Mandibular Advancement Devices or MAD’s
What is a Mandibular Advancement Devices and how it can help you stop snoring…
Snoring is a whole of life issue, impacting not only the snorer, but also their partner, family and colleagues. The effect is not simply about noise, but about how snoring effects energy, health, lifestyle and work productivity caused by poor sleep. Mandibular Advancement Devices or MAD’s are the answer for many…
What Is A Mandibular Advancement Device
A mandible (as in Mandibular) is a jawbone and advancement means “the act of moving forward”, which means that an MAD is a gadget that fits in the mouth that moves the jaw forward.
How Does It Work
There are many reasons why people snore (see our Snoring section), many of which are connected to the partial obstruction of the airway to and from the lungs by the tongue or throat tissue.
An MAD helps to diminish any restriction that occurs in the back of the throat by moving the jaw (and by inference your tongue) forward and away from the back of your throat which increases the size of the upper airway, thus reducing the air resistance that leads to snoring.
Typically, MAD’s fit within the mouth and are moulded to your teeth to provide and substantive platform through which the upper jaw acts a fixed frame and the lower jaw is pushed forward. The best MAD’s provide a mechanism through which the advancement of the jaw can be incrementally increased until the ideal balance between the back of the tongue and the soft tissue of the throat is achieved, and snoring stops.
There are three sub-types of MAD:
- Boil and bite MAD’s that can be bought from pharmacies and online – the fit is achieved by softening the resin/silicone with hot water, then once cooled slightly, placing in the mouth and clamping down to get a good fit; some of these devices now include the ability to adjust to suit the user
- Semi-custom Devices where a user takes a custom mould of their teeth and then sends this away to be custom fitted and a good fit, quality device is returned, again with some ability for incremental adjustment
- Custom Dental MAD’s – based on physician referral and custom made by dentists or sleep specialists and delivering a perfect fit and the ability to be refined and fitted by experts
Each of the above has a cost/benefit outcome with costs ranging from $40 for an off the shelf product to $2000 for a custom, dentist fitted solution. Whilst price is not the sole determinant of performance, the more you invest, the more likely you will get a better result.
Sleep physicians often recommend a Sleep Test prior to determining whether a Mandibular Advancement Device is the best solution.
And of course, in order to work properly, you have to wear a MAD while you sleep.
FAQ’s – Frequently Asked Questions
Are There Any Side Effects Using A MAD
Because a MAD causes the jaw to move forward for extended periods ie overnight in most cases, and is braced by fitting to your teeth, some discomfort can be experienced, initially and for some enough to warrant stopping usage. The jaw can become sore and stiff, and teeth can ache and move out of alignment. In the extreme, there can be painful wear of the joints and tooth ache.
Clinical testing of MADs users has also identified hyper salivation, mouth dryness, tooth discomfort and jaw joint tenderness, but at relatively minor levels, offset well and truly by the benefit of stopping snoring.
Can A MAD be Used With Dentures
Which Is Better, a Mandibular Advancement Device or a Tongue Stabilizing Device
Whether an MAD or TSD or other anti-snoring device is best for you is somewhat a matter of trial and error. We recommend that you consult with your doctor or physician for advice on the best solution for you; at the same time your medical practitioner or specialist can check for other sleep disorder issues such as Sleep Apnea
How Much Does A MAD Cost
Prices for MAD’s range from $39 to $2000 with the majority of off the shelf devices being between $75 and $150 and custom devices in the $1500-2000 range
How Long Does A MAD Last
Naturally, the frequency of usage and regular cleaning will have an impact on how long a Mandibular Advancement Device will last however, you should expect a minimum of six months and up to two years effective life. Typically you would renew your off the shelf MAD every year and custom MAD’s every 3 years.
Does Health Insurance Cover MAD’s
Most medical insurance companies have policies the provide cover for medical sleep devices, however whether you will be covered will depend on the type of policy and depth of coverage; please consult with your health insurance provider for an up to date opinion on the inclusion of MAD’s
Do I Need To Get A MAD Professionally Fitted
Fitting varies with the customisation factor. Normally an off the shelf or bought online MAD is a relatively straightforward device. Simply place the device in hot water, allow to cool, place in your mouth and let the silicone mold to your mouth. Once fitted to your mouth most MAD’s offer incremental adjustments.
Custom MAD’s are general fitted by professional sleep doctors or dentists and have a close and comfortable fit that can also be incrementally adjusted.
Are MAD’s Adjustable
The more modern and contemporary pharmacy or online sourced solutions can include a basic adjustment, with the very best ones offering increments of 1.0mm or 1/16 of an inch. Custom fitted MAD’s also include micro adjustment options.
Are MAD’s Painful To Wear
Not usually. There may be some discomfort from having the device in your mouth, but experiencing pain would be highly unusual and if you experience pain in any way you should stop wearing the device. It can take a week or so to get completely comfortable with the jaw being held forward with a MAD.
How Do I Keep My MAD Clean
Placing your MAD in hot water should minimise any build-up of bacteria or germs; regular brushing with toothpaste or soaking in mouthwash will keep things fresh for the life of your Mandibular Advancement Device
What If Snoring Persists
Sadly there is no guarantee that Mandibular Advancement Devices will resolve your snoring problem. MAD’s don’t work for everyone, particularly if the snoring is in tandem with other health issues, but they do provide improvement for most users. Correct fitting is essential, as is ensuring the device is not damaged or worn out. A change/increase in weight can also have an impact on your snoring as can increasing your consumption of alcohol.
If your MAD does not help you stop snoring, or stops helping, it is time to consider escalating to the next level of stop snoring options:
- Visit Your Sleep Doctor
- Anti Snoring Pillows
- Nasal Strips
- TSD’s – Tongue Stabilizing Devices
- Dental Appliances
- Insomnia Medications & Sleeping Pills
- Positive Airway Pressure – CPAP Machines
- Bidirectional Positive Airway Pressure – BiPAP Machines
- Elective Snoring Surgery
A Mandibular Advancement Device can often be a good next step to help you or your partner to stop snoring – they are relatively economical and because most can be adjusted they can suit a wide range of snorers. You can find our recommended list of anti snoring devices here, which includes the MAD’s we have reviewed.
It is really important to talk with your physician as you explore anti snoring devices; sometimes snoring can indicate other health issues that only an experienced medical professional can identify and resolve.
The American Sleep Association (ASA) was founded in 2002 by a group of Sleep Professionals seeking to improve Public Health by increasing awareness of the importance of Sleep in ensuring a high quality of life, as well as the dangers of Sleep Disorders. Through our own Research, and investing in the Research of others, the ASA Members and Board are committed educating millions of people on the importance of sleep health and to resolving Sleep Disorders, Insomnia and Sleep Apnea.
- The Stanford Center for Sleep Sciences and Medicine
- Johns Hopkins Center for Sleep