Sleep apnea oral appliances

What it is

In obstructive sleep apnea, the soft tissues in your throat relax during sleep and narrow or block your airway. Your breathing stops and starts, often many times a night. It can leave you tired during the day, and it raises the risk of health problems such as high blood pressure.

Sleep apnea is a medical condition, so a physician must diagnose it, usually with a sleep study at home or in a sleep center.

The most common oral appliance gently holds your lower jaw a little forward, which helps keep your airway open. It looks a bit like a sports mouthguard, made to fit your teeth. Sleep medicine guidelines recommend custom appliances that can be adjusted over time.

CPAP (a machine that blows air through a mask while you sleep) is usually the first treatment physicians suggest. Oral appliances are often used for mild to moderate sleep apnea, or for people who can’t use CPAP.

Who it helps

An oral appliance may be an option if:

• A physician has diagnosed obstructive sleep apnea after a sleep study
• Your sleep apnea is mild to moderate, or you’ve tried CPAP and couldn’t keep using it
• Your physician recommends an oral appliance for you
• You have enough healthy teeth to hold it in place

An appliance may be less effective for severe sleep apnea, and it may not suit people with active gum disease, loose teeth, or some jaw joint problems.

If you snore loudly, wake up gasping, or feel tired after a full night in bed, talk with your physician. Snoring alone doesn’t mean you have sleep apnea, but it can be a sign.

What happens

1. Diagnosis by your physician. Your physician orders a sleep study and talks with you about treatment. If an oral appliance makes sense, you’ll get a prescription or referral.
2. Dental exam. Dr. Minici checks your teeth, gums, jaw joints, and bite to make sure an appliance is a good fit. X-rays may be taken.
3. Impressions. We take impressions (molds) of your teeth and a record of your bite, and a dental lab makes the appliance. The impression material can feel thick, but it’s only in for a few minutes.
4. Fitting. We check the fit and show you how to put the appliance in, take it out, and clean it. It should feel snug, not painful.
5. Adjusting. Over the next few weeks, the appliance is moved forward in small steps, while you tell us how it feels and how you’re sleeping.
6. A follow-up sleep test. Your physician usually orders another sleep test with the appliance in place to see how well it’s working.

Recovery and aftercare

There’s no recovery time, but there is a getting-used-to period. In the first weeks, your teeth or jaw may be sore in the morning, and you may have extra saliva or a dry mouth. Your bite may also feel a little off for a while after you take the appliance out. These usually ease.

Over the years, some people’s bite slowly changes. That’s why regular dental visits matter while you use an appliance, along with check-ins with your physician.

Clean the appliance every morning as shown, and keep it in its case.

Cost and insurance

Because sleep apnea is a medical condition, medical insurance, rather than dental insurance, often covers oral appliances. Plans usually require a physician’s diagnosis and a sleep study, and some want you to try CPAP first. Ask your medical plan what it covers and what it requires.

The cost also depends on the appliance and the number of adjustment visits. To learn about payment options, see insurance and financing.

Alternatives

• CPAP is the most studied treatment and is usually tried first.
• Lifestyle changes, such as losing weight, sleeping on your side, and avoiding alcohol before bed, help some people.
• Surgery or an implanted device may be options for some people. Your physician can explain them.
• Store-bought snoring mouthpieces aren’t a treatment for sleep apnea.