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 are still undergoing research and are not 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 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 are 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.
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.
Oral Appliances Compared to Other Sleep Apnea Treatments
The benefits of oral appliances have mainly been compared to the benefits of CPAP therapy, the most common treatment for obstructive sleep apnea. Other treatment options like surgery are generally only appropriate for people who have not been able to tolerate or benefit from positive airway pressure (PAP) therapy or an oral appliance.
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.
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
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.
Talk to Your Doctor About Oral Appliances for Sleep Apnea
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 have 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.