Getting an Oral Appliance for Sleep Apnea Therapy

No one will argue that continuous positive airway pressure (CPAP) is good for everyone with sleep apnea. Many people struggle valiantly to try to overcome the difficulties they have using a CPAP, but as many as 30 to 50% of people with sleep apnea end up not using it. 

If you have persistent symptoms of sleep apnea and don't use your CPAP, you should have a conversation with your sleep doctor to review alternative treatments, including potentially using an oral appliance and trying some exercises, as long as you do not have severe sleep apnea. Oral appliances are a good and effective alternative to CPAP in treating mild to moderate sleep apnea.

What is the experience of getting and using an oral or dental appliance like? The oral appliance is an appealing treatment for sleep apnea and snoring provided by specialty dentists, but what do you need to know to find an effective option? What side ​effects should be avoided?

A man feels sleepiness due to untreated sleep apnea
Ben Richardson / Getty Images

Finding the Right Oral Appliance

There is no shortage of available oral appliances and the sheer variety of options can be confusing. There are more than 100 different models available on the market. Some oral appliances work by holding your tongue forward, while others reposition the lower jaw, known as the mandible.

With a few clicks on the Internet, you'll find a variety of suppliers of oral or dental appliances, and you may even find some for mail order. With the mail-order appliances, the plastic can be heated in boiling water and molded to fit your bite. They're relatively inexpensive, but unfortunately, they're often not maximally effective. If they do not fit right, they can cause your teeth to move and this can even lead to tooth loss.

Alternatively, you can find a specialty dentist or orthodontist in your area who can provide an appliance. Not every dentist is fully qualified, however, so you should seek one who is a member of the American Academy of Dental Sleep Medicine. Additionally, not all dentists use the same devices. Some are more effective, while others pad profit margins without offering much in the way of therapy.

Getting Oral Appliances Fitted by Dentists

How do you recognize if you're getting a proper appliance? Your oral appliance should be specially fitted for you. Do not accept a generic sizing system that doesn't account for the uniqueness of your teeth and bite. 

The appliance should be made based on plaster molds of your teeth. These higher-quality models are adjustable over time, and although more expensive, sometimes costing from $500 to several thousand dollars, these devices are more reliable.

When you visit the dentist to get your device, you'll probably have plaster molds of your teeth made, though digital impressions are sometimes used. If you have plaster molds, quick-drying plastic material will be mixed and placed into a tray that is sized to your bite. If you have a strong gag reflex, let your dentist know. Excessive plaster may overflow from the trays, and a conscientious dental assistant will minimize this.

Based on these initial molds, your dentist will construct firmer plaster molds of your teeth and gums. This plaster replica will be used to recreate your bite, which will be further assessed and measured at this appointment. You will also be asked at this fitting to jut your lower jaw forward as far as you can, which is a key indicator of how effective treatment with these mandibular devices may be. By moving the lower jaw and tongue forward, the upper airway, especially the throat, opens up, and snoring and sleep apnea can be reduced. If you are unable to move your jaw forward adequately, the treatment may be ineffective.

After this first assessment, your plaster molds will be used to create your oral appliance. The molds will most likely be sent out to a specialized laboratory where the appliance for both the upper and lower teeth will be made from hardened acrylic plastic. Much like a retainer, these will fit over your teeth, and maintain a modified bite.

At your second appointment, the oral appliance will arrive from the manufacturer and be adjusted. You'll be shown how to put it in, and based on comfort, the appliance can be slightly modified in the dentist’s office. An edge may be smoothed to prevent pain in the gums, for example. Once you find the oral appliance to be comfortable, you will be ready to start using it.

Side Effects

Once properly fitted, your oral appliance is ready for use, but the work does not end there. Higher quality adjustable models are not only specially fitted but, importantly, adjusted over a period of several months. During this period, you should also be aware of any adverse effects you might experience.

Oral appliances are slightly uncomfortable, but they should never be painful. If you develop pain in your jaw joint, known as the temporomandibular joint (TMJ), you should let your dentist know immediately.

TMJ pain may become chronic and lead to clicking, popping, or dislocation of the jaw. If you have TMJ dysfunction, it is actually a contraindication to the use of an oral appliance, meaning you should not use one.

Some people will experience the movement of their teeth, which should also be closely monitored by your dentist with regular evaluations. This may lead the posterior teeth to not touch with chewing, and though present, this may be tolerated.

Adjustments to Oral Appliances Maximize Benefits

Over a period from two months up to six months, the amount of advancement of your jaw will be increased. Initially, it will slightly pull your lower jaw forward, and as you get used to this and your jaw muscles relax, this tension will be increased. This is done gradually so that there are fewer risks of side effects. At the end of this time period, your oral appliance treatment will be optimized.

In order to determine if your oral appliance treatment is effectively eliminating your snoring or sleep apnea, it is advisable to undergo a second sleep study with the oral appliance in place. You should have this done at the same location where you had your first diagnostic study. The two studies can then be properly compared to assess the oral appliance’s effectiveness. Hopefully, the testing shows complete resolution of the sleep apnea that was previously noted with an apnea-hypopnea index (AHI) below 5 events per hour.

A Word From Verywell

An oral appliance can be an attractive and useful treatment for snoring and sleep apnea. Be sure to select a qualified provider of an appliance that is properly fitted and adjusted over a period of months. At the conclusion of this period, you should undergo a proper reassessment to establish its effectiveness, which will help you decide if your efforts and expense have been justified. If the treatment is insufficient, you may need to repeat the consultation with your sleep doctor.

Frequently Asked Questions

  • What does an oral appliance for snoring look like?

    Many oral appliances for snoring resemble a nightguard with two hinges that connect the top and bottom rows of teeth. There are many different kinds of oral appliance for snoring, and not all will share a similar design.

  • Is it better to use a CPAP or an oral appliance for snoring?

    There is no clear winner in the choice between a CPAP and an oral appliance for snoring. Some people find success with a CPAP, while others find that an oral appliance meets their needs. To determine which option is best for you, it may help to speak to a healthcare provider.

4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Almeida FR, Bansback N. Long-term effectiveness of oral appliance versus CPAP therapy and the emerging importance of understanding patient preferencesSleep. 2013;36(9):1271–1272. doi:10.5665/sleep.2938

  2. Doff MH, Hoekema A, Wijkstra PJ, et al. Oral appliance versus continuous positive airway pressure in obstructive sleep apnea syndrome: a 2-year follow-upSleep. 2013;36(9):1289–1296. doi:10.5665/sleep.2948

  3. American Academy of Dental Sleep Medicine. Oral Appliance Therapy.

  4. American Academy of Sleep Medicine. Oral Appliance Therapy — Benefits and Side Effects.

By Brandon Peters, MD
Brandon Peters, MD, is a board-certified neurologist and sleep medicine specialist.