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Imagine waking up 112 times per night.
If you have sleep apnea, then this could be the challenge you face every evening as you try to get a good night’s rest.
Many patients with obstructive sleep apnea are instructed by their doctors to get a CPAP machine, which stands for continuous positive airway pressure.
A CPAP device may help you breathe better and sleep more comfortably, but it also involves wearing a mask over your face and using a machine to help keep your airways clear.
It’s only natural to wonder what your other alternatives are, so in this article, we’ll share helpful information about dental (oral) appliances for sleep apnea, discuss the pros and cons of these devices, and answer some common questions we get when it comes time to choose the right solution for this condition.
What is Obstructive Sleep Apnea?
This sleep disorder affects approximately 4% of men and 2% of women. Despite its prevalence, only about 10% of sufferers seek treatment.
So, what is it?
Obstructive Sleep Apnea or OSA is when your airways become either partially or entirely blocked while you’re asleep. It’s the result of the muscles of the throat relaxing to a point where they collapse and close off the air supply. Fortunately, the brain will wake you up to resume breathing.
Sometimes, you’ll be fully roused, and other times, you won’t become fully conscious. However, either way, it’s interrupting your sleep and making you susceptible to other health challenges that come from lack of sleep.
There are also two other types: central and mixed. While obstructive is a mechanical disorder where a part of your body doesn’t work as it’s supposed to, central is characterized by a neurological condition in which the brain doesn’t send the proper signal to breathe. Mixed is even more problematic because it’s a combination of obstructive and central apneas.
The most common type is Obstructive Sleep Apnea, so that will be the focus of this article. In addition to disrupted sleeping and the annoying side effect of snoring, sufferers are also at a higher risk of sudden cardiac death, according to the Mayo Clinic.
Dental Devices for Sleep Apnea
Mandibular Advancement Devices
The goal of dental devices is to keep the airways unobstructed by opening up the jaw and preventing the tongue from collapsing back into the throat. One of the most popular tools used is a mandibular advancement device (MAD). Mandibular means lower jaw.
The device looks like a mouth guard, but it has custom springs and adjustments that push the lower jaw and tongue forward. This, in turn, opens up the mouth and airway, keeping you breathing peacefully through the night.
Not only do mandibular advancement devices reduce the symptoms, they also work to strengthen the muscles of the tongue and surrounding mouth muscles. When these muscles become stronger, the incidences of apneas tend to decrease.
Tongue Retaining Mouthpieces
This mouthpiece is more straightforward than a MAD, but there’s a tradeoff. It looks a bit like an adult pacifier. However, it gets high marks from people who’ve tried it, so many think it’s worth looking a little bit silly in exchange for a full night of uninterrupted sleep.
A tongue retaining mouthpiece works by holding the tongue forward. You insert your tongue into the device, and it keeps it in a prominent position, away from the back of your throat.
How do Oral Appliances Work?
For people who can’t tolerate a CPAP machine, dentists may recommend an oral appliance. The purpose of this appliance is to keep your airway open while you sleep, so that you can breathe easily without any apnea interruptions.
They should be custom-fitted by your dentist to ensure both comfort and effectiveness.
While CPAP machines are still considered to be the recommended treatment plan, dental appliances serve well as a backup or in concert with a CPAP device.
A CPAP machine costs anywhere from $500 to $3,000, with an average price point of about $850. Some high-end custom mandibular advancement devices can cost around $1,800 to $2,000 but could also be considerably less. Tongue retaining mouthpieces are a fraction of the cost. Overall, many patients shy away from the cost of a CPAP machine in favor of an oral appliance.
CPAP machines come with a hose, power cord, filters, manuals, an air delivery system, and a mask. It’s a bit like sleeping with a kitchen appliance. By contrast, oral appliances are a single piece of lightweight material that goes in your mouth. It’s a much simpler set up.
People who frequently travel often complain that it’s inconvenient to carry a CPAP machine with them. It’s even more of a challenge for camping enthusiasts who have to find alternative power sources to run their machines. Oral devices, on the other hand, are easy to transport and often come with a compact case to make it even more convenient.
Depending on which device you choose and how it’s fitted, there is an adjustment period. Again, this is considered a tradeoff because some patients find that a CPAP mask is intolerable. Keep in mind that when you get a new oral appliance from your dentist, it may take some time to get used to it and you might experience mild discomfort for the first few weeks or even months.
Dental appliances cause your jaw muscles to be engaged slightly throughout the night. This is especially true in the case of mandibular advancement devices, which often have hinges that keep your jaw open. As the muscles in your mouth get stronger, the pain should quickly fade. Your dentist will be able to address any concerns directly as well.
This complication is the most widely reported, but also the easiest to fix. If a patient is experiencing sore teeth from this course of therapy, it’s usually because the device needs to be adjusted. Once it’s aligned properly, the soreness tends to disappear.
Excessive Salivation or Dry Mouth
If you breathe through your mouth while you’re asleep, then be on the lookout for dry mouth or drooling. The dry mouth can often be solved with spray specifically designed for this issue. In the case of drooling, make sure you drink plenty of water in the morning and during the day to prevent dehydration.
Jaw Position Change or Damage
Since these devices force the jaw into a forward angle for hours each day, there is a potential risk for them to change the position of your jaw or bite. To prevent this from happening, do daily jaw exercises each morning to stretch and reposition your mouth.
Loosening of Dental Restorations
If you have crowns or bridges, they can loosen over time if you don’t take preventive measures. Again, there’s shifting that occurs in the mouth with these devices, so make sure your dentist makes the proper adjustments to your devices and monitors the condition of any dental restorations on each visit.
Who Qualifies for Oral Appliances?
These treatment options are not meant to be used for severe forms of the condition. In these cases, it’s often recommended to use a CPAP machine exclusively or to use it in conjunction with an oral appliance.
Frequently Asked Questions
Are these better than the CPAP machine?
The short answer is it depends. Partly it’s a matter of preference. Some people intensely dislike having to wear a mask on their face and deal with cleaning their machines on a regular basis. Sleeping partners even complain about the whooshing of air. However, CPAP machines are widely regarded as the most effective treatment.
The mouthpieces discussed in this article are effective at curing snoring and mild forms of this sleep disorder. They’re also helpful when used in conjunction with a CPAP machine. For example, patients with acute cases find that they have to turn the pressure of their machines up to a high level that is uncomfortable for them. However, if they use an oral appliance, they’re usually able to turn down the pressure to a level that’s more tolerable.
Are oral appliances expensive?
Again, it depends, but in general, you’ll pay much less for an oral appliance than a CPAP machine. Most dentists offer payment plans. Also, there are insurance plans that cover some or all of the costs associated with treatments.
Can I get dental appliances over the counter?
While an over the counter option can be useful for improving snoring, sleep apnea is a much more serious issue and needs to be treated by a trained professional. Therefore, it’s not recommended to get a one-size-fits-all solution. Instead, we recommend consulting with your dentist for a custom fit mouthpiece.
Oral appliances continue to improve as technology and materials advance. If you have sleep apnea and would like to explore the idea of a mouthpiece, talk to your doctor first. Then, he or she will prescribe a device that you can have custom-made by a dentist.
Remember, it’s not just snoring and disrupted shuteye that are associated with sleep apnea. The Mayo Clinic reports that the risk of sudden cardiac death doubles when someone has this disorder. Recommended courses of action include weight loss, sleep posture changes, CPAP machines and dental appliances.
Sources and References:
- Mouth Devices for Sleep Apnea – webmd.com
- Sleep Apnea Mouthpiece & Mouth Device for Snoring. FDA listed mouth device for treatment of sleep apnea and snoring. – sleepassociation.org