Sleep Apnea Appliances

Sleep apnea is a serious, sometimes fatal medical disorder in which breathing repeatedly stops and starts during sleep. Affected individuals may experience hundreds of breathing interruptions in a single night, with normal breathing ceasing because the airway becomes obstructed. This causes a serious reduction in airflow to the lungs and deprives the brain and body of oxygen. Sleep apnea affects approximately 10% of men over age 40 and 6% of women over age 40, making it a common condition that requires treatment.

Common symptoms of sleep apnea include loud snoring, gasping or choking during sleep, witnessed pauses in breathing by a sleep partner, excessive daytime sleepiness, morning headaches, irritability, mood changes, difficulty concentrating, and decreased sexual function. Many people don’t realize they have sleep apnea because the symptoms occur during sleep. A sleep partner is often the first to notice the condition. If you experience these symptoms, it’s important to consult with a healthcare provider for a proper diagnosis.

Sleep apnea dental appliances work by repositioning the jaw and tongue to keep the airway open during sleep. The goal of most dental devices is to separate the jaws slightly and push them forward. This repositioning prevents the tongue and soft tissues from collapsing inward and blocking the airway, allowing oxygen to flow freely. These devices work similarly to mouthguards and are custom-made to fit each patient’s mouth precisely.

Sleep apnea appliance wearers report numerous benefits including elimination of loud snoring, improved daytime alertness and restfulness, better sleep quality, improved mood and concentration, reduced morning headaches, and greater comfort when going to sleep. Many patients also experience better overall health outcomes due to improved oxygen levels during sleep. These benefits can significantly improve quality of life and reduce health risks associated with untreated sleep apnea.

Sleep apnea dental appliances offer an attractive alternative to Continuous Positive Airway Pressure (CPAP) machines. Unlike CPAP machines, which require electricity and can be bulky and uncomfortable, dental appliances are small, portable, custom-fitted devices that work mechanically. They don’t require masks or hoses and are easier to travel with. Many patients find dental appliances more comfortable and easier to tolerate than CPAP machines, though effectiveness may vary. Your dentist can help determine which option is best for your situation.

We recommend an initial diet of soft foods that do not require significant chewing. Good options include smoothies, yogurt, pudding, applesauce, soup (lukewarm, not hot), eggs, and mashed potatoes. As you feel more comfortable and as healing progresses, you can gradually resume your normal diet. However, avoid hard, crunchy, sticky, and hot foods during the initial healing period. Most importantly, stay well hydrated by drinking plenty of water and other fluids. Proper nutrition and hydration are essential for healing.

There are several types of sleep apnea appliances available, falling into two main categories: fixed and adjustable. Fixed appliances maintain the jaw in a consistent position, while adjustable appliances allow for customization of jaw positioning. Common types include the TAP® 3, OASYS appliance, KlearwayTM appliance, and Herbst Telescopic Appliance. Each has unique features and benefits. Your dentist will recommend the most appropriate device based on your individual needs, anatomy, comfort preferences, and the severity of your sleep apnea

The TAP® 3 (Thornton Adjustable Positioner) is the smallest and most comfortable member of the TAP family of sleep apnea appliances. It is a two-part custom-created device that fits over the teeth much like a sports mouthguard. The TAP® 3 projects the jaw forward to prevent the tongue and soft tissues from obstructing the airway. The lower jaw positioner is adjustable, allowing it to be modified to suit your specific comfort level. It can accommodate various types of bite patterns and allows the lips to close fully, making it discreet and easy to wear during sleep.

The OASYS appliance is designed to move the base of the tongue toward the front of the mouth by gently repositioning the jawbone (mandible). This shift opens the oropharynx (the middle part of the throat) and strengthens the upper airway. An extension of the upper shield projects toward the nose, creating a larger nasal opening and reducing resistance to normal airflow. The OASYS appliance is adjustable, comfortable to wear, and extremely patient-friendly, making it a popular choice for many sleep apnea patients.

The KlearwayTM Appliance is generally used to alleviate obstructive sleep apnea and eliminate snoring. What makes it unique is that both you and your dentist can project the jaw forward in precise increments of 0.25mm at a time, ensuring maximum comfort for the sleeper. The appliance is made from VariflexTM heat-softening acrylic, which makes it easier to insert and adjust. Running warm water over the appliance makes it pliable for insertion, but once placed in the desired position, the acrylic hardens again, maintaining the position throughout the night.

The Herbst appliance is held in the mouth by clasps and friction grips and is made of acrylic with adjustable metal wiring. The primary advantage of this appliance is that wearers can move their jaw vertically and laterally (side to side) without dislodging the device, allowing for more natural jaw movement during sleep. The Herbst appliance is usually used for mild to moderate cases of sleep apnea and is highly effective at eliminating loud snoring. It’s a good option for patients who want more jaw mobility while wearing their sleep apnea device.

A sleep apnea appliance is custom-created based on impressions and molds of your teeth and bite. Your dentist will take detailed impressions of your upper and lower teeth, and may also obtain information about your jaw position and any other relevant anatomical features. The device is then fabricated in a dental laboratory specifically for your mouth. Once created, your dentist will have you try the appliance to ensure proper fit, comfort, and function. Multiple appointments may be needed to adjust the device and ensure it’s working optimally before you take it home for regular use.

Proper care of your sleep apnea appliance extends its lifespan and ensures it works effectively. Clean your appliance daily with a soft toothbrush and mild soap and water, or use a denture cleaner. Avoid using hot water, as this can warp some appliances. Store your appliance in a protective case when not wearing it to prevent damage. Brush your teeth before inserting the appliance to maintain good oral hygiene. Have your dentist inspect and adjust the appliance periodically as part of your regular dental care. Never attempt to adjust the appliance yourself unless it’s specifically designed for patient adjustment, like the KlearwayTM.

Most patients need a few weeks to fully adjust to wearing a sleep apnea appliance. You may initially experience slight discomfort, excess saliva, or mild jaw soreness, which is normal and typically subsides as you become accustomed to the device. Start by wearing the appliance for short periods during the day, then gradually increase usage until you can wear it comfortably throughout the night. Some patients adjust very quickly, while others need more time. Communicate with your dentist about any discomfort, as adjustments to the device may help speed up the adaptation process.

A sleep study (polysomnography) is important for diagnosing sleep apnea and determining its severity before getting a dental appliance. This test measures how many times per hour you stop breathing during sleep and how low your oxygen levels drop. A sleep study helps your healthcare provider and dentist determine if a dental appliance is appropriate for your specific condition. Some dental offices can refer you to a sleep specialist for a study, or you may already have results from a previous sleep study. Insurance may also require a sleep study diagnosis before covering the cost of a dental appliance.

Many dental and medical insurance plans cover sleep apnea appliances, particularly if you have a documented diagnosis of sleep apnea from a sleep study. Coverage varies significantly between plans and insurers. Some plans cover the full cost, while others cover a percentage. Some insurance companies may require that you attempt CPAP therapy first before approving a dental appliance. Check with your insurance provider about your specific coverage. Your dentist’s office can often help verify insurance benefits and file claims on your behalf.

Regular follow-up appointments are important to ensure your sleep apnea appliance is working effectively. Your dentist typically recommends follow-up visits a few weeks after you start wearing the device, and then periodically thereafter. During these appointments, your dentist will check the fit and function of the appliance, ask about your symptoms and sleep quality, and make any necessary adjustments. Most patients benefit from visiting their dentist at least twice a year for sleep apnea appliance maintenance and evaluation. These appointments help ensure the device continues to provide optimal treatment for your sleep apnea.

Sleep apnea appliances are generally safe and well-tolerated. However, because they apply gentle pressure to reposition the jaw, some patients may experience minor changes in their bite over time or temporary jaw discomfort. These changes are usually minimal and often resolve after the adjustment period. Your dentist will monitor your teeth and bite during regular checkups to ensure the appliance is not causing any problems. If you experience persistent jaw pain or notice changes in your bite, inform your dentist immediately. Proper fit and adjustment of the appliance minimizes these risks.