouthguards provide you with the opportunity to address your condition without requiring regular access to electricity.
- Reduced Risk of Developing Complex Sleep Apnea: While OSA is the leading form of sleep apnea, there is another type that arises when the brain fails to communicate properly with the respiratory muscles. This is called Central Sleep Apnea (CSA), and it can be caused by a number of conditions. Sometimes CSA can be triggered when a person who has Obstructive Sleep Apnea becomes reliant on their CPAP machine. When this arises, it is referred to as Complex Sleep Apnea.
- Increased Comfort: People who sleep with CPAP machines often struggle with side effects that can make it very difficult to sleep at night. The flow of high-pressure air can dry out your sinuses and airways, causing discomfort. Some individuals complain of headaches as a result of sleeping with a CPAP. While mouthguards have their own side effects, they are typically less intense and easier to overcome.
- Side and Stomach Sleeper Friendly: Because CPAP machines require you to wear a mask, you typically have to sleep on your back while wearing one. This may be difficult for some people who prefer other positions. It is much easier to find the most comfortable position while sleeping with an oral appliance.
Advantages of CPAP Therapy
Although Oral Appliance Therapy has its many perks, CPAP does offer some very important benefits. CPAP machines are:
- More Effective: First of all, we have decades of studies proving just how effective these machines are at treating a wide range of sleep apnea cases. CPAP is often the first line of treatment, even for mild cases, but evidence suggests that it is also highly effective for people with severe apnea.
- Easier to Purchase: Additionally, CPAP machines are more readily available. While the air pressure setting must be set by a specialist, the machine itself can be purchased with a prescription. Alternatively, a prescription-grade sleep apnea mouthguard must be custom-made by an oral health specialist, such as a dentist or orthodontist.
- Do not Interact with Your Teeth and Gums: If you are particularly prone to mouth sores or have especially sensitive teeth, Oral Appliance Therapy may not be the best solution for you. CPAP offers effective sleep apnea treatment without increasing your risk for jaw pain or tooth discomfort.
Who Should Avoid Oral Appliance Therapy
Although mouthguards are an excellent solution for many people with OSA, there are some circumstances in which Oral Appliance Therapy should not be used. These reasons vary from physical traits to condition severity. If you have one or more of the following criteria, this method of treatment may not be appropriate for you.
- Severe OSA
- Central Sleep Apnea
- Underlying conditions which complicate your sleep apnea
- Having low blood oxygen levels while your awake
- Gum disease
- Sensitive teeth
- Temporomandibular Joint Disorder (TMJ)
Getting Your Own Sleep Apnea Mouth Guard
There are two ways that you can get your own sleep apnea mouth guard. This depends largely on whether you are looking for a high-priced product that is available by prescription only. Or if you are wanting to try out Oral Appliance Therapy using more widely-available options that do not require a doctor’s orders or involve trips to an oral health specialist.
Prescription-Based Oral Appliances
If you wish to obtain your own customized sleep apnea mouthguard, the first step is to seek out the advice of your healthcare provider. If you have not yet been diagnosed with Obstructive Sleep Apnea but are currently showing signs, your doctor will likely order a sleep study to be completed either at a sleep clinic or in the comfort of your own home using a send-off test. The results of this test should also give your doctor an idea of how severe your condition is.
If you qualify for an OSA diagnosis but do not present with signs of severe sleep apnea, your doctor may suggest a range of treatment options, including CPAP and Oral Appliance Therapy. In the event that OAT is the right choice for you, you will be provided with a prescription or referral to an oral health provider such as a dentist or orthodontist. This specialist will take molds of the inside of your mouth, which will then be sent off to a production company. There they will create your very own customized oral appliance.
After your mouthguard has been created, it will be sent back to the oral health specialist’s clinic. You will then return to the office so that your provider can double-check the fit before sending you home with your new mouthguard.
Over-the-Counter Oral Appliances
While there are several of these types of devices that require a prescription, there are also a few over-the-counter options that we love. These types of devices are a great option if you are just getting started with this type of treatment or if you don’t actually have OSA but are simply looking to reduce your snoring.
One of our favorite products is the myTAP Oral Appliance for Sleep Apnea. With over 45 peer-reviewed studies, this device has proven its value as an excellent solution for people with mild to moderate sleep apnea. The myTAP is available at a reasonable price of just under $200. But the best part is that it still offers the benefit of a custom fit via an at-home molding kit!
This FDA-approved mouthguard is highly rated by both users and providers. If you have any interest in trying out OA therapy for the first time, we encourage you to speak to your doctor about trying the myTAP Oral Appliance!
Here are some commonly asked questions regarding the use of sleep apnea mouthguards!
How Much Do Sleep Apnea Mouth Guards Cost?
The cost largely depends on the type of device you are using. Amazon has some inexpensive solutions for under one hundred dollars. However, those may be less likely to effectively reduce your risk of sleep apnea.
Prescription-grade oral appliances can cost hundreds or potentially even a couple thousand dollars. This cost is increased by the fact that you will need to see a specialist to be fitted for your mouthguard. The good news is that insurance oftentimes covers at least part of the cost of these devices.
Who Are Sleep Apnea Mouth Guards Best for?
Sleep apnea mouth guards are best for individuals who have mild to moderate Obstructive Sleep Apnea without any underlying conditions that could complicate things. Additionally, they are often suggested for individuals who struggle to keep up with using their CPAP machine, either due to discomfort or difficulty maintaining the equipment.
Do You Need a Prescription for a Sleep Apnea Mouth Guard?
Technically you can buy an oral device for OSA on Amazon or some other online retailer. However, these appliances are typically much less effective. If you want a product that will effectively manage your sleep apnea, it is important to speak with your healthcare provider so that they can provide you with a prescription for a custom-made mouthguard.
How Often Should You Clean Your Sleep Apnea Mouth Guard?
You should clean your mouthguard at least once a day, especially after you wake up. Start by rinsing your device in cool water before gently brushing it with a soft-bristled toothbrush. After rinsing once again, some people choose to soak their oral appliance in denture cleaner.
If you or a loved one has been diagnosed with Obstructive Sleep Apnea and have concerns about CPAP therapy, we want you to know that you have options. Starting with Oral Appliance Therapy! This form of treatment uses a device called a sleep apnea mouth guard to position the muscles in your mouth and throat in a way that prevents them from collapsing into your airway.
There are three main types of mouthguards for OSA. The most common and most effective is the Mandibular Advancement Device, which creates some additional muscle tension and opens up the airway by moving the jaw forward. The second is the Tongue Stabilizing Device. This oral appliance holds the tongue in place so that it cannot fall into the back of the throat while you are asleep. And the last category includes the Soft Palate Lifters, which, as the name suggests, raise the soft palate and increase the size of the airway.
In the right circumstances, these mouthguards can be very effective for treating sleep apnea. They have been proven to reduce the number of apnea events and sleep disturbances in people with mild to moderate cases of OSA. But perhaps the biggest benefit is that they often offer a suitable substitute for people who cannot tolerate, maintain, or afford to keep up with the requirements of a CPAP machine.
If you have any concerns about your own sleep health or think that you may be living with undiagnosed sleep apnea, it’s best to speak with your healthcare provider. Your doctor will guide you through the process of testing and then help you settle on the best course of treatment for you. If that involves Oral Appliance Therapy, you will be sent to an oral health specialist who will ensure that you end up with a solution that fits your needs perfectly.
Nate aims to make learning about sleep apnea and CPAP products as enjoyable as possible. When he’s not spending time working, you’ll find him volunteering at the local animal shelter or cultivating his vegetable garden.