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Mouthpieces and Dental Devices

Oral device for sleep apnea

There are several alternatives to CPAP for sleep apnea treatment. One of the options is sleep apnea mouthpieces. Sleep apnea mouthguards are custom made by dentists using a plastic-like mold to form to the specific shape of the patient's teeth and mouth. Not only do they help with sleep apnea, but certain oral devices can also prevent snoring.

How Do Sleep Apnea Mouthpieces Work?

Most sleep apnea mouthpieces work by moving the jaw forward. Also called jaw advancing devices (JAD) or mandibular advancement devices (MAD), these sleep apnea mouthguards increase the size of the upper airway, thus reducing the air resistance that leads to sleep apnea and snoring. Some sleep apnea mouthpieces allow the user to adjust the degree to which their jaw is moved forward. An example of this kind of sleep apnea mouthpiece is the Thornton Adjustable Positioner (TAP).

Tongue retaining devices are another type of sleep apnea mouthpiece. These oral devices for sleep apnea use a splint that keeps the tongue in place to ensure that the airway remains open during sleep.

Although anti-snoring devices work in a similar way, if you are suffering from sleep apnea the oral device you use must be designed for sleep apnea specifically.

How Effective Are Sleep Apnea Mouthpieces?

Although CPAP is the most popular sleep apnea treatment, dental appliances are becoming more common as research solidifies their efficacy in treating mild to moderate sleep apnea and snoring.

Oral devices for sleep apnea are often used as a substitute for CPAP or sleep apnea surgery, as they are more cost-expensive and less invasive. Sleep apnea mouthpieces can be used in conjunction with a weight loss program if the patient is overweight. If you also suffer from snoring, you may find that your sleep apnea mouthguard also reduces airway turbulence.

Sleep apnea mouthpieces are not suitable for all patients. They are generally more effective in mild to moderate sleep apnea cases, although they may be recommended to patients with severe sleep apnea who cannot tolerate CPAP. It is important to work with your doctor to determine whether this treatment would be right for you.

Even after you have received your sleep apnea mouthguard, your doctor may request a sleep study to determine if it is effective. Follow-up care is imperative to ensure that you are getting the right treatment.

Benefits of Oral Devices for Sleep Apnea

When used consistently and under the guidance of your doctor, you may experience many benefits from your sleep apnea mouthpiece. Most patients see an improvement to their sleep quality after the first night of use. And because sleep apnea mouthpieces are easy to use, there is a higher rate of compliance compared to other treatments for sleep apnea.

Other benefits of oral devices for sleep apnea include:

  • Convenience – Sleep apnea mouthpieces are compact and portable 
  • Discreteness – Sleep apnea mouthpieces are not visible to your bed partner when your mouth is closed
  • Energy conservation – Unlike CPAP machines, sleep apnea mouthpieces do not use any electricity. You don’t have to plug them into a wall to function, which means they are easier and cheaper to use.

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Disadvantages of Oral Devices for Sleep Apnea

Some sleep apnea patients who use sleep apnea mouthpieces experience temporomandibular joint (TMJ) arthritis or arthralgia. Others report an unusual sensation shortly after removing the device in which they have difficulty bringing their teeth together in the usual position. Some patients experience teeth shifting after prolonged use. Occasionally orthodontic care is required to normalize the teeth positioning.

One of the complaints with sleep apnea mouthpieces is that they are difficult to monitor compliance. Most new CPAP machines have tracking software which shows the patient and the healthcare providers the amount of hours of use and the presence of persisting respiratory events. Because of their size, oral devices for sleep apnea are not able to contain the same amount of technology that a CPAP device contains. However, there are some newer sleep apnea mouthpieces with microchips that are able to measure the amount of hours of use.

Another reported problem with sleep apnea mouthpieces is that they have a limited life expectancy. They are not designed to last forever. Many are only effective for a year or two before the materials weaken and the appliances lose efficacy. If you choose to use an oral device for sleep apnea, you will probably have to replace it regularly.

Woman getting sleep apnea mouthguard fitted

Getting an Oral Device for Sleep Apnea

The first step to getting any sleep apnea treatment is talking to your doctor. You may be a candidate for certain sleep therapies while others may be excluded because of your medical history or anatomy. Discuss your symptoms with your healthcare professional. You may be asked to undergo a sleep study and if you are diagnosed with sleep apnea, you and your doctor can discuss treatment options.

With the increase in supply of manufacturers and qualified dentists, oral devices for sleep apnea have become a popular treatment for sleep-disordered breathing and snoring. If a dental device is indicated, you will be referred to a dentist who specializes in the treatment of sleep apnea. The dentist usually takes an impression of your teeth bite called a bite registration. A reproduction of your teeth is then made of plaster. Your sleep apnea mouthpiece will be designed using this model so that it fits your teeth and mouth perfectly.

You should only seek oral devices for sleep apnea that are FDA cleared. Although there are businesses that sell sleep apnea mouthpieces on the internet, it is important that your sleep physician, primary care doctor, and/or dentist approve the appliance. Many of the over-the-internet ‘boil and bite’ sleep apnea mouthguards are not effective.

How Much Do Sleep Apnea Mouthpieces Cost?

The average cost for a sleep apnea mouthguard is estimated at $1800 – $2000. This includes the actual sleep apnea mouthpiece, dentist visits, adjustments, follow-ups, and modifications to the dental device. Most health insurance companies and Medicare cover oral devices for sleep apnea.

For more details on sleep apnea mouthpieces and prices, take a look at our review page here.

To arrange for a sleep apnea mouthpiece, contact your local dentist or primary care provider.

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66 comments on “Mouthpieces and Dental Devices”

  1. should I work with my regular dentist or find one who is certified. I believe my OSA is considered mild. I am also on oxygen at night.

  2. What makes these devices cost so much? I have a cpap machine and I cant get used to this blowing in my face. Is there any over the counter, lower cost mouth guard that will do the same thing?

  3. I have been using an appliance from Pure Sleep for about 8 years with much success. It was recommended by an employee at a sleep lab. Only $60!

  4. Its like you read my mind! You appear to know a lot about this, like you wrote the book in it or something. I think that you can do with some pics to drive the message home a little bit, but other than that, this is magnificent blog. A great read. I will certainly be back.|

  5. I got the SomnoDent when it was first introduced and it worked 100%. Amazing. I think your success with these will depend on WHY you have apnea. My brother tried the same model and it did NOT work for him. I am thin and my apnea is caused 100% by my jaw slipping back, so this worked perfectly for me. I think it is critical to get either doctor or dental input to find what is right for you. This is DEFINITELY NOT a -one-size-fits-all situation!

  6. I live in the southern suburbs of Denver. My old Herbst appliance is worn out and I need a recommendation of a dentist or MD who has lots of experience with fitting me for a new appliance, any type that works would be fine. I have moderate sleep apnea since 2000.
    Thanks!

  7. I got an oral appliance months ago. My teeth are moving, my jaw hurts and i still snore. There was no follow up. I do not know who to contact for help

    1. I had the same problem -- it was like torture wearing the appliance! I went back to my dentist to have the appliance adjusted. After the adjustment, I was fine. The appliance is great! Also, ask your dentist to give you the retainer-like hard wax strip (it is an impression of your natural bite). It will help you align your bite and relieve any stress in your TM joint in the morning. Good luck!

  8. Somnodent got my apneas down from 21 per hour to only 3 per hour. But the downside is that I still haven't found any products that will keep the mouth moist during a 6-8 hour long sleep. That is something the scientists should be working on. The best product, of course, isn't available any more. It's just not very comfortable waking up with a burning sensation in your mouth that for most parts last all through the day. It's terrible.

    1. Xlimelts by Oracoat, available from Amazon and other sellers has been very effective for me. I used to use 2 when I was using a cpap but now just one works. Perhaps it will help your dry mouth.

    2. My mouth gets dry too when wearing the appliance. I keep a glass of water next to my bed. I swish a bit of water in my mouth prior to going to sleep to get the appliance "wetter."

  9. I've been using Somnodent for about 5--6 years. Now, my bite is pretty much permanently ruined and some of my lower teeth have moved.I was not warned in the beginning that this might happen and I was not given enough serious exercises to use every day which might have limited or prevented the problem. I'm having to return to CPAP, which I don't tolerate well and might have to consider surgery to fix my bite.

    I'd like to hear from others who have had a similar problem and have found a good solution. I've seen a physical therapist and am doing jaw exercise now, but it's like closing the barn door after the horse has gotten out. The Somnodent does very well in controlling sleep apnea, but at what price?

    1. Hi. My dentist gave me a retainer-like piece of rigid wax to use in the mornings, after removing my appliance. It is very effective at getting my jaw and bite realigned. It is also comfortable. If I feel any stress or pressure in the temporomandibular joint area, I use it to help relieve the discomfort. Good luck.

  10. Can an oral mouthpiece be used if you have an upper plate? My husband cannot tolerate a cpap machine, and has returned two of them. He will never use another mask and refuses to return to the pulmonologist. Is there anything he can do or use besides a machine and a mask?

  11. Looking for a Dentist to make my MAD mold/ appliance in San Antonio, Texas. Anybody out there that can help? I already have my script but the Simple Sleep Services went out of business and didn’t pass that info to me!
    Doralee

  12. My orthodontist had a Tap3 device made for my sleep apnea. I tried it for about it week but it a) holds my mouth open when I sleep which drys out my mouth and b) it shifts my lower teeth forward a lot. I used the "bite adjuster" in the morning but the whole thing was painful. I have had it adjusted but it still really shifts my teeth (having aching teeth in for multiple hours throughout the day is not fun) and my mouth is obnoxiously wide open with this device.
    Is there a device that doesn't shift the teeth so much and doesn't cause your mouth to be open so wide?

  13. I have a question about the costs that were stated in your article. How old is this $1800-$2400 cost figure? And where did that figure come from? I've checked around and the costs are up to $6500. Even allowing for regional UCR's, this is quite a discrepancy...

      1. Keith,

        I’m looking for an appliance to supplement my OSA therapy when I’m backpacking or camping without power for my CPAP. Where in NE Ohio is your practice? I am in Portage county.

  14. I have overbite and cannot protrude bottom jaw outside top jaw. Also have fixed upper plate (4 front teeth) over 35 years old and don't want to mess this up, as extremely expensive to replace. And severe periodontal disease kept in check through 4 annual visits to periodontist. I've had sleep study. One sleep doctor said I had severe obstructive sleep apnea, needed CPAP machine & took me to CPAP sales office in clinic to pay my $1000. I couldn't breathe through any of the masks, which doctor attributed to nervousness and me to blocked sinuses (he had left by then). Second opinion doctor to read results said he would call it moderate apnea not severe, suggested oral appliance (non-custom as cheaper). Do you think such an appliances would work without damaging my upper plate?

  15. when you have a sleep study (wheter its through an app or at a lab) once you've been wearing your mouthgard piece, then how do you test with or without piece on?

  16. The single biggest issue that I'm experiencing with the Herbst sleep apnea appliance is all my lower teeth are moving forward. The am aligner does nothing to bring back the lower teeth back to original position. Its also a problem with crowned teeth. I had to have an implant placed on a lower moler that moved enough to crack it causing an infection which required removal. I really don't think some dentists are privy to this. I'm actually considering an attorney to make my point to the manufacturer and dentist. My dentist said the sacrifice of good sleep is moving teeth. We 'll see about that. The association's affiliated with the aforementioned issues better step up otherwise they 'll find themselves in suit as well.

  17. I too am like a previous person who commented... A mouth breather due to sinus and allergy issues... Is there a recommended appliance?

  18. What if I have sleep apnea, but am a mouth breather, because of sinus and perhaps some seasonal allergies. If my mouth is locked down with the appliance, will this still be an option for me?

  19. I need the name of a dentist in the Washington DC area who will charge the recommended fee of $1800 to $2000 for a replacement somnomed device

    1. I live in Northern Virginia (Fairfax County) - any luck finding a dental practice that is a Medicare provider for oral appliances?

  20. I have had the Moses dental device for sleep apnea. I am seeing a dentist that specializes in sleep apnea. She said my tongue is too large for my mouth & I have a narrow trachea so a c-pap wouldn't help me. It has cost me over $4,000 & it doesn't work in spite of numerous adjustments. My teeth "pop" apart during the night & it wakes me up. I was told Medicare didn't pay for dental devices nor does my secondary insurance, Tricare. I found out they sent the bill to Medicare without a billing code since they knew Medicare wouldn't pay. I feel I have been scammed by the billing dept & they wouldn't have accepted the amount they would have been paid. Has anyone else dealt with this?

    1. Medicare and Tricare both cover Oral Appliance therapy. However Medicare specifies which appliances have been approved to issue to their members. They will only pay for those type of appliances. The secondary normally follows suit with primary insurance. The office that made your appliance should have instructed you on which appliance is covered by your insurance, and given you the option to choose to upgrade to a different device (the Moses) appliance and then had you to sign a form called an ABN. You are correct in that your insurance would cover portions of the cost. The office you chose may not be a participating provider with Medicare as well an so does not accept the amount Medicare allows. In this case they are able to bill you for the remaining portion. I would contact the office to see if they show that you signed an ABN, and exactly what they billed to your insurance to see if they can correct the issue. I do know that the last time I checked the Moses is not a covered appliance with Medicare. There are several types of appliance that are covered by medicare and tricare. Narvall, Herbst and Somnomed have appliance that are covered and would most likely work better for you since you are having the issue of popping out of the appliance you currently have. I hope this was helpful sorry you were taken advantage of.

      1. $4000 for an acrylic sleep appliance? I'm in NYC and charged $800 for one I made recently. The Moses locks you into one position and many people don't care for that. The two piece design with elastic hinges offers movement and adjustment. There are many similar designs of these. The Silent Night and EMA are examples.

  21. I HAVE MODERATE SLEEP APNEA-----AND WOULD PREFER A MOUTHPIECE VS. A MACHINE. (HAVE TRIED.)
    WHAT APPLIANCE DO YOU RECOMMEND?

    1. Hi Bobbie,

      I have a Herbst Adjustable mouthpiece and love it. I tried a number (quite a few) cpap masks and just could not get used to them. I could fall asleep, but after about 4 hours I would rip them off in my sleep.

      Medicare and my co-insurance covered my entire charge. It was wonderful. But my sleep is what is wonderful. My oral appliance has really made a difference and for that, I am thankful.

      1. Hi, Peggie,
        I couldn't tolerate the air constantly blowing up my nose. I couldn't tolerate the idea of having my mouth covered, too, so I got a triangular shaped nose-piece but had a lot of air leakage, especially when I changed sleep positions, so I didn't get a good seal. I also disliked the two-piece assembly of the nose cushion. I was lucky to have the sleep-study therapists suggest a bi-pap machine, which set the outgoing and ingoing pressure, which can differ. I used that mask for a long time, until I tried getting a new machine, which Medicare wouldn't pay for, since the old one was still functional, so I returned the new one. But the new one-piece nose-piece was smaller, with a better fit. That solved the problem. I like my current set-up. I don't use a mouthpiece. Julie G.

  22. my oral appliance plastic bothers me. I mean the material it is made of. Could it be made of denture material ?

  23. I had a mouth guard--after almost a year no matter what I cleaned it with it still had a offensive taste and smell. I would like to get another one that medicare will pay for. info please

      1. As long as guidelines are met. Face to face with sleep dr, sleep study no more than year old, criteria of documentation for each type (mild-excessive daytime sleepiness, heart problems, hypertension - one of these documented), moderate, severe (requires CPAP trial and failure or contraindication). Prescription or order by a Physician (MD).

        They have a list of approved devices, one of which is a Herbst. The device must be on the list to be covered.

  24. I already have issues with slight TMJ. Is it wise for to consider get an oral appliance for snoring if this will only aggravate the problem?

  25. I suffer from acute sleep apnea and will stop breathing for up to 90 seconds at a time. I have the c pap machine gave me a runny nose all the time so I had a mandibular splint fitted. I have been using the mandibular splint for almost 20 years now and it is very successful.

  26. My sleep apnea is there I stopped reading 70 to 80 times an hour. I have done to overnight sleep studies but have difficulty tolerating the quantity of air necessary to help me. I'm looking for an oral appliance that is useful for severe sleep apnea is there one? My medical coverage through Kaiser says there is not

    1. The air pressure I must use to be in compliance is high. I found that working with my sleep center through my doctor allowed me to try different masks and headgear to find what worked for me. It took a little trial and error, but with the help of my RT, found the perfect combination of headgear, mask and heated humidity that allows me to sleep a full night and be comfortable. Also, the newer machines have ramping that allows the pressure to slowly increase and let your respiratory system slowly get used to the pressure over a period of time. I personally don't need to use but it is very helpful for some patients. If it is still uncomfortable, make another appt with your dr. Hope this helps you.

  27. Denise Sandford: I had the same problem with the top part of my telescopic Herbst. I now pry down hard on the front of the top part. When it slides down, I then pry down on the back part. The top piece is now free and the bottom component pops out easily.

  28. I have a tough time removing my top portion of my device. It feels like it's stuck. And as its coming off, it feels like it's going to rip my teeth out with it. Is this how it's sposed to be.

    1. I have had my device for only three weeks. I must say I did not have much confidence in it at all. We did the impressions dr. answered all my questions and concerns I ask. Took about 3 weeks to receive. Dr. had me put the OSA in my mouth and I thought how will I keep this in my mouth all night. (first night)I must say it was so easy and it did just what the Dr. said it would do. My husband said I did not snore, I slept all night , no tossing and turning and waking each turn, no dreaming, that was great because some were not good dreams. I want to tell you I tried about (6) different mouth pieces with the apna machine you have to wear on your face. I gave up and took the machine back and told them I was getting less sleep with it than I was without wearing it. Could not keep it on more than 4 hours . You have to try to become a believer and I am now a believer, sleeping, no snoring , no waking every time I move and no dreaming. This works.
      Carolyn Campbell

      1. Hi Carolyn, Does your jaw hurt and have you noticed any moving of your teeth? Please contact me as I really don't want to use a CPAP!

        1. Find a provider who has extensive experience. They can work through pain and get it adjusted to reduce the possibilities of pain and movement.

          It's important to use a morning repositioner or aligner to minimize movement.

    1. By comparing a pre-appliance sleep study with a post-appliance sleep study. Symptoms of sleep apnea should also decrease if the applianc e is working.

  29. Will these oral appliance's also take care of grinding one's teeth? I currently wear retainer to stop this and hopefully these appliance's can kill two birds with one stone? Also, do these appliances need to be replaced or can one last a lifetime?

    1. Yes, most sleep apnea appliances eliminate the need for a nite time grinding mouth guard or splint. The stone does kill two birds. Check with your dentist to confirm.

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