Oral appliances for sleep apnoea: Benefits and how they work

Quick takeaways

• Oral appliances, such as Mandibular Advancement Devices (MADs) help keep the airway open by gently moving the jaw or tongue forward during sleep.
• Custom-fit MADs prescribed by a doctor and adjusted by a dentist tend to provide the most comfortable and effective results.¹
• MADs are an effective alternative to treat OSA, even if CPAP remains the most effective treatment for more people.² But they can be used in combination in select cases.

Obstructive sleep apnoea (OSA) is a condition where breathing repeatedly stops and starts due to blocked airways during sleep. Left untreated, OSA can impact nearly every part of your life. It’s linked to serious health concerns like high blood pressure, heart disease and diabetes.³

Beyond physical health, obstructive sleep apnoea can also lead to daytime fatigue, low mood and memory issues that impact your work or social activities.⁴ In fact, around 32% of people in romantic relationships say that their partner’s snoring or other symptoms associated with obstructive sleep apnoea make it harder to sleep.⁵

For some people with obstructive sleep apnoea, oral appliances are a portable, non-invasive treatment option. Explore what sleep apnoea oral appliances are, how they work and what to know before using one below.

What are oral appliances?

Oral appliances are designed to keep your airway open while you sleep.

Many people are familiar with dental night guards, which help protect your teeth from grinding while sleeping. Oral appliances for obstructive sleep apnoea are also worn at night and are specifically designed to help keep the airway open and reduce breathing interruptions associated with OSA such as gasping or choking while sleeping.

Two main types of sleep apnoea oral appliances exist:

• mandibular advancement devices (MADs)
• tongue retaining devices (TRDs)

Both devices are made from medical-grade materials, such as silicone, acrylic or thermoplastic to support safety, durability and comfort.

Since there is insufficient evidence to assess the efficacy of TRDs for the treatment of adult patients with OSA, the rest of this article will focus on mandibular advancement devices (MADs), which are the most commonly used today.

How do Mandibular Advancement Devices help treat obstructive sleep apnoea (OSA)?

MADs are the most common sleep apnoea oral appliance. These treatment options gently shift the lower jaw forward, helping to better position the tongue, soft palate and uvula and to open the airway and ease breathing. According to scientific guidelines⁶, MADs have to be custom-made and titratable (over non-custom oral devices), which means they allow precise changes in jaw positioning. The ability to make small changes helps create a fit that’s comfortable and effective.

MADs work by gently pulling the lower jaw (mandible) forward. The tongue and soft tissues in the mouth also shift forward, making more room in your throat for air to flow. In a recent study, up to 63% of participants using MADs reported that they stopped snoring⁷ due to a more open airway.

For a mandibular advancement device to be effective, the bottom and top pieces need to fit comfortably. A sleep specialist can write a prescription for the device. From there, a trained dentist can make adjustments to ensure the new device is comfortable and fits your mouth correctly.

What to consider before using an oral appliance

When considering a MAD for obstructive sleep apnoea, it’s important to research treatment effectiveness, cost and other factors.

Effectiveness and treatment outcomes

Many people considering sleep apnoea oral appliances want to know if they can replace continuous positive airway pressure (CPAP) therapy. Deciding on a treatment can vary based on many factors and should be made with a doctor.

CPAP is widely recognised as the first-line therapy, particularly for patients with complex comorbidities.⁸ MADs, on the other hand, are often associated with higher adherence rates and represent an effective and well-tolerated alternative for many patients, especially those who are unwilling or unable to continue CPAP therapy.⁹

Although MAD therapy is not as effective as CPAP in controlling the occurrence of obstructive events, this is counterbalanced by better adherence to treatment. The improvement in symptoms and quality of life after up to 12 months are similar with MAD therapy and CPAP.¹⁰

Diagnosis and getting started

OSA is diagnosed with a sleep test, either at home or overnight in a lab. After taking a sleep test, you and your doctor can review the results and, if diagnosed with OSA, determine the best treatment option.

If you and your doctor determine that an oral appliance is appropriate, a dentist will get dental impressions. This can be done with a physical mould or digital scans. The goal is to determine how far forward your jaw needs to move to support comfort and effective OSA treatment.

Next, a custom MAD is made. During fittings, the device is adjusted to fine-tune your jaw position. Once you start sleeping with your oral appliance, you’ll want to follow up with your dentist. During these check-ins, your dentist can make sure your device is properly fitted and effectively treating your OSA.

Side effects and comfort considerations

The most common side effect when using an oral appliance for sleep apnoea can be mild discomfort. That may include jaw soreness, tenderness in the mouth, dry mouth or excessive salivation. Often, these minor irritations only occur in the first few weeks as people get used to the oral appliance.¹¹

Long-term issues are rare but can include tooth movement, ongoing discomfort in the jaw and changes in your bite.¹⁰ Regular follow-ups with your dentist can help catch these problems early. Adjustments to the device can support a comfortable fit and encourage consistent use.

People who use sleep apnoea oral appliances tend to have better experiences when the devices fit properly and are comfortable. Regular follow-ups with your dentist can help fine-tune the device’s fit and address any discomfort or changes.

Oral appliances as part of comprehensive obstructive sleep apnoea treatment

MAD and CPAP are not used together at the same time. But oral appliances and other therapies like positional and weight management can be used together.

Because obstructive sleep apnoea (OSA) can evolve over time, follow-ups are needed to ensure treatment is still efficiently reducing the frequency of breathing pauses during sleep. They can help check whether your oral appliances are effectively controlling symptoms and provide data that guides necessary adjustments.

This blog post contains general information about medical conditions and treatments. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. The information is not advice, and should not be treated as such. You must not rely on the information on this website as an alternative to medical advice from your doctor or other professional healthcare provider.

If you have any specific questions about any medical matter, you should consult your doctor or other professional healthcare provider. If you think you may be suffering from any medical condition, you should seek immediate medical attention. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this website. The views expressed on this blog and website have no relation to those of any academic, hospital, practice, or other institution with which the authors are affiliated and do not directly reflect the views of Resmed or any of its subsidiaries or affiliates.

References:

1. Johal, Ama, et al. “Ready-Made Versus Custom-Made Mandibular Repositioning Devices in Sleep Apnea: A Randomized Clinical Trial.” Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine, vol. 13, no. 2, Feb. 2017, pp. 175–82. PubMed, https://doi.org/10.5664/jcsm.6440.
2. Cao, Michelle T., et al. “Continuous Positive Airway Pressure Therapy in Obstructive Sleep Apnea: Benefits and Alternatives.” Expert Review of Respiratory Medicine, vol. 11, no. 4, Apr. 2017, pp. 259–72. PubMed, https://doi.org/10.1080/17476348.2017.1305893.
3. Knauert, Melissa, et al. “Clinical Consequences and Economic Costs of Untreated Obstructive Sleep Apnea Syndrome.” World Journal of Otorhinolaryngology – Head and Neck Surgery, vol. 1, no. 1, Sept. 2015, pp. 17–27. PubMed, https://doi.org/10.1016/j.wjorl.2015.08.001.
4. Kerner, Nancy A., and Steven P. Roose. “Obstructive Sleep Apnea Is Linked to Depression and Cognitive Impairment: Evidence and Potential Mechanisms.” The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry, vol. 24, no. 6, June 2016, pp. 496–508. PubMed Central, https://doi.org/10.1016/j.jagp.2016.01.134.
5. Resmed’s 2025 Global Sleep Survey. https://sleepsurvey.resmed.com/
6. Ramar, Kannan, et al. “Clinical Practice Guideline for the Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy: An Update for 2015.” Journal of Clinical Sleep Medicine, vol. 11, no. 7, July 2015, pp. 773–827. https://doi.org/10.5664/jcsm.4858.
7. Vecchierini, Marie-Françoise, et al. “Mandibular Advancement Device Use in Obstructive Sleep Apnea: ORCADES Study 5-Year Follow-up Data.” Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine, vol. 17, no. 8, Aug. 2021, pp. 1695–705. PubMed, https://doi.org/10.5664/jcsm.9308.
8. Understanding Pap, 2021. Division of Sleep Medicine at Harvard Medical School. https://sleep.hms.harvard.edu/education-training/public-education/sleep-and-health-education-program/sleep-health-education-37.
9. Basyuni, Shadi, et al. “An Update on Mandibular Advancement Devices for the Treatment of Obstructive Sleep Apnoea Hypopnoea Syndrome.” Journal of Thoracic Disease, vol. 10, no. Suppl 1, Jan. 2018. jtd.amegroups.org, https://doi.org/10.21037/jtd.2017.12.18.
10. Attali, Valérie, et al. “Efficacy and Tolerability of a Custom-Made Narval Mandibular Repositioning Device for the Treatment of Obstructive Sleep Apnea: ORCADES Study 2-Year Follow-Up Data.” Sleep Medicine, vol. 63, Nov. 2019, pp. 64–74. ScienceDirect, https://doi.org/10.1016/j.sleep.2019.04.021.
11. Dieltjens, Marijke, and Olivier M. Vanderveken. “Oral Appliances in Obstructive Sleep Apnea.” Healthcare, vol. 7, no. 4, Nov. 2019, p. 141. PubMed Central, https://doi.org/10.3390/healthcare7040141.