We’ve all felt exhausted and run down after a few nights of lost sleep. That’s an indication of just how important sleep is to your health. Without enough high-quality sleep every night, it’s difficult for the body and brain to recover and repair. This can lead to significant health problems – from hypertension and obesity to reduced immunity, depression, and heart disease.¹

So, anything that impacts the length and/or quality of sleep should be taken seriously. Sleep apnea is a common sleep disruptor, causing frequent waking and impacting crucial REM and deep sleep phases. The good news? There are medical devices that can help.  

In this article, we’ll look at the causes of sleep apnea, the functions of sleep apnea mouthguards, and the pros and cons of this solution compared with others. 

What is a sleep apnea mouthguard?

Sleep apnea causes breathing to stop or slow repeatedly during sleep, potentially reducing blood oxygen levels and affecting the quality and duration of sleep.² There are two main types of this condition: Obstructive sleep apnea (OSA), which is caused by a physical blockage of the airways, and central sleep apnea (CSA), resulting from an issue with the area of the brain that controls breathing. 

To measure OSA severity, the number of times per hour your upper airway partially or fully collapses is measured by the Apnea-Hypopnea Index (AHI). The prevalence of OSA among the general adult population ranges from 9 to 38%, with higher rates recorded among men.³ 

People with sleep apnea tend to snore or wheeze while asleep and may wake up gasping or feeling breathless during the night. Thanks to a lack of quality sleep, they often feel exhausted in the daytime. Sleep apnea may be diagnosed in a sleep study (also called polysomnography), which involves tracking airflow, breathing, pulse, and blood oxygen while the patient is asleep.⁴

There are different approaches to treating OSA, including continuous positive airway pressure therapy (CPAP), surgery, and sleep apnea mouthguards, also known as oral appliances.⁵ Unlike CPAP therapy, which utilizes a continuous flow of air to keep the airway open, mouthguards physically reposition the mouth, jaw, or tongue – depending on the type of guard applied.  Every person experiencing sleep apnea is different, which means it may take trial and error to find the best treatment option for you.

Different types of sleep apnea mouthguard 

There are two types of mouthguards commonly used to treat sleep apnea – mandibular advancement devices (MAD) and tongue-retaining devices (or tongue-stabilizing devices, TSD). These oral devices may be prescribed as the patient finds CPAP treatment unsuitable or is unwilling or unable to consider surgical options.

While MADs are prescribed more often, some patients may find TSDs more effective, depending on the underlying problems that cause their sleep apnea. 

MADs – helpful for mild to moderate apnea

Mandibular-repositioning devices push your lower jaw forward and down. By repositioning the jaw, the device helps increase space in the airway and prevents the constriction of the throat. Early MADs were bolted to the jaw, but today’s devices are reusable and repositionable plastic – more similar to a sports mouthguard than to orthodontic braces. You can buy off-the-shelf MADs, but custom devices fitted to the shape of your jaw and teeth tend to be more comfortable and effective. 

MAD devices are the most prescribed oral appliances and tend to be most helpful for patients with mild-to-moderate sleep apnea, female patients, and younger people.⁶ While they’re designed to treat sleep apnea, they can also be used to prevent or reduce snoring. 

Tongue-Retaining Devices (TRDs) – holding the tongue in place

As the name suggests, tongue-retaining devices hold the tongue in place during sleep, using a plastic bulb. This keeps the tongue from obstructing the airway, helping prevent sleep apnea and snoring.⁶ 

TRDs are less common than MADs but can be beneficial for some patients with mild sleep apnea. 

Do sleep apnea mouthguards work and how does it compare to CPAP

CPAP therapy is among the most effective and widely prescribed sleep apnea treatments, and the preferred option in most cases.⁷ Research shows that MADs and TRDs are less effective than CPAP therapy in terms of reducing the number of breathing disruptions and improving vital blood oxygen levels during sleep.⁷ However, oral devices also aim to reduce daytime drowsiness, snoring and lowering blood pressure.⁸ 

Despite being slightly less effective in some cases, mouthguards can be particularly helpful for those who do not tolerate CPAP treatment. These people tend to use their CPAP machine less regularly and less effectively, reducing the benefit of the treatment. In those cases, it makes sense to use a treatment that’s technically less effective, but more likely to be maintained long-term.⁹

While sleep apnea mouthguards can be a good choice for some people, traditional CPAP therapy is still the most prescribed treatment for OSA.⁷ This is because CPAP is well-established as a safe treatment, is the most effective overall, and can be used for a wider range of patients. Mouthguards do have their place but tend to be used as a backup or secondary treatment option if CPAP therapy isn’t suitable for specific patients.⁸  

For those with milder symptoms, a mouthguard could be a positive first step – with CPAP as a follow-up treatment if the mouthguard isn’t effective.¹⁰

Pros and cons of sleep apnea mouthguards

As with any medical treatment, there are upsides and downsides to sleep apnea mouthguards. As everyone has different factors contributing to their sleep apnea, including differences in jaw and mouth shape, and varying tolerances for discomfort, the only way to tell whether a treatment is effective for you is to trial it. 

Here’s a look at some of the pros and cons associated with mouthguards: 

Pros⁹

• Easy to use  

After being fitted, mouthguards are straightforward – just place in the mouth and go. 

• Portable 

While CPAP machines can be difficult to transport, mouthguards are completely portable, making them a good option for trips and holidays. 

• No power needed 

As they don’t need to be plugged in, mouthguards may be a better option for people in areas with unreliable power supplies.  

Cons⁹

• Less effective

As we’ve seen, mouthguards have been shown to be less effective at treating sleep disruptions and

improving blood oxygen than CPAP therapy, making them a secondary option for most patients. 

• Tooth and jaw pain 

Some patients develop discomfort or pain in the teeth and jaw after using a mouthguard – although adjusting the mouthpiece can help alleviate this. 

• Changes to teeth or bite 

As mouthguards reposition the jaw, they can cause gradual changes to your bite, and even shift or loosen teeth over time. 

What to do if you think you have sleep apnea

Snoring, daytime sleepiness, headaches, or gasping for air as you wake – if you have some or all of these symptoms, you could be suffering from sleep apnea. It’s a serious disorder, so if that sounds like you, get help as soon as you can. 

Consider taking Fisher & Paykel Healthcare’s sleep apnea assessment if you think you are being impacted by OSA. Depending on the results, you may wish to schedule a consultation with your doctor to get a diagnosis.  

Frequently asked questions 

What is a sleep apnea mouthguard?

A sleep apnea mouthguard (also called an oral appliance) is a device used to treat sleep apnea by repositioning the mouth, jaw, and/or tongue to keep the airway open.⁸ 

How do sleep apnea mouthguards work?

There are two main types of sleep apnea mouthguard. Mandibular advancement devices (MADs) work by pushing the mouth and jaw forward to open the airway and prevent obstruction. Tongue-retaining devices (TRDs) sit in the mouth and hold the tongue in place, so it can’t move back and block the airway.⁸   

Are sleep apnea mouthguards safe?

Sleep apnea mouthguards are generally safe, but can have side effects including jaw and tooth pain, dryness and drooling, and changes to the bite or tooth positioning. Most of these effects are mild and will disappear as the user gets more familiar with the device.¹¹ 

Are sleep apnea mouthguards effective?

Mouthguards can help reduce some symptoms of sleep apnea, including daytime sleepiness, concentration issues, snoring, and high blood pressure. However, they’re less effective than CPAP therapy when it comes to improving blood oxygen levels and breathing disruption during sleep.¹² 

Who shouldn't use a sleep apnea mouthguard? 

Mouthguards are suitable for people with mild-to-moderate sleep apnea, but may not be effective for people with:¹² 

• Severe sleep apnea
• Certain dental issues    
• Central sleep apnea (CSA) – as this disorder originates in the brain, a mouthguard won’t be an effective treatment option. 

How much do sleep apnea mouthguards cost?

Sleep apnea mouthguards vary in cost, depending on the type of device and where it’s purchased. Off-the-shelf products tend to be less expensive. If your doctor or dentist offers custom mouthguard fitting, the cost of the device will include the cost of consultations, x-rays images or dental impressions, fittings and adjustments. 

How can I find out if I’m eligible to use a sleep apnea mouthguard? 

When you seek treatment for sleep apnea, your doctor or specialist will be able to tell you whether a mouthguard is a treatment option for you. This will depend on the severity of your symptoms, the factors behind your sleep apnea, and whether you have other medical issues. Talk to your doctor to find out more.

The content is for educational purposes only. It should not be used as a substitute for the medical advice of one’s healthcare provider.