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sleep apnea oral appliance

Sleep Apnea oral appliance as an alternative to CPAP.

If you struggle with snoring or obstructive sleep apnea, wearing a custom dental device may be your best option for peaceful sleep. Oral appliances that treat snoring and apneas are small custom dental devices worn in the mouth similar to custom sports guards or orthodontic retainers.

These devices are professionally fitted by dentists educated in sleep disorders and dental sleep medicine. This CPAP alternative is a non-surgical treatment for obstructive sleep apnea for patients with mild to severe sleep apnea.  

In most cases, an oral appliance device becomes as effective as a CPAP and eliminates the need to rely on a CPAP nightly. Sometimes, however, patients with severe sleep apnea combined with other medical conditions qualify for the oral appliance but may need to supplement their therapy with a CPAP at a low pressure.

What is a sleep apnea oral appliance?

Oral sleep appliances or mandibular repositioning devices (MRD’s) work by repositioning and stabilizing the jaw in a forward position and/or upward position. This mechanism can prevent muscles and tissues from collapsing back into the airway which causes airway obstruction resulting in snoring and apnea.

Most patients find oral appliances far more comfortable and less cumbersome than CPAP therapy, a common treatment option for obstructive sleep apnea. When successful, oral appliances vastly improve the quality of life and improve relationships. Positive results include:

Eliminated or reduced snoring

Absence or improvement of apnea events

Improved sleep quality and fewer awakenings

Improvement in chronic health conditions such as high blood pressure

medical insurance paperwork

Will my insurance cover an apnea oral appliance?

Most insurers and Medicare do cover an oral appliance. Documentation, paperwork and coverage of an oral appliance device can vary by the insurer. The minimum documentation required may be a copy of a recent sleep study showing you have sleep apnea, sleepiness questionnaire, clinical notes from the sleep apnea screening appointment and a CPAP refusal or intolerance affidavit may be needed. Some insurers may ask for a copy of a physician’s written order for the oral appliance. Each insurer has its own guidelines for coverage. In addition, individual deductibles, copayment amounts or percentages need to be considered. 

How do I get an oral appliance?

To start the process, contact a sleep center or a sleep dentist that offers this alternative treatment. A recent sleep study evidencing sleep apnea will be required. This test would be conducted in the sleep lab or at home via a home sleep test before fabricating a sleep apnea oral appliance. A sleep dentist will then conduct a consultation to determine if you are a candidate for an oral appliance. Some patients may require some dental work before an oral appliance can be fabricated. If the results indicate that you may benefit from a sleep apnea appliance, dental impressions and a registration of your bite are made to fabricate the oral appliance tailored to you.

oral appliances for sleep apnea

Are there any side effects?

All treatments for sleep apnea have the potential for side effects. CPAP therapy, the most commonly prescribed treatment for sleep apnea is no exception. Some common side effects of CPAP include dry mouth, dry eyes, skin irritations, nasal dryness and sinus infections. Here are the more common side effects that you may experience when wearing a dental sleep apnea device. 

Increase in saliva production that improves after the first few weeks of wearing your device.

Sore teeth and gums are common but usually gone within minutes to an hour after removing the appliance. If soreness persists, minor device adjustment may be made to the appliance at your next visit.

A slight change in the bite when you wake up should return to normal once you have done morning stretches or other recommendations given to you by your sleep physician.

Slight to moderate jaw pain. This pain will subside with use however, your sleep dentist will provide you with treatment and recommendations if the pain persists.

Dry mouth. This may be reduced with the use of elastics on your device to help keep your mouth closed and may increase comfort and, in many cases, improve the results of therapy.

Long term side effects may include loosening of dental work that was compromised in some way (older filling, cement under crown washing away, etc.). Therefore it is important to have your sleep dentist monitor you regularly.

How effective are oral sleep appliances?

In approximately 70-85% of cases, oral appliances will effectively reduce or eliminate apnea events. Snoring is eliminated or considerably reduced in approximately 90 % of cases. Factors such as the dentist’s experience providing the service, limitations of the device chosen, the severity of apnea, natural jaw movements, and the weight of the individual can all impact success levels. Compared to CPAP therapy, oral devices overall stack up quite high in ‘effectiveness.’ CPAP therapy may be more effective when used. Still, oral devices are tolerated considerably and worn for more hours than CPAP therapy. In other words, they might be similar in the overall effectiveness for treating obstructive sleep apnea.

What does successful apnea appliance treatment look like?

Successful treatment for snoring and apnea can have a large positive impact on the quality of your life. And your relationships! For those that suffer with noticeable symptoms, successful oral appliance therapy (OAT) can result in:

Improved sleep quality

Feeling refreshed when you awaken

Feeling more awake later in the day or during driving

More peace in relationships with eliminated or improved snoring levels

Deeper, more peaceful sleep

Couples are rejoined in bedroom

Less trips to the bathroom during sleep

Improvement in chronic health conditions such as high blood pressure

Improved oxygen blood levels during sleep

Absence or improvement of the number of apnea events

Can I wear an oral appliance if I grind my teeth?

Yes, patients that wear a nightguard currently or have been told they grind their teeth are often excellent candidates for oral sleep appliances. If successful, oral appliances can treat the apnea and manage the bruxing (teeth grinding) while eliminating the patient wearing a CPAP (Continuous Positive Airway Pressure Device) simultaneously with a nightguard. Wearing both at the same time can add more difficulty to CPAP usage. 

Can I use an oral appliance if I’ve had TMJ in the past?

Yes, patients with a history of TMJ or jaw pain symptoms often transition nicely into regular usage of an oral appliance. However, it is recommended that TMJ problems be managed before starting oral sleep appliance therapy. In some cases, patients with current mild “TMJ” symptoms often feel improvement after wearing an oral sleep appliance. 

Patient reasons for considering an oral appliance as an alternative or in conjunction with CPAP therapy.

I wore my CPAP but it didn’t work. I tried many masks

I HATE my CPAP, it keeps me up all night

I refuse to wear a CPAP. I’d rather die a few years early

I’m still dating and don’t want to wear a mask

The CPAP gave me major sinus issues

My CPAP left marks on my face hours after I took it off in the morning

I developed rashes on my face from the mask

I hate taking my CPAP during travel. I usually leave it behind

I have panic attacks when I strap the mask on my face

I would like to have something so I don’t snore on airplanes

I’d rather wear an oral device when my grandkids are staying over

Apnea Oral Device Follow-Up

Once your appliance is fabricated the sleep dentist will begin the process of adjusting the device to its most effective and comfortable setting. A sleep study at home or in a lab will be necessary to confirm the efficacy of your oral device. This will ensure that your device is functioning at an optimal level for your specific sleep apnea.  For those patients that adapt well to an oral device, your dental sleep medicine specialist may order an in lab titration study to expedite the finding of the optimal position of the oral appliance. 

If the sleep appliance is determined to be beneficial, you will be seen at least annually for evaluation and to verify the fit and effectiveness of your oral appliance.

You should also see your sleep specialist as recommended. With time, changes may occur in soft tissue, dental conditions and other body structures that may make it necessary to be refitted or to evaluate other alternative treatments.

If you are ready to treat your sleep apnea or say goodbye to your CPAP machine, call the sleep lab at (909) 987-3535 or contact our recommended board certified dental sleep medicine specialist at (909) 941-2811 to begin your dental consultation today. 


  1. Sheats, R. D. (2020). Management of side effects of oral appliance therapy FOR SLEEP-DISORDERED BREATHING: Summary of American Academy of Dental sleep MEDICINE RECOMMENDATIONS. Journal of Clinical Sleep Medicine, 16(5), 835–835. https://doi.org/10.5664/jcsm.8394
  2. Murphy, S., Maerz, R., Sheets, V., McLaughlin, V., Beck, M., Johnston, W. M., & Firestone, A. R. (2020). Adherence and side effects among patients treated with oral appliance therapy for obstructive sleep apnea. Journal of Dental Sleep Medicine, 7(1). https://doi.org/10.15331/jdsm.7104