If you or your partner snore loudly, wake up unrefreshed, or have been told you stop breathing in your sleep, you may already have heard of CPAP – the mask and machine often used to treat obstructive sleep apnoea (OSA).
But what if you simply cannot get used to the mask?
What if you travel a lot, sleep on your side, or keep taking the mask off in your sleep?
This is where dental sleep medicine and oral appliances can sometimes work better for you in real life, particularly for mild to moderate OSA or when CPAP is not tolerated.
CPAP or Oral Appliance: How Do They Work and Their Differences
CPAP works by delivering air pressure through a mask to keep the airway open while you sleep. When used properly, it is highly effective at reducing breathing events and improving oxygen levels.
On the other hand, oral appliance therapy (OAT) for OSA uses a small, custom-made mouthguard-like device, called a mandibular advancement device (MAD). It works by gently holding your lower jaw slightly forward while you sleep. This helps keep the airway more open and can reduce snoring and breathing pauses.
Key points about oral appliances:
- They are custom-fitted by a dentist with training in dental sleep medicine
- They are adjustable, so the position can be fine-tuned over time
- They are small, portable and quiet, with no mask or hoses
When Can An Oral Appliance Be A Good Option?
According to Australian guidance, mandibular advancement devices can be an alternative to CPAP for obstructive sleep apnoea, particularly for certain groups.
An oral appliance may be suitable if:
1. You have mild to moderate OSA
For many people with mild to moderate OSA, an oral appliance can significantly reduce snoring and breathing events and improve how rested they feel.
2. You cannot tolerate CPAP
If you have tried CPAP and struggle with:
- Claustrophobia
- Mask leaks or discomfort
- Dryness
- Disturbed sleep
Then, an oral appliance may be discussed as an alternative to CPAP.
3. You travel or have an active lifestyle
Oral appliances are:
- Easy to pack in a small case
- Simple to use in different sleeping environments
- Discreet, so they are useful if you share a room or travel frequently
For some people, this practicality means they actually use their oral appliance for more hours each night than they used CPAP, and this can improve overall, real-world results.
What Does Treatment With A Mandibular Advancement Device Involve?
Dental sleep medicine is a team effort between you, your doctor and your dentist. If you’re considering getting MAD or any oral appliance that will support your sleep apnoea, here is what the process usually looks like.
1. Medical Diagnosis And Referral
- Your GP or sleep physician arranges a sleep study to confirm whether you have OSA and how severe it is.
- If an oral appliance is appropriate, they refer you to a dentist experienced in dental sleep medicine.
2. Dental Assessment
If you partner alongside our team, your dentist will:
- Check your teeth, gums and bite
- Assess your jaw joints (TMJ) and muscles
- Talk about any history of clenching or grinding (bruxism)
- Make sure your mouth is healthy enough to support a device
3. Custom Device And Fitting
If you are suitable for a mandibular advancement device, you are also likely going to expect:
- Digital scans or impressions of your teeth are taken
- A custom, adjustable device is made to fit your mouth
- You are shown how to insert, remove and care for it
4. Titration And Follow-Up
“Titration” simply means gradually adjusting the device to find the right balance between. This also have in:
- Opening your airway enough to help your breathing
- Keeping the device comfortable for long-term use
You will also be required by your dentist to do follow-up visits so your dentist can:
- Check comfort and fit
- Make small adjustments
- Monitor your bite and jaw joints
Your sleep physician may arrange a follow-up sleep study (often a home sleep study) to see how well the device is working for your OSA.
Possible Side Effects and How They Are Managed
Most people adapt well to oral appliances, but like any treatment, there can be side effects.
These may include:
- Temporary jaw stiffness or soreness when you wake up
- Changes in how your teeth meet (your bite) over time
- Increased salivation or a dry mouth at first
That’s why careful planning and regular checks are important. If you already have TMJ issues or significant bite problems, your dentist will discuss whether a device is appropriate for you or whether extra precautions are needed.
If you clench or grind your teeth (bruxism), your dentist will also consider this when designing and adjusting your device.
Which is Better: CPAP or Oral Appliance?
In a nutshell, there is no single “best” treatment for everyone since each of these oral devices has its own benefits.
In general:
- CPAP is usually recommended as first-line treatment for moderate to severe OSA, as it can reduce breathing events very effectively when used as prescribed.
- However, oral appliances are a well-recognised option for:
- Mild to moderate OSA
- Primary snoring with documented airway collapse
- People who cannot use CPAP or prefer an alternative
The right choice depends on:
- The severity and type of your sleep apnoea
- Your general health
- Your jaw and bite
- Which treatment are you most likely to use every night
Regardless, the best step to knowing what the most appropriate appliance works for you is when your GP, sleep physician or dental professional guides you.
If you’re looking to work with a dentist to guide you with your obstructive sleep apnoea in Bellevue Hill, our team at Bellevue Hill Dental is delighted to work closely with them to support your care.
Book a consultation with us for more guidance.
Frequently Asked Questions
1. What is dental sleep medicine?
Dental sleep medicine is a field of dentistry that works together with medical sleep specialists to help manage conditions such as snoring and obstructive sleep apnoea. It often involves the use of custom-made oral appliances that are worn during sleep to help keep the airway more open.
2. How do oral appliances differ from CPAP?
CPAP uses a machine, tubing and a mask to deliver air pressure and keep your airway open. Oral appliances look similar to a custom mouthguard and work by gently holding your lower jaw slightly forward. No mask or hose is used, and the device fits completely inside your mouth.
3. Are oral appliances suitable for all types of sleep apnoea?
Oral appliances are generally considered for people with snoring or mild to moderate obstructive sleep apnoea, or for those who cannot tolerate CPAP. People with more severe sleep apnoea usually start with CPAP.
Your GP, sleep physician or dental partner will also assess your sleep study results and overall health before recommending the most appropriate option.
4. Do I need a sleep study before getting an oral appliance?
Yes. A formal diagnosis is important before starting treatment. Your GP, sleep physician or dental clinician will usually arrange an overnight sleep study, either at home or in a sleep clinic. The results help determine whether an oral appliance is suitable and provide a baseline to measure how well your treatment is working.
5. What are the possible side effects of a mandibular advancement device?
Some people notice temporary jaw stiffness, tooth tenderness, changes in their bite or extra saliva when they first start wearing a device. These effects are usually mild and can often be managed with careful design, gradual adjustments and regular reviews with your dentist. Any ongoing discomfort should be discussed with your dental and medical team.
6. Can I switch from CPAP to an oral appliance?
In some cases, yes. If you find CPAP difficult to use, you can speak with your GP or sleep physician about whether an oral appliance might be an option for you. They may review your sleep study, medical history and symptoms, and then work together with a dentist trained in dental sleep medicine to plan the next steps.
7. How long does it take to get used to wearing an oral appliance?
Most people need a few nights to a few weeks to adapt. At first, the device can feel unusual, but many patients find that it becomes part of their normal bedtime routine. Follow-up visits allow your dentist to check the fit, adjust the device and help you stay comfortable as you get used to wearing it.
