Sleep Apnea Mouth Guards

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How Mouth Guards Treat Sleep Apnea

An estimated 10% to 30% of adults Trusted Source UpToDate More than 2 million healthcare providers around the world choose UpToDate to help make appropriate care decisions and drive better health outcomes. UpToDate delivers evidence-based clinical decision support that is clear, actionable, and rich with real-world insights. View Source have obstructive sleep apnea (OSA), although the condition often goes undiagnosed. In OSA, a person’s airway completely or partially collapses Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source during sleep, causing gasping, choking, and snoring sounds, along with lowered blood oxygen levels and sleep disturbances.

Oral appliances for sleep apnea address underlying structural factors that contribute to obstructive sleep apnea, such as a small lower jaw or a tongue that falls back into the throat. Most commonly, sleep apnea mouth guards move the lower jaw forward, opening up the airway, although some adjust the tongue’s position forward instead.

While these oral appliances may be referred to as mouth guards, it’s important to note that they differ from over-the-counter mouth guards for teeth grinding or anti-snoring devices.

Types of Sleep Apnea Mouth Guards

Sleep apnea mouth guards come in a few designs that work in different ways to help keep the airway open during sleep. Each type targets a specific cause of airway obstruction—whether it’s the tongue falling back, the jaw relaxing, or the soft palate vibrating.

While all share the goal of improving airflow and reducing apneas, their comfort, effectiveness, and suitability can vary from person to person. Understanding how each device works can help you and your healthcare provider choose the right one for your needs.

Mandibular Advancement Devices (MADs)

Also known as a mandibular repositioning device (MRD) and mandibular advancement splint (MAS), a mandibular advancement device moves the lower jaw into a forward position. The word mandibular refers to the lower jawbone.

Some MADs have a one-piece design, while others have a two-piece design, with upper and lower guards that are connected. One-piece designs fix both the upper and lower jaw in place, which some people find restrictive Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source .

Because two-piece designs have separate pieces for the upper and lower jaw, they allow for more movement and opening of the lower jaw, which some people may find more comfortable. However, oral appliances that allow more movement may not be ideal for people who sleep on their backs Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source .

Tongue-Retaining Devices (TRDs)

Tongue-retaining devices, or TRDs, are oral appliances designed to keep the tongue in a forward position during sleep, preventing it from falling back and blocking the airway.

A TRD typically looks like a soft, flexible mouthpiece that sits between the lips and teeth. The front portion has a small bulb or chamber that uses gentle suction to hold the tip of the tongue in place while you sleep. It resembles a pacifier, but instead of being chewed or bitten, the user inserts their tongue into the device and creates suction to keep it forward.

Unlike MADs, which reposition the lower jaw, TRDs work without requiring jaw movement, making them a potential option for people who have temporomandibular joint (TMJ) disorders, limited jaw mobility, or missing teeth. However, some users find TRDs less comfortable or harder to adjust to, as the suction can cause mild tongue soreness, drooling, or difficulty maintaining a seal through the night.

Soft Palate Lifters

Soft palate lifters are a less common type of oral appliance designed to elevate the soft palate and uvula—the tissues at the back of the mouth that often vibrate and contribute to snoring. By gently supporting or repositioning these structures, soft palate lifters aim to reduce airway vibration and collapse, helping minimize snoring and mild airflow obstruction during sleep.

However, clinical research on soft palate lifters is very limited, and their effectiveness for treating obstructive sleep apnea has not been well established. Some early designs showed promise for reducing snoring, but results have been inconsistent, and many users report discomfort or difficulty keeping the device in place through the night. As a result, they’re not commonly prescribed for moderate or severe sleep apnea.

Custom-Fitted vs. Over-the-Counter Mouth Guards

Sleep apnea mouth guards are available in two main categories: custom-fitted devices prescribed by a dentist or sleep specialist, and over-the-counter (OTC) mouth guards that can be purchased online or in stores. While both are designed to help keep the airway open during sleep, they differ significantly in comfort, effectiveness, and long-term use.

Custom-fitted oral appliances are individually molded by a qualified dentist, often using digital scans or impressions of your teeth and jaw. This allows for a precise fit that supports your airway while minimizing discomfort or jaw strain.

OTC mouth guards, often called “boil-and-bite” devices, are heated and molded at home to fit your teeth. They’re primarily marketed for snoring reduction, though some users try them as a lower-cost alternative for mild OSA.

Benefits of Sleep Apnea Mouth Guards

Research has found that sleep apnea oral appliances can provide the following benefits Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source for people with obstructive sleep apnea:

• Reduce the number of pauses in breathing (apneas) or episodes of shallow breathing (hypopneas)
• Significantly improve blood oxygen levels
• Decrease the frequency and volume of snoring
• Reduce daytime sleepiness

After a few years of treatment, sleep apnea mouth guard usage is associated with improvements in diastolic and systolic blood pressure, as well as continued improvement in quality of life and decreased daytime sleepiness.

Sleep apnea oral appliances can be a safe and effective alternative to CPAP therapy. As many as 46% to 83% of people Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source don’t continue with CPAP therapy due to discomfort or another reason. If people find mouth guards more comfortable, they may be more likely to follow through with their treatment as directed.

Studies show that people who use an oral appliance to treat OSA may use it one more night per week, on average, than people who use CPAP, and nearly two hours longer per night. As a baseline, sleep experts recommend using either a mouth guard or CPAP machine for at least four hours per night for OSA therapy. Only 43% of people using CPAP meet this recommendation, compared with 76% of those using a mouth guard.

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Potential Risks of Sleep Apnea Mouth Guards

While oral appliances are a good option for some, they’re not always as effective in treating OSA as CPAP. Nearly twice as many people completely treat OSA with CPAP than with a mouth guard. Research also suggests that CPAP therapy contributes to a further reduction in respiratory events during sleep and a larger improvement in blood oxygen levels. And for about one-third of people, mouth guards do not significantly improve their sleep apnea symptoms Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source .

Although some people find oral appliances Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source more comfortable than CPAP, not all do. One small survey found that more than half of the respondents had stopped using their mouth guard within a year due to discomfort. However, those who continued wearing the mouth guard reported better sleep quality, with less snoring and daytime sleepiness.

Sleep apnea mouth guards can also cause changes in teeth position or bite. In some cases these changes can actually be beneficial, such as reducing overbite or overjet, which is when the upper teeth bend forward at an angle over the bottom teeth. Often, these changes are barely noticeable, but they may appear within six months of starting treatment.

Are Sleep Apnea Mouth Guards Safe?

Generally, sleep apnea mouth guards are considered safe, but they can have side effects. It’s important to work closely with your health care provider when selecting and using a sleep apnea mouth guard.

Side effects are most common in the first two months and usually go away as a person gets used to the device. Side effects may include:

• Drooling
• Dry mouth
• Gum irritation
• Headaches
• Tooth pain
• Temporomandibular joint (TMJ) discomfort

For some people, TMJ pain may be more acute initially, though it typically decreases over time and resolves in most cases within six to 12 months.

How to Choose the Right Sleep Apnea Mouth Guard

Finding the right sleep apnea mouth guard depends on your diagnosis, comfort preferences, and treatment goals. Because not every device works the same way—or fits every mouth—understanding the key factors can help you make an informed decision and get the best results.

Before buying any mouth guard, it’s essential to confirm whether you have obstructive sleep apnea (OSA), central sleep apnea, or primary snoring. A sleep study is the only way to determine the type and severity of your condition. Mouth guards are most effective for mild to moderate OSA and may not be suitable for more severe cases that require CPAP or other medical treatments.

Consider the Type of Device

As explained above, the two main types of oral appliances are:

• Mandibular Advancement Devices (MADs): move the lower jaw forward to prevent airway collapse
• Tongue-Retaining Devices (TRDs): hold the tongue in a forward position to keep the airway clear.

Your provider can help determine which design best fits your mouth shape and breathing pattern.

Evaluate Fit and Comfort

Comfort is key for long-term use. Look for a device that feels secure but not restrictive, allows you to breathe through your nose easily, and doesn’t cause excessive drooling or soreness. Custom-fitted devices offer the best comfort and results, while over-the-counter versions may require trial and error.

Check Adjustability and Follow-Up Care

Many custom mouth guards allow for incremental jaw adjustments, helping fine-tune the position for maximum airway support. Regular follow-ups with your dentist or sleep specialist are important to assess fit, reduce side effects, and track treatment success.

When to Talk to Your Doctor

If you’re considering a mouth guard for sleep apnea, the first step is to speak with your healthcare team, which may include a primary care provider, sleep specialist, and dentist trained in oral appliance therapy. These professionals can help determine whether a mouth guard is appropriate for your type and severity of sleep apnea and guide you through the fitting process.

A sleep study—either in a lab or at home—is typically needed to confirm your diagnosis and measure how severe your sleep apnea is. Based on those results, your doctor can discuss whether a MAD, TRD, or another treatment option is best suited for you.

Once your device is fitted, follow-up care is essential. Schedule appointments with your dentist and sleep specialist every few months during the first year to ensure:

• The device still fits properly and remains comfortable.
• It’s effectively reducing apnea events and improving sleep quality.
• You are not developing side effects such as jaw pain, shifting teeth, or bite changes.

If your symptoms return, your partner notices loud snoring or breathing pauses, or your device becomes uncomfortable, contact your provider for an adjustment. Over time, your mouth guard may need to be refitted or replaced to maintain optimal results.

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