Mandibular Advancement Devices for Obstructive Sleep Apnea: How They Work and Wh...

Quick takeaways

• Mandibular advancement devices (MADs) are custom mouthpieces that gently move your lower jaw forward, keeping your airway open as you sleep.¹
• Although CPAP therapy remains the most effective treatment for most people,¹⁷ MADs may reduce snoring and help people living with mild to moderate obstructive sleep apnea (OSA).³
• MADs work best when custom-fitted by a dentist trained in sleep medicine. Regular adjustments may help improve comfort and results.³
• People who snore but don’t have OSA may benefit from a MAD, but only after talking with a doctor.³

• If you were recently diagnosed or are living with obstructive sleep apnea (OSA), you might be searching for treatment options. Mandibular advancement devices may be an option. This guide describes how these mouthpieces can help improve your quality of sleep and whether they’re a practical option for managing sleep apnea symptoms.

Understanding obstructive sleep apnea

Before learning about how mandibular advancement devices work, it’s helpful to understand what OSA is and how it can affect your health.

What is obstructive sleep apnea?

Sleep apnea is a condition that causes your breathing to stop and restart many times throughout the night.⁴ These interruptions can make it harder for your body to get enough oxygen. The most common type is obstructive sleep apnea (OSA), which happens when your upper airway becomes blocked repeatedly during sleep, making it harder for air to flow.⁵ These blockages can reduce or completely stop the flow of air, causing your breathing to pause throughout the night. Common symptoms of OSA include:⁶

• Excessive daytime sleepiness
• Morning headaches
• Feeling irritable or moody
• Difficulty concentrating, struggling to feel present during the day
• Snoring or gasping for air while you sleep

Pauses in breathing may lead to lower oxygen levels. These drops in oxygen make it difficult to get deep, restorative sleep. Normally, blood oxygen levels while sleeping range from 95% to 100%. For people with sleep apnea, these levels can drop significantly — sometimes lower than 88%.⁷ Your heart, lungs and brain all run on oxygen. When oxygen levels drop, your body feels it.⁸ Tissues can weaken, and in severe cases, cells may actually start to die.

Reduced oxygen during sleep may help explain why sleep apnea is associated with serious health conditions, such as:⁵

• High blood pressure
• Heart disease
• Diabetes
• Obesity
• Depression
• Stroke
• Kidney disease

How airways become blocked

As you sleep, the muscles in the throat relax, causing the tongue, palate and uvula to change positions. For some people, the tongue and other soft tissues relax too much. This can cause them to block airflow. Sleeping on your back, narrow airways and extra throat tissue can all increase the risk of a blocked airway during sleep.⁹

Introduction to mandibular advancement devices (MADs)

Mandibular advancement devices (MADs) may help some people with obstructive sleep apnea (OSA). However, it’s important to speak with a doctor to determine if they’re an appropriate treatment option for you.

What are mandibular advancement devices?

Mandibular advancement devices (MADs) are custom mouthpieces worn during sleep.¹ They gently move the lower jaw (mandible) forward, which helps keep the upper airway open.³ MADs are available in two varieties:

1. Custom-fitted devices made by a dentist who’s trained in sleep medicine (recommended)³
2. Over-the-counter devices, which aren’t customized and may not address your specific sleep needs¹

How MADs help with obstructive sleep apnea

When you wear a MAD, it moves your jaw forward, increasing the amount of space behind your tongue.¹ This can help keep the airway open during sleep. Using a MAD may lead to benefits such as:

• Improvement of OSA symptoms, including frequent snoring
• Reduction in the number of breathing pauses you experience during sleep
• Better ability to stay asleep
• Fewer sleep disruptions

Who can benefit from a MAD?

Some people may be candidates for MADs, depending on their symptoms and a doctor’s recommendation. They include people who:³

• Are living with mild or moderate obstructive sleep apnea (OSA)
• May not have been diagnosed with OSA but frequently snore
• Are finding it difficult to adjust to CPAP therapy

MADs may not be appropriate for people with severe OSA, depending on their symptoms and doctor’s guidance.³ They may also not be a good option for people who are at risk of significant temporomandibular joint (TMJ) problems or certain bite issues.¹⁰

The TMJ is the hinge joint that connects the jaw to the skull and allows the jaw to move when you talk, chew or yawn. Because MADs work by gently moving the lower jaw forward during sleep, they may place pressure on the TMJ and cause pain for some people.¹⁰

How effective are MADs?

MADs may be an option for people who frequently snore or are living with mild to moderate OSA, depending on their doctor’s recommendation. However, they’re not the right fit for everyone.

How well MADs work for obstructive sleep apnea

MADs may significantly reduce apnea-hypopnea index (AHI) scores in many people with mild to moderate OSA.¹¹ AHI measures how many times your breathing becomes shallow or slows (hypopnea) or stops (apnea) each hour while you sleep.¹²

“Apnea” means you stop breathing for at least 10 seconds.¹² “Hypopnea” means your airway is partly blocked, causing shallow breathing. A sleep test can measure how many of these events you have per hour. This number is called your apnea–hypopnea index (AHI). Your AHI helps show how severe your sleep apnea is, and the goal of treatment is to bring that number down to a healthier level.¹³ Your AHI helps show how severe your sleep apnea is, and the goal of treatment is to bring that number down to a healthier level.

The American Academy of Sleep Medicine classifies the severity of OSA as follows:¹⁴

• Mild: AHI of 5 to 15
• Moderate: AHI of 15–30
• Severe: AHI greater than 30

MADs are also associated with better sleep quality, reduced snoring and less daytime tiredness.¹⁵ Due to these benefits, researchers have suggested mandibular advancement devices as a viable alternative to OSA surgery, especially in people who have a high risk of surgical complications.¹⁶ However, continuous positive airway pressure (CPAP) therapy remains the preferred treatment for moderate to severe OSA.¹⁷ CPAP therapy uses a gentle stream of air to help keep the airway open as you sleep.¹⁸

What affects treatment success?

Proper custom fitting can play an important role in how well MADs work. The process begins with an evaluation by a dentist who has specialized training in sleep medicine.¹⁹ This evaluation includes examining a person’s teeth and discussing their medical history. The dentist also checks the jaw’s range of motion, which helps determine if the jaw can move forward enough to help with obstructive sleep apnea (OSA) symptoms.

Once you have a mandibular advancement device, it has to be adjusted gradually.³ A dentist might refer to this as titration. Gradual adjustments help your dentist find a position that may help manage symptoms associated with OSA while minimizing side effects, such as tooth movement or misalignment of the upper and lower teeth.

Comfort and consistency also affect treatment success with MADs.¹⁵ The more comfortable a MAD is, the more likely you may be to wear it at night. And the more consistent you wear a MAD, the better the results may be.

MADs vs. CPAP therapy

Continuous positive airway pressure (CPAP) therapy is designed to help people with sleep apnea breathe consistently throughout the night.¹⁸ Both mandibular advancement devices (MADs) and CPAP therapy are drug-free options, they use different approaches to open the airway. While MADs are designed to move the lower jaw forward, CPAP therapy uses a gentle stream of air to keep the airway open while you sleep.

Some people find MADs helpful because they:

• Do not require a machine or air pressure
• Work without creating any noise
• Are easy to travel with
• Can feel comfortable to use while sleeping

However, MADs have some limitations, especially when compared to CPAP therapy. Over time, using a MAD nightly may lead to jaw soreness or changes in your bite.¹⁵ MADs and CPAP therapy are both effective for managing obstructive sleep apnea (OSA), but CPAP therapy generally works better at reducing breathing pauses and improving oxygen levels.²⁰

When choosing a sleep apnea treatment, personal preference is an important consideration. Although some people prefer the comfort and convenience of MADs, CPAP therapy remains the most effective treatment for most people.⁵ CPAP also has zero medication-related side effects.

Long-term outcomes

Over time, many people experience consistent benefits from using mandibular advancement devices (MADs).¹⁵ Common benefits include lower AHI and reduced daytime sleepiness. To maximize these benefits, it’s important to follow up with a dentist trained in sleep medicine.³ Regular checkups ensure that the device continues to fit correctly.

You may also need a repeat sleep test to confirm that the MAD is working as intended.³ A sleep test is an overnight study used to determine if you have a sleep condition. It provides a picture of your health by collecting information from your body such as oxygen levels, heart rate, brain waves and breathing patterns while you sleep.²¹

Things to consider for using a MAD

Oral appliances may be an option for some people living with OSA, depending on their condition and doctor’s recommendation. If you and your doctor decide a MAD might be the right option, you’ll work closely with a dentist to ensure the device fits properly.

Getting fitted for a MAD

Mandibular advancement devices (MADs) are available by prescription only. They are only provided after a doctor evaluates and diagnoses a person with mild or moderate obstructive sleep apnea (OSA). Once you have a diagnosis, a dentist trained in sleep medicine will take impressions or digital scans of your teeth and jaw.²² This ensures that the device conforms to your mouth’s unique structure. Adjustments are made over several visits to help improve comfort and how the device works.³

Benefits and potential side effects

MADs offer several potential benefits for people living with mild to moderate obstructive sleep apnea (OSA).²² Because they may help keep the airway open during sleep, a MAD can reduce snoring and improve airflow.²³ When you’re not waking up multiple times per night due to temporary pauses in breathing, you can also get more restorative sleep.¹⁵

For some people, MADs may feel more convenient to use than CPAP. This is because a MAD does not require equipment like a machine, tubing and mask.

Despite these advantages, MADs have some potential side effects:¹⁵

• Jaw soreness
• Dry mouth
• Tooth discomfort

Note that these side effects are mostly temporary.²⁴ They may improve over time with regular use and device adjustments. Some people may notice bite changes with long-term use, though the extent can vary from person to person.¹⁵

Maintenance and care

Like your teeth, tongue and gums, a mandibular advancement device (MAD) requires daily cleaning. To help prevent damage, use mild soap and a brush made for cleaning dentures.²⁵ Before placing your MAD in a case, allow it to air dry. Your dentist may also recommend that you disinfect the MAD weekly.

It’s also important to have the device checked regularly for fit and wear. A dentist trained in sleep medicine can make small adjustments to help improve comfort.³ MADs are durable, but they don’t last forever. Replacing your device as recommended may help maintain proper fit and function over time. According to researchers, the average replacement rate is typically once every 3 years.²⁶

When MADs aren’t the right fit

For people living with severe OSA, CPAP is typically recommended when it can be used comfortably, while MADs may be considered for people who prefer or require an alternative option.¹ MADs may not be appropriate for people with dental instability, missing teeth or significant TMJ disorders.^2,22

MADs for long-term management of obstructive sleep apnea

Mandibular advancement devices (MADs) may help reduce snoring and support better breathing and sleep quality for some people. MADs may be an option for people who frequently snore, are living with mild to moderate obstructive sleep apnea, or are exploring treatment options outside of CPAP therapy with their doctor. Because sleep apnea varies from person to person, it’s important to work with a sleep specialist and qualified dentist to find the right treatment approach.

If you think a mandibular advancement device might be right for you, talk with your doctor or sleep specialist about your symptoms and testing options.

Understanding your sleep health is the first step toward better nights and better days. Take a sleep assessment to learn more now.

This article is for educational purposes only and is not a substitute for medical advice. Always consult your doctor or a qualified sleep specialist before making changes to your sleep apnea treatment.

References:

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