Obstructive Sleep Apnea (OSA) is a common sleep disorder where the upper airway repeatedly collapses during sleep, significantly reducing or stopping airflow. This obstruction forces the brain to briefly wake the individual to restart breathing, leading to fragmented sleep and daytime fatigue. Specialized mouthguards, formally known as Oral Appliance Therapy (OAT), are a recognized and effective treatment option for managing OSA in certain patients. These custom-fitted devices offer a non-invasive alternative to the Continuous Positive Airway Pressure (CPAP) machine, helping to maintain an open airway throughout the night.
How Oral Appliances Work to Manage Sleep Apnea
Oral appliances work by physically modifying the anatomy of the upper airway to prevent soft tissue collapse during sleep. The most common mechanism involves holding the lower jaw (mandible) in a slightly forward position. This forward repositioning pulls the attached soft tissues, including the tongue and soft palate muscles, away from the back of the throat.
Advancing the mandible increases the space in the pharyngeal region, the area most susceptible to obstruction. This minimizes the likelihood of the tongue falling back and blocking the airway when muscle tone relaxes during sleep. Imaging studies confirm that mandibular advancement enlarges the upper airway, particularly in the velopharyngeal area.
This action also increases tension in the soft palate and surrounding tissues. This tension stiffens the airway walls, making them less prone to vibration (snoring) and less likely to collapse. The device provides a mechanical “splinting” effect to ensure a clear path for air movement. Optimal results are achieved when the degree of jaw advancement is precisely determined through gradual adjustment, balancing airway opening with patient comfort.
Types of Sleep Apnea Mouthguards and Their Efficacy
Oral appliances are generally categorized into two main types: Mandibular Advancement Devices (MADs) and Tongue Stabilizing Devices (TSDs). MADs are the most widely used and commonly recommended appliances, functioning by holding the lower jaw forward using custom-fitted trays that snap over the teeth. These devices are highly effective, particularly for patients with mild to moderate OSA, often reducing breathing events by approximately 50%.
TSDs are a less common alternative that use suction to hold the tongue in a forward position, preventing collapse into the throat. TSDs may be preferred for individuals who cannot tolerate MADs due to dental issues or insufficient healthy teeth needed for anchoring. Custom-made MADs and TSDs are significantly more effective than over-the-counter “boil-and-bite” devices.
Custom-fitted devices are fabricated from dental impressions, ensuring a precise fit crucial for comfort and therapeutic effectiveness. These professional appliances are adjustable, allowing a dentist to fine-tune the degree of jaw protrusion to maximize airway opening. Over-the-counter mouthguards are less customizable, generally not cleared by the FDA to treat sleep apnea, and often only address simple snoring.
Determining If Oral Appliance Therapy is Right for You
Oral Appliance Therapy is primarily indicated as a first-line treatment for patients diagnosed with mild to moderate Obstructive Sleep Apnea. It is also a preferred alternative for people with severe OSA who cannot tolerate or remain adherent to CPAP therapy. Suitability begins with a formal diagnosis, typically confirmed by an overnight sleep study (polysomnography), which measures the severity of breathing disruptions.
A sleep physician evaluates the patient’s individual circumstances and overall health profile to determine if OAT is appropriate. Certain dental and medical conditions, known as contraindications, can disqualify a person from using an oral appliance. These include severe temporomandibular joint (TMJ) disorders, insufficient healthy teeth to anchor the device, or active periodontal disease.
The appliance works best when the upper airway collapse is primarily in the velopharyngeal region, a determination sometimes made through specialized imaging. OAT is not recommended for Central Sleep Apnea, which involves a failure of the brain’s signals rather than a physical blockage. Patients who are not overweight and those whose apnea improves when sleeping on their side are considered better candidates for successful treatment.
The Process of Getting and Using a Custom Device
Obtaining a custom oral appliance requires coordination between a sleep physician and a dentist specializing in dental sleep medicine. Following a physician’s prescription for OAT, the patient is referred to a qualified dentist for a thorough oral and dental evaluation. The dentist assesses the health of the teeth and gums and the mobility of the jaw to ensure the device can be safely and effectively worn.
The next step involves taking precise digital scans or physical impressions of the teeth, along with a bite registration, to capture the exact contours of the mouth. These molds are sent to a specialized lab to fabricate the custom appliance. Once ready, the patient returns for a fitting session where the dentist adjusts the device to an initial therapeutic position.
Over the following weeks, the dentist makes gradual adjustments to the device’s protrusion to find the optimal jaw position that maximizes airway opening without discomfort. Proper maintenance involves daily cleaning with a toothbrush and mild soap or a specialized cleanser, and storing the device in a protective case when not in use. Follow-up appointments, including a repeat sleep study with the appliance in place, are necessary to confirm the treatment is effectively controlling the sleep apnea.