Oral appliances work by pushing or pulling your lower jaw forward. By doing this, your tongue is in a position that does not block your airway. This reduces the risk that the airway may vibrate (heard as a snoring sound) or your tongue may obstruct your airway during sleep. If this device is helping you, the sound of snoring should be gone entirely or lessened.
As with all treatments, not everyone gets the same benefit from oral appliances. For some, the obstructive sleep apnea and snoring go away completely, while for other people, other forms of treatment are needed. Oral appliances are more likely to work if you have mild or moderate sleep apnea. If your sleep apnea gets better when you lie on your side (compared to when you lie on your back) and if you are not overweight, you are also more likely to benefit from this appliance. If you have central sleep apnea (a less common condition than obstructive sleep apnea), then oral appliances are unlikely to be helpful. Until you have been properly fitted for an oral appliance and tried it, no one can know how well it will work for you.
CPAP (Continuous Positive Airway Pressure) is a reliable treatment for sleep apnea. Immediate results are usually always seen with CPAP. It works very well in almost all people who use it, regardless of how bad the sleep apnea is. An oral appliance will usually improve your sleep apnea, but may not completely control it. If you have moderate or severe sleep apnea, CPAP is more likely to work to correct your sleep apnea than an oral appliance. Oral appliances are also not the main therapy if you have significant heart disease or are very sleepy during the day. In these cases, CPAP is the best treatment. A sleep specialist can provide guidance regarding the most appropriate therapy for you.
If fitted well, the oral appliance should be comfortable during the night. However, because it acts to push your jaw forward, some people feel discomfort when first using the appliance. This discomfort tends to improve as you use it more. If discomfort happens, it is usually in the joint at the back of your jaw, just in front of the ear (the temporomandibular joint). This discomfort should go away when you take the appliance out in the morning. Others find that oral appliances cause increased saliva to build up in their mouth, or makes their teeth feel tender. These symptoms usually settle quickly the more you use the device. Over time, there may be tooth movement, changes in your bite or problems with the joint and muscles of your jaw. It is important to have regular follow-up visits with the dentist who supplied you with the appliance to detect and correct problems early.
Your health care provider can refer you to a sleep specialist. They will find out how bad your sleep apnea is. This evaluation usually requires an overnight sleep study. After the sleep study, you will have a follow up appointment with your sleep specialist to talk about the results of the sleep study and to discuss possible treatment options. If you decide on an oral appliance, your sleep specialist will refer you to a dentist who specializes in the treatment of sleep apnea.
Each person has a different mouth and jaw shape, so you should have the oral appliance made to fit you. Your dentist will take an impression of your teeth and send the dental impression (dental mold) to the lab for the appliance to be made. This usually takes a few weeks. When the appliance is fitted into your mouth, it will be adjusted so that it moves your jaw forward to a position that will be effective but is still comfortable. The device may have a screw adjustment to allow further fine tuning of the appliance’s position in your mouth, over the next few weeks. Your dentist will help supervise this adjustment. After the appliance is fitted, follow-up visits with your dentist or sleep specialist will be needed. There are some kinds of dental devices that you can buy over the counter (without a prescription). These devices are cheaper, but they usually do not work. Getting the proper fitting device is important in helping your sleep problem.
You should brush and floss your teeth before you put your appliance in each night. Plaque can build up on an appliance just like on your teeth. You must therefore wash it carefully each day. Make sure you dry it out each day before using it again. Also, keep your appliance in a safe place away from children and pets.
When an oral appliance is working well, there should be no snoring. If you are wearing the appliance because of sleep apnea, you may see improved symptoms of sleepiness, fatigue and other symptoms of sleep apnea. A good way to find out if you are getting the help you need from your oral appliance is to have a repeat overnight sleep study with the oral appliance in place. If the study shows that wearing the oral appliance has helped your sleep apnea, you should continue to use if every night. If it is not helping your sleep apnea, other treatments (such as CPAP) will be recommended.
If symptoms of snoring or sleep apnea return (for example feeling tired during the day), it is important to have a follow up appointment with your dentist or your sleep specialist. Your dentist might need to adjust the appliance. After a number of years, some people using an oral appliance find they need to consider other treatments for their sleep apnea.