Oral Appliance Therapy for Sleep Apnea: How It Works and Why Proper Fitting Matters

Getting a sleep apnea diagnosis is only half the battle for some people. Treating this condition can be a whole different ballgame. While CPAP therapy is the optimal solution, some people may need or want CPAP alternatives.

“A lot of my patients come to me precisely because they were diagnosed, handed a CPAP, and just couldn't live with it — the mask felt claustrophobic, it leaked, the pressure bothered them, or they simply gave up,” observes Luke Bauserman, DDS, D.ABDSM, CCSH, Director, Better Sleep Mid-Ohio Valley: Center for TMJ & Sleep Apnea. 

According to a 2013 study published in Sleep, physicians “typically select CPAP as the primary treatment” for sleep apnea due to its effectiveness. 

But for those who aren’t comfortable using CPAP therapy, says Dr. Bauserman, “an oral appliance is often the difference between treating their apnea and not treating it at all.” 

Ultimately, your preferred treatment path is a personal decision. 

“The best sleep apnea treatment is the one the patient will actually use every night,” says Dr. Bauserman. “CPAP and oral appliances are both good tools, and the honest comparison isn't ‘which is stronger on paper’ — it's ‘which one gets worn.’"

If you’re someone still debating the right sleep apnea treatment approach — or if you’re a bed partner researching treatment options for loud snoring — you’ve come to the right place. 

After reading this article, you will have a clear understanding of what oral appliance therapy for sleep apnea is and how it works, why it might be the best option for you, and what the process of obtaining an oral appliance entails.  

What is oral appliance therapy and how does it work?

Per Healthcare (Basel, Switzerland), oral appliance therapy prevents upper airway obstruction in one of three ways: holding the tongue in a forward position, lifting the soft palate, or supporting the jaw in a forward position. These devices fit like a sports mouth guard or orthodontic retainer and widen the airway while you sleep.

Oral appliances for sleep apnea are a viable alternative to CPAP therapy because, compared with CPAP, “there's no surgery, no mask on your face, no hose, no machine humming on the nightstand, no electricity required,” says Dr. Bauserman. “It's quiet, it's portable, it fits in a pocket for travel or camping, and there's nothing to interfere with sleeping close to a partner.”

In the sections below, we explore the different types of oral appliances available.

What types of oral appliances are there?

The two most common types of oral appliances include a mandibular advancement device (MAD) and a tongue-retaining/tongue-stabilizing device (TRD). Both reposition your tongue or jaw to open your upper airway. The third type of device, soft-palate lifters, has limited evidence so they aren’t used as often. For that reason, we’ll focus on just MAD and TRD.

Mandibular advancement devices (MADs)

Mandibular advancement devices are the most commonly used oral appliances, according to the American Academy of Sleep Medicine. They move your lower jaw forward and down to keep your airway open. 

MADs are made of molded, hard plastic fitted over your lower and upper teeth. MADs can be adjustable or fixed. Adjustable versions feature metal hinges and screws that can be tightened by small increments to adjust jaw positioning until breathing improves. They are typically more effective than fixed MADs for treating OSA, per the Journal of Clinical Sleep Medicine. Custom-made, adjustable MADs are also the most recommended type of oral appliance because they can be fine-tuned for a better fit and may be easier to use consistently.

Tongue-retaining / tongue-stabilizing devices (TRDs)

A tongue-retaining device uses suction to hold the tongue forward and in place, keeping your airway open. Unlike MADs, they don’t require custom fitting. 

This type of sleep apnea mouthpiece may be recommended as an alternative to an MAD if the patient is susceptible to dental and/or temporomandibular joint (TMJ) side effects. 

While studies have found TRDs to be effective in treating sleep apnea, these devices can cause some side effects like discomfort and dry mouth. 

Newer and over-the-counter options

Other options for treating snoring and sleep apnea include newer FDA-cleared treatments like tongue-muscle stimulation. A removable, specialized device — used while awake — delivers neuromuscular stimulation to the tongue. The intent is to improve tongue muscle function, which will eventually prevent the tongue from collapsing and obstructing the airway during sleep. 

Over-the-counter (OTC) sleep apnea mouth guards are another option. Like MADs, these mouthpieces are meant to help to reposition your lower jaw, but instead of a specialist creating your mouth guard, you would use the “boil and bite” method: Briefly placing the device in a cup of boiling water and then biting down on the softened plastic, allowing it to mold to your teeth.

The American College of Prosthodontists published a statement warning consumers that the research on over-the-counter devices is thin, and therefore, inconclusive. The published studies that are available on OTC mouthguards are enough to question their effectiveness. A 2014 study published in the Journal of Clinical Sleep Medicine, found that these “boil and bite” mouthpieces were less effective than their custom-made counterparts because of low adherence and the patients’ preference for a customized fit. 

Do oral appliances actually work for sleep apnea?

Yes, oral appliance therapy for sleep apnea does work — as long as you understand the nuance of that answer.

First, CPAP therapy is “still considered the gold standard [for sleep apnea treatment],” says Dr. Bauserman, noting that oral appliances are “generally less effective in the most severe cases of sleep apnea.” 

But here’s where the nuance comes into play: CPAP only works when it's worn, continues Dr. Bauserman, “and a large share of people don't wear it consistently.” A 2025 study published in Sleep and Breathing found that fewer than half of the 1,907 sleep apnea patients monitored achieved high adherence to CPAP therapy 24 months after starting CPAP. What’s more, 39% were non-adherent altogether.

On the other hand, “oral appliances tend to get worn far more reliably because they're so much easier to tolerate,” says Dr. Bauserman.

It’s for these reasons, explains Dr. Bauserman, that the professional guidelines endorse oral appliance therapy for mild-to-moderate sleep apnea, and for severe apnea when someone can't tolerate CPAP.

When comparing oral appliances vs. CPAP, CPAP is more powerful for treating severe sleep apnea. But oral appliance therapy often wins the adherence contest because people are more likely to use their mouthpieces consistently. 

The success of oral appliance therapy for sleep apnea is also “heavily dependent on proper fitting and titration,” notes Dr. Bauserman.  

Who is a good candidate for oral appliance therapy?

According to Dr. Bauserman, the best candidates for oral appliance therapy are adults with mild-to-moderate obstructive sleep apnea (OSA), and people with severe apnea who genuinely can’t tolerate CPAP.

If you relate to any of the following scenarios, you may be a good candidate for oral appliance therapy for sleep apnea.

• Mild-moderate OSA: A 2017 study published in Current Sleep Medicine Reports found that oral appliance therapy has become an “increasingly common alternative” for sleep apnea patients — primarily those with “milder” OSA.

• CPAP-intolerant: A 2023 study published in BMC Pulmonary Medicine noted that a “significant” percentage of patients with OSA are unable to tolerate CPAP therapy.

• For severe OSA when CPAP is not tolerated or refused: Since oral appliances are worn more reliably than CPAP devices, it may be a recommended option under specialist guidance.

• Frequent travelers: Dr. Bauserman notes that oral appliance therapy is preferable for people who travel often because, as opposed to bulky CPAP machines, these mouthpieces are “highly portable” and “discreet.”

On the flip side, poor candidates for oral appliance therapy for sleep apnea can include:

• People with significant missing teeth or unhealthy teeth and gums: “There's not enough there to anchor the device securely,” explains Dr. Bauserman, “and it ends up bulky, loose, and uncomfortable, which means it won't get worn.”

• People with central sleep apnea: “The problem is the brain not sending the signal to breathe, rather than a blocked airway,” says Dr. Bauserman. Oral appliances won’t help here, “because there's no obstruction to open.”

• People with active, untreated jaw-joint (TMJ) problems: This issue needs to be sorted out first before beginning oral appliance therapy, says Dr. Bauserman. Because if your mouthpiece “doesn't fit comfortably and stay put, it won't get used.” And “a treatment that isn't used doesn't work.”

Why does professional fitting matter (and why not over-the-counter)? 

A professional, custom oral appliance fitting matters because this is a mouthpiece treating a serious, potentially life-threatening condition like sleep apnea.

“An oral appliance is a prescription medical device, not just a sleep gadget,” says Dr. Bauserman. “And the details are what make it work or fail.” 

Unlike over-the-counter “boil and bite” models or mail-order mouthpieces, getting a custom oral appliance means dental and sleep specialists are by your side during every step of the process, ensuring effective treatment. Not to mention both the American Academy of Sleep Medicine and the American Academy of Dental Sleep Medicine recommend a custom dental appliance for sleep apnea prescribed by a sleep physician and created by a qualified dentist. 

“A dentist trained in dental sleep medicine takes precise records of your teeth, measures the range of motion of your jaw, checks for underlying TMJ issues, and, critically, sets the exact starting position of your lower jaw,” explains Dr. Bauserman. 

Then, he continues, the dentist “titrates [your oral appliance] — advancing the jaw in small increments over several weeks to find the sweet spot that opens your airway without straining the jaw joints.” 

Once your appliance is ready for use, your care team remains involved: “They monitor and address side effects early,” says Dr. Bauserman, “and work with your physician to determine if the appliance is effectively treating your sleep apnea.”

This “dialing-in” process, as Dr. Bauserman calls it, is a “big part” of why professionally fitted appliances succeed. 

The over-the-counter or mail-order appliances may cause you to believe your apnea is being treated when it actually isn’t. Not only is this dangerous from a cardiovascular perspective, but Dr. Bauserman notes that poorly made appliances and/or a lack of professional oversight could cause “unwanted tooth movement, bite changes, and jaw problems.”

How do you get an oral appliance? 

Getting an oral appliance is a team effort between a physician — usually a sleep specialist — and a dentist. 

The process is approximately seven steps, which are as follows: 

1. Consult a sleep provider: At Dreem Health, our licensed specialists will discuss your concerns — snoring, witnessed pauses, daytime fatigue, teeth grinding, or other signs of sleep apnea — via a video consultation appointment.

2. Take a home sleep test: The next step is sleep apnea testing, which your sleep physician can order. This evaluation can even be conducted in the comfort of your own home with an FDA-approved home sleep test. To be clear, says Dr. Bauserman: “Dentists don't diagnose sleep apnea; that's the physician's role.”

3. Review results and get a diagnosis and treatment plan: Your Dreem Health sleep specialist will then review your at-home sleep test results with you, as well as provide a diagnosis and treatment plan.

4. Get an Rx for an oral appliance: If your Dreem Health sleep specialist diagnoses you with sleep apnea and recommends an oral appliance, they will give you a prescription.

5. Meet with a dentist for oral appliance fitting and titration: For this step, you will bring your oral appliance prescription to a dentist — preferably one who specializes in dental sleep medicine.
   
   At this stage, says Dr. Bauserman, “a qualified dentist examines your teeth, gums, and jaw to confirm you're a good candidate, then takes impressions or a digital scan and a precise bite registration that sets where your jaw will start.” Afterward, a dental lab will build “a custom, adjustable appliance from those records.” Once it’s ready, the dentist will then fit and titrate the appliance in your mouth.

6. Repeat a home sleep test to determine oral appliance efficacy: As part of Dreem  Health’s sleep apnea treatment, your sleep specialist will want to confirm the oral appliance is controlling your apnea through a follow-up home sleep test.

7. Ongoing follow-ups to manage treatment and symptoms: Once a second sleep test confirms your oral appliance is working, you’ll “see your dentist periodically (at least annually) to check the fit and your bite because this is a condition you manage over the long haul,” says Dr. Bauserman.

Book an appointment with a Dreem Health sleep provider today.

How much does oral appliance therapy cost, and does insurance cover it?

The cost of oral appliance therapy can range from approximately $1,500 to $4,500, and is commonly covered by insurance. It’s important to keep in mind, however, that these prices usually include not only a custom-made appliance, but ongoing monitoring and adjustments. Also, cheaper over-the-counter options ultimately may be more expensive over the long-term if they don’t treat your condition. 

An oral appliance that is specifically used to treat sleep apnea can be covered via medical (rather than dental) insurance under the Durable Medical Equipment benefit. If a (sleep) physician provides a prescription for the oral appliance, that is what allows the device to be billed to medical insurance, confirms Dr. Bauserman. Be advised that oral appliances are generally not covered for snoring alone, and it’s always a good idea to verify your insurance plans before obtaining an oral appliance. 

What are the side effects of oral appliance therapy?

While there are some short-term and long-term side effects of oral appliance therapy, ongoing dentist and sleep-physician oversight can manage any complications. 

Common short-term side effects can include:

• Excessive salivation

• Dry mouth

• Tooth and jaw discomfort

• Temporary bite changes

However, it is possible for some patients to experience more long-term complications, which is all the more reason why follow-ups and consistent monitoring with your dentist and sleep specialist are paramount. Make sure to report any of the following symptoms to your providers immediately:

• Jaw/TMJ pain

• Permanent changes to your bite

The bottom line

Even though CPAP therapy is considered the “go-to” sleep apnea treatment, it may not be the right option for you. Oral appliance therapy could mean the difference between treating your sleep apnea and potentially placing your health at risk.

By working hand-in-hand with qualified dentists, Dreem Health sleep specialists can help you figure out an oral appliance therapy plan that will effectively treat your sleep apnea.

Scheduling a virtual consultation with Dreem Health is a great way to not only learn more about your oral appliance therapy options, but to start feeling better while you sleep. 

Frequently asked questions (FAQs) 

Can I buy an oral appliance over the counter or online?

Yes, you can buy an oral appliance over the counter or online, but they are not recommended by sleep or dental professionals for treating sleep apnea. Joint guidelines for both the American Academy of Sleep Medicine and the American Academy of Dental Sleep Medicine advise treating sleep apnea with a custom-fitted dental appliance prescribed by a sleep physician and created by a qualified dentist. The key to success with oral appliances is consistent monitoring and adjustments by medical and dental professionals. This level of oversight isn’t available with over-the-counter/online devices.

What are the disadvantages of oral appliances for sleep apnea?

The disadvantages of oral appliances for sleep apnea include the fact that CPAP therapy is still considered the “gold standard” sleep apnea treatment, meaning oral appliances can be less effective. In addition, patients may experience minor short-term effects like excessive salivation, dry mouth, tooth and jaw discomfort, and temporary bite changes. Some patients may also experience long-term complications like jaw/TMJ pain or permanent bite changes. Any pain or mouth-related changes should be reported to your care team ASAP. 

What sleep apnea devices are covered by Medicare?

Sleep apnea devices like CPAP machines and custom-fitted oral appliances are covered by Medicare when they’re categorized by your healthcare provider as Durable Medical Equipment. This classification allows oral appliances to be covered under medical insurance, rather than dental insurance. Oral appliances for snoring only are usually not covered by insurance/Medicare.