Are Sleep Apnea Mouth Guards a Viable Treatment for Obstructive Sleep Apnea (OSA)?

Sleep apnea is a serious sleep disorder characterized by repeated interruptions in breathing during sleep. Maintaining good sleep health is crucial, and treating sleep apnea effectively can have a significant impact on overall well-being.

The two main types of sleep apnea are obstructive sleep apnea (OSA) and central sleep apnea (CSA), each requiring different treatment approaches. OSA, the most common form, occurs when the muscles at the back of the throat fail to keep the airway open, causing brief pauses in breathing.

While Continuous Positive Airway Pressure (CPAP) therapy is the most widely recommended treatment, many people find it uncomfortable or challenging to use consistently. As a result, alternatives like sleep apnea mouthguards have gained popularity. But how effective are they in treating OSA?

Mouth guards are mandibular advancement devices designed to reposition the lower jaw, preventing airway obstruction during sleep. Oral Appliance Therapy is a popular treatment option for obstructive sleep apnea, offering a non-invasive alternative to CPAP therapy. Patients who use oral appliances often report better sleep quality, with fewer interruptions and more restful nights.

In this article, we will discuss the efficacy of mouthguards as a treatment option for OSA, comparing them with traditional treatments, and discussing whether they might be a suitable alternative for you.

Understanding Obstructive Sleep Apnea (OSA)

What is Obstructive Sleep Apnea?

Obstructive Sleep Apnea (OSA) is a common sleep disorder where the muscles in the throat relax excessively during sleep, leading to a partial or complete blockage of the airway. This obstruction results in pauses in breathing, known as apnea events, which can last for a few seconds to over a minute.

These interruptions in breathing can occur multiple times throughout the night, leading to fragmented sleep and reduced oxygen levels in the blood. Low blood oxygen levels due to untreated sleep apnea can lead to serious cardiovascular problems over time.

Symptoms and Risks of OSA

Common symptoms of OSA include loud snoring, choking or gasping during sleep, excessive daytime sleepiness, and difficulty concentrating. Left untreated, OSA can lead to serious health issues such as high blood pressure, heart disease, stroke, and diabetes. It’s crucial for individuals experiencing sleep apnea symptoms to seek a proper diagnosis and treatment.

Traditional Treatments for OSA

The most common and effective OSA treatment is CPAP therapy, which involves wearing a mask connected to a machine that provides a continuous stream of air to keep the airway open. While highly effective, some patients find CPAP therapy uncomfortable or difficult to adhere to. This has led to the exploration of alternative treatments, including sleep apnea mouthguards.

What is a Sleep Apnea Mouth Guard?

A sleep apnea mouthguard, also known as an oral appliance or mandibular advancement device (MAD), is a custom-made device worn in the mouth during sleep. It is designed to treat OSA by repositioning the lower jaw and tongue forward, which helps to keep the airway open during sleep. By preventing the airway from collapsing, a mouthguard can reduce or eliminate apnea events, improving sleep quality and reducing associated health risks.

How Do Sleep Apnea Mouthguards Work?

The primary function of a sleep apnea mouthguard is to adjust the position of the lower jaw (mandible) and tongue. This adjustment helps to keep the airway open by preventing the soft tissues at the back of the throat from collapsing. There are different types of sleep apnea mouthguards, but they generally work in the following ways:

• Mandibular Advancement Devices (MADs): These are the most common type of sleep apnea mouthguards. MADs work by moving the lower jaw slightly forward, which in turn pulls the tongue forward and tightens the soft tissues and muscles of the upper airway. This forward movement reduces the likelihood of airway collapse during sleep.

• Tongue Retaining Devices (TRDs): TRDs are less common but work by holding the tongue in a forward position. This prevents the tongue from falling back into the throat and obstructing the airway.

Types of Sleep Apnea Mouth Guards to Treat Sleep Apnea

There are various types of sleep apnea mouthguards available, each with unique features tailored to the needs of different patients. Here are the main types:

Custom-Fit Mandibular Advancement Devices (MADs)

Custom-Fit Mandibular Advancement Devices (MADs) are considered the most effective type of sleep apnea mouthguard. These devices are specifically tailored to the individual’s dental structure, providing a precise fit that maximizes comfort and efficacy.

How They Work:

• Jaw Advancement: MADs work by repositioning the lower jaw slightly forward, which in turn pulls the tongue and other soft tissues forward. This forward movement of the jaw helps to widen the airway, preventing the collapse of tissues at the back of the throat that can obstruct breathing.
• Custom Molding: The custom-fit nature of MADs ensures that they are molded to the user’s unique dental impressions, which helps in distributing the pressure evenly across the teeth and jaw, thereby reducing discomfort.
• Adjustability: Many custom-fit MADs come with adjustable components that allow users to fine-tune the degree of jaw advancement. This feature is particularly useful for optimizing comfort and effectiveness, as small adjustments can significantly impact the user’s experience and the device’s efficacy.

Advantages:

• High Effectiveness: Custom-fit MADs are highly effective for treating mild to moderate OSA and can significantly reduce or eliminate apnea events.
• Comfort: The personalized fit ensures greater comfort, which can improve compliance and overall treatment success.
• Durability: These devices are typically made from high-quality, durable materials that last longer than generic options.

Who Should Use It:

• Patients with mild to moderate OSA.
• Individuals who have not tolerated CPAP therapy well.
• Those seeking a long-term solution with a custom fit.

Potential Drawbacks:

• Cost: Custom-fit MADs are more expensive than over-the-counter options due to the custom molding process and higher-quality materials.
• Adjustment Period: Some users may experience an initial adjustment period where they may feel jaw discomfort or mild pain as their jaw adapts to the new position.

Boil-and-Bite Mouthguards

Boil-and-Bite Mouthguards offer a more affordable alternative to custom-fit devices. These mouthguards are made from a thermoplastic material that softens when heated in boiling water, allowing users to bite into the material to create a semi-custom fit.

How They Work:

• Self-Molding: After heating the mouthguard in boiling water, the user bites down on it to create an impression of their teeth and jaw. This process provides a fit that is more personalized than generic, one-size-fits-all devices, but less precise than custom-fit options.
• Jaw Advancement: Similar to MADs, boil-and-bite mouthguards reposition the lower jaw forward to keep the airway open. However, they may not offer the same level of fine-tuning and adjustability as custom-fit devices.

Advantages:

• Affordability: Boil-and-bite mouthguards are significantly less expensive than custom-fit options, making them accessible to a broader range of users.
• Ease of Use: The ability to mold the mouthguard at home provides convenience and simplicity.
• Accessibility: These devices are widely available without a prescription, making them an easy option for those looking to try a mouthguard before committing to a more expensive, custom-fit device.

Who Should Use It:

• Patients with mild OSA.
• Individuals who are new to oral appliance therapy and want to try a more affordable option before investing in a custom-fit device.
• Those who need a temporary or interim solution.

Potential Drawbacks:

• Fit and Comfort: While boil-and-bite mouthguards offer a more personalized fit than generic devices, they may not be as comfortable or effective as custom-fit options.
• Durability: These devices are often made from less durable materials, which may require more frequent replacement.

Tongue Retaining Devices (TRDs)

Tongue Retaining Devices (TRDs) are an alternative type of sleep apnea mouthguard designed specifically to hold the tongue in a forward position, preventing it from falling back into the throat and blocking the airway.

How They Work:

• Tongue Positioning: TRDs use a suction mechanism to hold the tongue in a forward position. By keeping the tongue in place, these devices help maintain an open airway during sleep, reducing the likelihood of apnea events.
• No Jaw Advancement: Unlike MADs, TRDs do not advance the lower jaw. This makes them a good option for patients who cannot tolerate jaw advancement due to TMJ (temporomandibular joint) disorders or other dental issues.

Advantages:

• Non-Invasive: TRDs do not require the movement of the jaw, making them less invasive and more comfortable for some users.
• Effective for Certain Users: TRDs can be particularly effective for individuals whose OSA is primarily due to tongue obstruction rather than the collapse of other soft tissues in the airway.
• Alternative to MADs: TRDs provide an option for those who cannot use MADs due to jaw or dental concerns.

Who Should Use It:

• Patients with mild to moderate OSA who cannot tolerate MADs.
• Individuals with dental issues that preclude the use of jaw-advancing devices.
• Those with a specific need to prevent tongue obstruction during sleep.

Potential Drawbacks:

• Comfort Issues: Some users may find TRDs uncomfortable, particularly if they are not accustomed to having something in their mouth that controls their tongue’s position.
• Saliva Production: TRDs can increase saliva production, which may cause discomfort or inconvenience during sleep.
• Limited Applicability: TRDs are not as versatile as MADs and may not be effective for all types of OSA.

Soft Palate Lifters (SPLs)

Soft Palate Lifters (SPLs) are a less common but innovative type of sleep apnea mouthguard designed to support the soft palate and prevent it from collapsing into the airway during sleep.

How They Work:

• Palate Support: SPLs work by lifting and stabilizing the soft palate, preventing it from collapsing backward and blocking the airway. This is particularly useful for individuals whose OSA is caused by a drooping or overly flexible soft palate.
• Customized Fit: Like MADs, SPLs are often custom-made to fit the user’s mouth, ensuring that the device is comfortable and effective. The customization allows for precise positioning of the palate lifter to match the individual’s anatomy.

Advantages:

• Targeted Treatment: SPLs offer a targeted approach to treating OSA caused by soft palate collapse, which is not typically addressed by other types of mouthguards.
• Non-Invasive: Similar to other oral appliances, SPLs are non-invasive and do not require surgical intervention, making them a safer alternative for treating specific causes of OSA.
• Complementary Use: In some cases, SPLs can be used in conjunction with other oral appliances, such as MADs, to provide a comprehensive treatment for complex cases of OSA.

Who Should Use It:

• Patients whose OSA is primarily due to soft palate collapse.
• Individuals who have not found success with other types of oral appliances or CPAP therapy.
• Those looking for a non-invasive treatment option that specifically addresses soft palate issues.

Potential Drawbacks:

• Availability and Cost: SPLs are less common and may be more expensive due to the customization required. They may also be harder to find compared to more conventional treatments like MADs and TRDs.
• Comfort and Adaptation: Like other oral appliances, SPLs require an adjustment period, and some users may find them uncomfortable initially.
• Specialist Consultation: Because SPLs are a more specialized treatment, patients will need to consult with a sleep specialist or dentist with experience in sleep medicine to determine if this is the right option.

Following is a comparison table between the different types of sleep apnea mouth guards that will help you to make an informed decision easily:

Effectiveness of Sleep Apnea Mouthguards

The effectiveness of sleep apnea mouthguards can vary depending on the severity of the condition, the type of mouthguard used, and the individual’s adherence to treatment. Here’s a closer look at how effective these devices can be:

Effectiveness in Treating Mild to Moderate OSA

Sleep apnea mouthguards are most effective in treating mild to moderate cases of OSA. Studies have shown that MADs can reduce the number of apnea events and improve sleep quality in patients with mild to moderate OSA. These devices can also lead to significant improvements in daytime sleepiness, snoring, and overall sleep quality.

Comparison with CPAP Therapy

While CPAP therapy remains the gold standard for treating OSA, sleep apnea mouthguards offer a viable alternative for patients who cannot tolerate CPAP. Although CPAP is more effective in treating severe OSA, mouthguards can be just as effective for mild to moderate cases and offer greater comfort and convenience for some patients.

Patient Compliance and Adherence

One of the significant advantages of sleep apnea mouthguards over CPAP therapy is higher patient compliance. Many patients find mouthguards more comfortable and easier to use, leading to better adherence to treatment and improved outcomes. Unlike CPAP, which requires a machine and mask, mouthguards are portable, quiet, and non-invasive, making them a more attractive option for some patients.

Long-Term Effectiveness

Long-term effectiveness of sleep apnea mouthguards depends on regular use and proper fit. Custom-fit devices, in particular, tend to maintain their effectiveness over time, provided they are adjusted as needed. However, it’s essential for patients to have regular follow-ups with their sleep physician or dentist to ensure the device continues to work effectively.

Benefits of Using Mouth Guards for Sleep Apnea

Sleep apnea mouthguards offer several benefits, especially for individuals who struggle with CPAP therapy or prefer a less invasive treatment option. Here are some of the key benefits:

Improved Comfort and Convenience

Mouthguards are generally more comfortable to wear than CPAP masks, and they don’t require the use of a machine, making them more convenient for travel. Their lightweight and portable design allows patients to maintain their treatment regimen even when away from home.

Reduced Snoring

One of the most noticeable benefits of sleep apnea mouthguards is the reduction in snoring. By keeping the airway open, these devices can significantly reduce or eliminate snoring, leading to a quieter and more restful sleep for both the patient and their partner.

Non-Invasive Treatment

Unlike surgical treatments for OSA, mouthguards are non-invasive and do not involve any recovery time. They are also adjustable, allowing for fine-tuning to achieve the best fit and effectiveness without the risks associated with surgery.

Enhanced Sleep Quality

By reducing the frequency and severity of apnea events, sleep apnea mouthguards can improve overall sleep quality. Patients often report feeling more rested, with reduced daytime sleepiness and improved concentration.

Potential Drawbacks of Sleep Apnea Mouthguards Treatment Option

While sleep apnea mouthguards offer many benefits, they are not without potential drawbacks. Here are some considerations to keep in mind:

Not Suitable for Severe OSA

Sleep apnea mouthguards may not be effective for treating severe cases of OSA. In such cases, CPAP therapy or other treatments may be necessary to manage the condition effectively.

Jaw Discomfort and Tooth Movement

Some patients may experience jaw discomfort, pain, or tooth movement when using a mandibular advancement device. These side effects are usually temporary but can be bothersome for some users. It’s essential to consult with a dentist or sleep physician to ensure the device is properly fitted and adjusted.

Regular Maintenance and Replacement

Mouthguards require regular cleaning and maintenance to ensure they remain effective and hygienic. Additionally, they may need to be replaced periodically, especially if the patient experiences changes in their dental structure or if the device becomes worn.

Initial Adjustment Period

Some patients may find it challenging to get used to wearing a mouthguard during sleep, especially in the initial adjustment period. It may take time for the patient to adapt to the device and find a comfortable position for sleep.

How to Choose the Right Sleep Apnea Mouthguard

Choosing the right sleep apnea mouthguard depends on several factors, including the severity of your OSA, your dental anatomy, and your personal preferences. Here are some tips to help you make the right choice:

Consult with a Sleep Physician

Before choosing a sleep apnea mouthguard, it’s essential to consult with a sleep physician or dentist who specializes in sleep medicine. If your symptoms suggest OSA, your doctor will likely order a sleep study.

They can help with diagnosis of obstructive sleep apnea and its severity, and accordingly, recommend the most suitable treatment options, and guide you in selecting the right mouthguard. The physician may also recommend another sleep study after the mouth guard has been adjusted.

Consider a Custom-Fit Device

For the best comfort and effectiveness, consider investing in a custom-fit mandibular advancement device. While these devices are more expensive, they offer a tailored fit that is more likely to provide long-term relief from OSA symptoms.

Evaluate Your Comfort Level

Comfort is a critical factor when choosing a sleep apnea mouthguard. Make sure the device you select feels comfortable in your mouth and does not cause excessive pressure on your teeth or gums. It’s also important to choose a device that allows for easy breathing and does not obstruct your airway.

Look for Adjustable Features

Some sleep apnea mouthguards come with adjustable features that allow you to fine-tune the position of your lower jaw. These features can enhance comfort and effectiveness, making the device more suitable for long-term use.

Check for FDA Approval

Ensure that the sleep apnea mouthguard you choose is FDA-approved. FDA approval indicates that the device has been tested for safety and effectiveness and meets the necessary standards for medical use.

Oral Appliance Therapy Versus CPAP Therapy 

When it comes to sleep apnea treatment two primary treatment options often come into consideration are Oral Appliance Therapy (OAT) and Continuous Positive Airway Pressure (CPAP) Therapy. For many patients with moderate to severe sleep apnea, CPAP therapy remains the first line of treatment.

Mild sleep apnea cases can often be managed effectively with oral appliances, which are less invasive than other treatments. Both therapies aim to keep the airway open during sleep, but they achieve this goal in very different ways. Understanding the distinctions between these treatments can help individuals with OSA make informed decisions about which option might be best suited for their needs.

How They Work

Oral Appliance Therapy (OAT):

• Functionality: Oral Appliance for sleep apnea involves the use of custom-fitted mouthguards, such as Mandibular Advancement Devices (MADs) or Tongue Retaining Devices (TRDs), which are worn during sleep. These devices work by repositioning the lower jaw or tongue to keep the airway open, preventing the collapse of soft tissues in the throat.
• Customization: Sleep apnea oral appliances are typically custom-made based on the user’s dental impressions, ensuring a comfortable and effective fit. This personalization is key to the device’s success in treating mild to moderate OSA.

CPAP Therapy:

• Functionality: CPAP therapy, on the other hand, uses a machine that delivers a continuous stream of air through a mask worn over the nose or mouth (or both). The air pressure from the CPAP machine acts as a pneumatic splint, keeping the airway open and preventing the soft tissues from collapsing.
• Consistency: CPAP machines are set to deliver a specific air pressure, which can be adjusted based on the severity of the OSA and the patient’s needs. CPAP is considered the gold standard for treating moderate to severe OSA because of its consistent ability to maintain an open airway throughout the night.

Effectiveness in Treating OSA

Oral Appliance Therapy (OAT):

• Efficacy for Mild to Moderate OSA: Oral appliances are highly effective in treating mild to moderate OSA. Studies have shown significant reductions in the number of apnea events and improvements in overall sleep quality for patients using these devices. However, their effectiveness may diminish for patients with severe OSA.
• User Compliance: One of the biggest advantages of OAT is higher patient compliance. Oral appliances are often more comfortable, less intrusive, and easier to use than CPAP machines, which leads to better adherence to therapy.

CPAP Therapy:

• Efficacy for Moderate to Severe OSA: CPAP therapy is the most effective treatment for moderate to severe OSA. It is particularly beneficial for patients with severe OSA, as it provides a consistent and controlled airway pressure that can eliminate almost all apnea events. CPAP therapy is also effective in reducing symptoms such as loud snoring and excessive daytime sleepiness.
• Challenges with Compliance: Despite its effectiveness, CPAP therapy often faces challenges with user compliance. The need to wear a mask connected to a machine, the noise of the machine, and discomfort with the air pressure can lead to reduced adherence, particularly among patients who find the setup intrusive or uncomfortable.

Comfort and Convenience

Oral Appliance Therapy (OAT):

• Comfort: Oral appliances are generally more comfortable to wear than CPAP masks, especially for patients who find it difficult to tolerate the sensation of air pressure or the feeling of being encumbered by a mask and tubing. Oral appliances are small, discreet, and easy to travel with, making them a convenient option for many users.
• Portability: The portability of oral appliances is another major advantage. Unlike CPAP machines, which require an electrical outlet and can be bulky to transport, oral appliances can easily fit in a small case, making them ideal for travel or use in situations where CPAP may not be practical.

CPAP Therapy:

• Comfort: CPAP therapy can be uncomfortable for some users, particularly those who are not accustomed to sleeping with a mask on their face. Issues such as mask leaks, skin irritation, and difficulty finding a comfortable sleeping position with the mask can also arise.
• Portability: While modern CPAP machines have become more compact and portable, they still require an electrical outlet and can be cumbersome to pack and carry, especially for frequent travelers.

Side Effects and Risks

Oral Appliance Therapy (OAT):

• Side Effects: The most common side effects of oral appliance therapy include jaw discomfort, tooth movement, and excessive salivation or dry mouth. These side effects are usually mild and can often be managed with adjustments to the device or changes in the user’s oral care routine.
• Risks: While generally safe, there is a potential risk of developing temporomandibular joint (TMJ) issues or changes in bite alignment over long-term use. Regular follow-ups with a dentist or sleep specialist are important to monitor and address any issues that may arise.

CPAP Therapy:

• Side Effects: Common side effects of CPAP therapy include nasal congestion, dry mouth, skin irritation from the mask, and a feeling of claustrophobia. Some users also experience difficulty exhaling against the continuous air pressure, though this can be mitigated with certain CPAP settings or machines that offer variable pressure.
• Risks: There are few serious risks associated with CPAP therapy, but issues like mask leaks can reduce the effectiveness of treatment. In some cases, users may develop pressure sores or infections if the mask and equipment are not properly cleaned and maintained.

Cost Considerations

Oral Appliance Therapy (OAT):

• Cost: The cost of oral appliance therapy can vary widely depending on whether the device is custom-made or an over-the-counter option. Custom-fit devices tend to be more expensive due to the need for dental impressions and personalized adjustments. However, many insurance plans cover oral appliance therapy, particularly if it is prescribed by a sleep specialist.
• Long-Term Costs: Oral appliances may need to be replaced every few years, depending on wear and tear. Additionally, patients should budget for regular follow-up visits with their dentist or sleep specialist to ensure the device remains effective.

CPAP Therapy:

• Cost: The initial cost of a CPAP machine can be significant, especially if additional features such as humidifiers or advanced pressure settings are included. However, many insurance plans cover CPAP therapy, making it more affordable for long-term use.
• Long-Term Costs: CPAP machines typically last several years, but users should expect to replace masks, tubing, and filters periodically. Regular maintenance and occasional machine servicing may also be required.

Who Should Choose Which?

Oral Appliance Therapy (OAT):

• Best for: Patients with mild to moderate OSA, those who have not tolerated CPAP therapy well, or individuals who prefer a more portable and less invasive treatment option.
• Considerations: Oral appliance therapy may be particularly suitable for patients who have difficulty adapting to CPAP therapy, who frequently travel, or who have specific dental or anatomical issues that make other treatments less effective.

CPAP Therapy:

• Best for: Patients with moderate to severe OSA, those who require consistent and highly effective treatment, or individuals who have had success with CPAP therapy in the past.
• Considerations: CPAP therapy is ideal for patients who need a highly reliable solution for managing OSA, particularly if they have severe symptoms or underlying health conditions that make effective treatment crucial.

Consulting a sleep medicine specialist can help you determine the most appropriate treatment for your specific type of sleep apnea. Oral appliances are an effective way to treat obstructive sleep apnea, particularly in mild to moderate cases.

Following is a simple table for you to learn easily about the differences between the oral appliances and CPAP therapy

Who Should Avoid Oral Appliance Therapy

While Oral Appliance Therapy (OAT) can be effective for treating mild to moderate obstructive sleep apnea (OSA), it may not be suitable for everyone. Individuals with severe OSA typically require CPAP therapy, as OAT may not provide sufficient airway support.

Those with severe temporomandibular joint (TMJ) disorders or significant dental issues, such as loose teeth or periodontal disease, should avoid OAT as it can exacerbate these conditions.

Additionally, patients with minimal or no teeth (edentulism) may struggle to achieve a proper fit with an oral appliance, reducing its effectiveness. Oral appliances are also ineffective for central sleep apnea (CSA), which requires different treatment.

Finally, individuals with severe bruxism (teeth grinding) or those who cannot tolerate the device due to discomfort or adaptation issues should consider alternative therapies. Consulting a sleep specialist or dentist is crucial to determine the best treatment option for your specific needs.

Conclusion

In conclusion, treating your sleep apnea is crucial for improving overall health and quality of life. For many sleep apnea patients, especially those with mild to moderate sleep apnea, mouth guards have gained popularity as an alternative treatment to CPAP therapy. These devices work by repositioning the jaw to keep the airway open, effectively reducing sleep disturbances and offering significant relief from sleep apnea symptoms.

While CPAP remains the gold standard for severe cases, using a sleep apnea mouth guard provides a comfortable and convenient option for those who struggle with CPAP adherence. OSA diagnosis should be followed by a thorough discussion with a healthcare provider to determine the best treatment approach, whether it involves wearing the mouth guard or CPAP therapy. Ultimately, finding the right treatment can greatly enhance sleep quality, reduce the risk of related health issues, and restore a sense of well-being to those affected by this common condition.