What Sleep Apnea Is and How It Affects Your Health
Sleep apnea is a condition where a person stops breathing repeatedly during sleep. These breathing pauses, called apneic events, can last from a few seconds to more than a minute. When breathing stops, oxygen levels in the blood drop. The brain senses this drop and briefly wakes the person so breathing can restart. Most people don't remember these wake-ups, but they happen many times each night, disrupting sleep quality.
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There are three main types of sleep apnea. Obstructive sleep apnea (OSA) is the most common form, affecting about 34 percent of men and 17 percent of women in the United States, according to research published in medical journals. OSA happens when the muscles in the throat relax too much during sleep, blocking the airway. Central sleep apnea occurs when the brain fails to signal the muscles that control breathing. Mixed sleep apnea combines both types.
The health effects of untreated sleep apnea are serious. When breathing stops repeatedly, the heart works harder to pump blood and maintain oxygen levels. Over time, this strain can lead to high blood pressure, irregular heartbeat, heart attack, and stroke. People with sleep apnea also face increased risk of accidents because daytime sleepiness affects focus and reaction time. Studies show that people with untreated moderate to severe sleep apnea have a higher risk of sudden cardiac death during sleep compared to those without the condition.
Common symptoms include loud snoring, gasping for air during sleep, witnessed breathing pauses, excessive daytime sleepiness, morning headaches, difficulty concentrating, and mood changes. Some people don't snore at all, so sleep apnea can go undiagnosed for years. If someone regularly experiences these symptoms, speaking with a healthcare provider is an important first step toward understanding what might be happening during sleep.
Takeaway: Sleep apnea is a medical condition that disrupts breathing during sleep and can affect heart health, daytime functioning, and safety. Recognizing symptoms helps people know when to talk with a doctor about their sleep quality.
Understanding Oral Appliance Therapy as a Treatment Option
Oral appliance therapy (OAT) is a treatment method that uses a custom-fitted device worn in the mouth during sleep to keep the airway open. Unlike continuous positive airway pressure (CPAP) machines, which use air pressure to hold the airway open, oral appliances work by moving the lower jaw or tongue forward slightly. This forward movement increases the space at the back of the throat, reducing the likelihood that soft tissues will collapse and block breathing.
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The American Academy of Sleep Medicine recognizes oral appliance therapy as an effective treatment option for obstructive sleep apnea. Research shows that oral appliances can reduce the apnea-hypopnea index (AHI)—a measurement of breathing disruptions per hour—by an average of 50 to 60 percent in many patients. Some patients experience even greater improvements. The devices are particularly noted as an option for people who cannot tolerate or don't respond well to CPAP therapy.
Oral appliances come in several designs. The most common type is a mandibular advancement device (MAD), which looks similar to a sports mouthguard or orthodontic retainer. This device holds the lower jaw in a slightly forward position throughout the night. Another type is a tongue-retaining device (TRD), which uses gentle suction to hold the tongue in a forward position, keeping it from blocking the airway. A few newer designs combine elements of both approaches. Each type of device works through the same principle: by opening the airway space, breathing becomes less likely to be interrupted.
Dentists with training in sleep medicine typically fit and manage oral appliances. The fitting process involves taking impressions of the teeth and jaw, then fabricating a custom device that matches the individual's mouth structure. The dentist then makes adjustments during follow-up visits to optimize fit and effectiveness. Many devices are adjustable, meaning the degree of jaw advancement can be changed over time to find the position that works best for each person's anatomy and comfort level.
Takeaway: Oral appliance therapy offers a non-invasive treatment option that keeps the airway open by positioning the jaw or tongue forward during sleep. Custom-fitted by dental professionals, these devices can significantly reduce breathing disruptions for many people.
Types of Oral Appliances and How Each One Works
Mandibular advancement devices (MADs) represent the most widely used type of oral appliance for sleep apnea treatment. These devices consist of upper and lower dental trays that are connected by a mechanism allowing the lower jaw to move forward. When worn, the device gently holds the lower jaw in a forward position, which stretches the tissues in the throat and increases the diameter of the airway. Many MAD designs allow for gradual, controlled advancement—the dentist can adjust how far forward the jaw is positioned to find the optimal setting for each person. Examples of commonly prescribed MADs include the SomnoDent, ResMed Narval, and Herbst appliance.
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Tongue-retaining devices (TRDs) use a different mechanism. These devices feature a small chamber that holds the tip of the tongue in a forward position using gentle suction. By keeping the tongue from relaxing backward into the throat, the device maintains airway space. TRDs are typically recommended for people who have difficulty tolerating MADs, people with limited teeth that make MAD fitting challenging, or those with certain jaw joint problems. The Tongue Retaining Mouthpiece (TRAM) and Good Morning Snore Solution are examples of TRD devices currently available. These devices require less complex adjustment compared to MADs but may take more time for users to become comfortable with.
Combination or hybrid devices represent a newer category of oral appliances. Some devices feature elements of both mandibular advancement and tongue retention, attempting to maximize airway opening through multiple mechanisms. These devices may offer benefits for patients who haven't achieved sufficient improvement with either MAD or TRD alone. Research on these newer designs continues to grow, and they represent an expanding option in the oral appliance marketplace.
Beyond device design, oral appliances differ in how they're manufactured. Traditional appliances are custom-made for each patient based on dental impressions. Some newer semi-custom designs offer pre-fabricated shapes with limited adjustability, potentially reducing manufacturing time and cost, though custom devices remain the standard recommendation. The choice of which appliance is most appropriate depends on a person's specific anatomy, the severity of their sleep apnea, how much their jaw can comfortably move, tooth health, and personal preferences regarding feel and appearance.
Takeaway: Different oral appliance designs work through different mechanisms—advancing the jaw, retaining the tongue, or combining both approaches. The right device for an individual depends on their anatomy, comfort preferences, and how their airway responds to treatment.
The Process of Getting Fitted and Adjusted
The journey toward oral appliance therapy begins with a sleep apnea diagnosis, typically confirmed through a sleep study. A sleep study records breathing patterns, oxygen levels, heart rate, and other data throughout the night. This test determines whether sleep apnea is present, what type it is, and how severe it is. Some sleep studies are done in a laboratory, while others are home-based portable tests. Once sleep apnea is confirmed, a person's doctor may recommend oral appliance therapy as a treatment option.
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After a doctor recommends oral appliance therapy, the next step is a consultation with a dentist who specializes in dental sleep medicine. During this consultation, the dentist reviews the sleep study results, examines the mouth and jaw structure, and discusses treatment goals. Important considerations during this visit include the health of the teeth and gums, the person's bite pattern, whether there's adequate space in the mouth for the device, and any history of jaw joint problems. The dentist also explains how the device works, what to expect during the fitting process, and discusses potential side effects. This is an opportunity to ask questions and understand whether oral appliance therapy seems like a workable option.
If the person decides to proceed, the dentist takes dental impressions—either traditional molds or digital scans—which are sent to a laboratory for custom device fabrication. The manufacturing process typically takes two to four weeks. During this waiting period, the dentist may have the person complete additional questionnaires or imaging to ensure the device will be designed appropriately. Once the device is ready, the person returns for a fitting appointment. The dentist checks how the device sits in the mouth, verifies