If you suffer from obstructive sleep apnea (OSA), there are two main ways to treat the condition. Which one is right for you will depend on the severity of the condition.
If your sleep apnea is mild to moderate, a good mouthpiece may be the best way to get the condition under control.
However, if your sleep apnea is severe, your doctor or healthcare provider is likely to suggest you use a CPAP machine instead.
Our list of best sleep apnea mouthpieces is for people who have been diagnosed with OSA and advised to use a sleep apnea mouthpiece instead of CPAP treatment.
All the best snoring mouthpieces are mandibular advancement devices (MADs). They work by holding the jaw forward during sleep.
MADs fit snugly over the top and bottom teeth. Due to the way they are set up, the lower jaw needs to advance slightly forward of its normal position so that the bottom teeth can fit inside.
This advancement of the jaw pulls the tongue forward, helping to prevent the blockages that interfere with normal breathing, causing a “sleep apnea.”
Although the two basic designs are always the same, many sleep apnea mouthpieces are not as good as the manufacturers claim. Quality issues and basic design flaws can reduce their effectiveness and/or make them less desirable to use.
Our list provides five of the best mouthpieces to use for controlling OSA. If you are looking for a new or replacement mouth guard, it’s a very good place to start.
AirSnore is a basic boil and bite mandibular advancement device.
As with all oral appliance MADs, the device molds itself to the teeth when you bite into it after first softening the plastic by placing it in hot water.
The AirSnore MAD doesn’t have an adjustment mechanism. You set it up by pushing your jaw forward while the plastic is still soft.
AirSnore also produces aromatic drops that help keep the nasal passages and airway clear. You can use the MAD with or without the drops.
However, although some OSA suffers may find the drops help keep their nasal passages and airway clear, they only offer support. It’s the mouthpiece that actually keeps OSA under control.
One of the best things about the AirSnore mouthpiece is the price. It’s a lot cheaper (and better value) than many other MADs but there has been no scrimping on materials or quality. AirSnore is a top of the range mouthpiece with an excellent track record. It’s already helped more than 80,000 people to enjoy better-quality sleep. It is also one the most effective anti snoring aids.
AirSnore is a reputable brand and the manufacturer offers a 60-day money-back guarantee. If you want a high-quality mouthpiece at a bargain price, AirSnore should be right up your street. Visit Airsnore website.
If you want a high-quality adjustable mandibular advancement device, VitalSleep should tick all the right boxes. As with most of the other MADs on this list of best sleep apnea mouthpieces, you set it up at home via boil and bite.
After the initial set up, you can further refine your lower jaw position by using the patented Accu-Adjust system. This makes it possible to move the jaw forward via a screw mechanism that allows precise fine-tuning.
The mechanism provides an 8 mm adjustment. That’s 4 mm in each direction so, if you over advance your jaw during the set up, or don’t advance it enough, it’s not the end of the world. There will be no need to repeat the boil and bite.
VitalSleep also has a low-profile design that helps provide a comfortable fit in the mouth. It’s also available in a choice of two sizes.
Women tend to have smaller mouths than men do, so the manufacturer provides a standard-size mouthpiece for men and a slightly smaller version for women.
Many of the people who buy VitalSleep are normal snorers but it works well for mild to moderate OSA too and has already helped more than 40,000 people to get a better night’s sleep.
Bearing in mind the various refinements, you’d expect VitalSleep to be one of the more expensive MADs on the market. It’s not. VitalSleep is only slightly more expensive than AirSnore and, like AirSnore, it has a 60-day money-back guarantee. Visit Vitalsleep website.
ZQuiet is a little different from the other MADs on our list because it doesn’t require boil and bite.
However, like VitalSleep, ZQuiet comes in two sizes. The standard-size ZQuiet is best for most men and the smaller option should be better for most women. There’s no need to worry about sizing issues though. Both options are included in the box.
ZQuiet also has an interesting design feature that helps it to stand apart from other MADs. It utilizes a special “living Hinge Technology.” ZQuiet is the only MAD that works in this way.
If that makes ZQuiet sound like it may be complicated to use, don’t worry. It’s not. The device does not require any setting up at all. All you need to do is try both sizes and decide which one feels best in your mouth.
The special hinge at the back of the device advances the jaw while also ensuring maximum flexibility and comfort. More importantly, it enables the ZQuiet to function regardless of whether your mouth is open or closed.
So, if you have a tendency to open your mouth during sleep, ZQuiet is probably the best mouthpiece to choose. The hinge will prevent it from falling out.
If you find ZQuiet appealing, you may be interested to learn you don’t have to buy it outright. The manufacturer offers a special deal that allows you to pay a small charge for postage and handling and get ZQuiet on a 30-day trial. Visit ZQuiet website.
SnoreRX is an adjustable snoring and sleep apnea device that has a maximum jaw advancement of 6mm. It can be adjusted in 1 mm increments at a time. Most people find a setting of 3-5 mm works best, so setting the MAD to position 4 may be a good place to start.
The adjustment is made possible due to the special Posi Lock mechanism. No tools are required. You move the lower tray forward by grasping the device at either side, squeezing it between your fingers, and then using a rocking technique to slide the lower tray forward one side at a time.
SnoreRX is a high-quality mouthpiece that exceeds industry standards and has amassed a surprisingly large volume of customer reviews. A lot of people like this MAD and have plenty of good things to say.
The Posi Lock system is not the only design feature that makes SnoreRX a little bit special. The device also has a special vent at the front that maximizes airflow if you need to breathe through your mouth instead of your nose.
SnoreRX costs a little more than the other MADs on this list but don’t let that put you off. The manufacturer offers new customers a 30-day trial. Visit SnoreRX website.
SnoreMeds is a boil and bite MAD that’s manufactured to high quality standards but doesn’t offer any extra frills. It’s not possible to adjust it, you have to set the level of jaw advancement during the set up.
Although it’s not adjustable, SnoreMeds comes in a choice of two sizes. As with similar options, it’s a case of one for the girls and one for the boys.
SnoreMeds is an established product that’s been on the market for over a decade and has excellent customer reviews. It’s also one of the few MADs that has front venting to assist people who cannot breathe through the nose.
The device comes with a special tool to lift it in and out of the water. With all the other options you need to just grab whatever is handy, such as a dessert spoon or a fork.
You could do that with SnoreMeds too, but the special tool is a nice touch. It fits into the device in a way that allows you to take it from the water and then insert it into the mouth without touching it with your fingers.
SnoreMeds is not a particularly expensive MAD to buy and it comes in a twin-pack. All things considered, you could say it’s a case of buy one get one free, and SnoreMeds has a very generous 45-day money-back guarantee. SnoreMeds website.
How We Ranked These Sleep Apnea Mouthpieces
At first glance, one sleep apnea mouthpiece can look very like another. The basic design concept is always the same. However, appearances can be deceptive. Some manufacturers use cheap low-grade materials that offer pure durability.
In many cases, poor-quality mouthpieces are uncomfortable to use as well.
All six of our chosen products are produced by reputable suppliers that use high-grade materials and bring quality to the fore.
All five products also have good customer reviews. There’s a good vibe about them and they have a reputation for delivering results. Each of them has earned a position on our list of best sleep apnea mouthpieces.
The selected sleep apnea devices also feature prominently on Dawnstudy’s best mouthpieces for snoring guide.
Depending on your personal preference, some mouthpieces may be more appealing than others but, whichever one you choose, you can be certain you have chosen well.
What is Sleep Apnea?
Sleep apnea is a condition that causes you to stop breathing during sleep. “Apnea” is a medical term that refers to a temporary cessation of breathing.
It’s normal to have up to five apneas an hour but people who have severe sleep apnea can get 30-100 apneas per hour.
Doctors measure the severity of sleep apnea using the apnea-hypopnea index (AHI):
Normal sleep: Less than five apneas per hour (on average)
Mild sleep apnea: 5-14 apneas per hour
Moderate sleep apnea 15-29 apneas per hour
Severe sleep apnea 30 or more apneas per hour
There are three main types of sleep apnea.
Obstructive sleep apnea is the most common. It happens when the throat muscles relax sufficiently to impede airflow.
Central sleep apnea occurs due to a disruption in signalling between the brain and the muscles that allow us to breathe.
Complex sleep apnea syndrome is somewhat of a hybrid condition because the apneas can be due to an obstruction, a problem with signalling, or both.
Who Could Benefit From a Sleep Apnea Mouthpiece?
Sleep apnea mouthpieces work best for people who have mild to moderate OSA. They can also be extremely effective for controlling snoring.
Although snoring is often a symptom of OSA, not everyone who snores has the condition. Snoring happens when a disruption in airflow causes turbulence that makes the soft tissues at the back of the throat vibrate. This produces the rasping sound that keeps so many people awake.
If you have OSA, the obstruction can be gradual enough to cause the flesh to vibrate before the airway fully closes up. In the case of normal snoring, the obstruction is unlikely to become severe enough to fully close the throat.
When a doctor diagnoses mild sleep apnea, a MAD will almost always be among the treatment suggestions.
If the condition is moderate, the doctor will make a judgment called based on their experience, along with their familiarity with your overall health, and your position on the AHI scale. If the sleep apnea is too severe to manage via a mouthpiece, it’s highly likely the doctor will recommend CPAP.
How Effective are Sleep Apnea Mouthpieces?
Using a mouthpiece can be an extremely effective way to control sleep apnea but it’s not the only treatment and it may not be the best. It’s largely dependent on the severity of the condition.
If the idea of using a mouthpiece to control sleep apnea seems strange, try to set aside your disbelief. Doctors often recommend MADs to their sleep apnea patients. There’s a good reason for that. Unless the condition is too severe, this type of mouthpiece is one of the best ways to get sleep apnea under control.
It’s also important to be aware, the value of this type of mouthpiece as a means of controlling sleep apnea has been the subject of a lot of research. There is plenty of scientific evidence to underpin using MADs in this way.
A research paper published in the Journal of Pharmacy & BioAllied Sciences (April 2015) provides an overview of their value.
The researchers responsible for the paper referenced the data from several credible studies and confirmed the value of this type of mouthpiece for treating snoring and OSA. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4439678/)
The results of a later study, published in the Journal of Thoracic Disease (Jan 2018), is equally supportive.
The researchers acknowledge the value of CPAP therapy, calling it the “gold standard treatment” for OSA. However, they also point out certain factors can undermine its effectiveness and say oral appliances are the “leading alternative to CPAP.”
Furthermore, after evaluating the data from numerous studies, the researchers suggest MADs may also be a viable option for treating severe sleep apnea when people cannot tolerate CPAP or decline to go this route. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5803051/)
There are oral, capsule type medications in development but so far nothing has proved to be a success.
“Research does not suggest any of the pharmaceutical companies have managed to develop anything viable yet.”
Advantages of Using Oral Appliances for Sleep Apnea
Mouthpieces offer several advantages over other treatments for sleep apnea. One of the biggest advantages is they can work incredibly well. Another is there is no need for a prescription.
Needless to say, a good mouthpiece is cheaper and safer than sleep apnea surgery. Most people with mild OSA would prefer to use a mouthpiece instead of going under the knife. Oral appliances of this type are cheaper than CPAP treatment too.
However, most of the advantages a mouthpiece provides are similar to those of other sleep apnea treatments:
Allows you to sleep better and wake up feeling refreshed
Prevents snoring that may disturb other people
Reduces the likelihood of headaches, memory problems, mental fog, and other symptoms of sleep apnea.
Disadvantages of Using Oral Devices for Sleep Apnea
Although using a mouthpiece is one of the best ways to control mild to moderate sleep apnea, the pros are accompanied by some cons. Drooling is one of them.
However, although this is a problem that can never be ruled out, drooling is less likely when you use a good quality sleep apnea mouthpiece.
Using an oral device to control sleep apnea may also entail mild to moderate discomfort. Especially during the first few weeks of use. It’s usually a temporary thing, so perhaps it’s appropriate to call this a teething problem.
The first thing to know is it may take a few nights to get used to sleeping with the device in your mouth. It involves an alien sensation but most people are quick to adjust and the benefits more than make the transition period worthwhile.
Some MAD users find they wake up with a headache and/or pain in the muscles around the jaw. Again, should they occur, reactions of this nature are usually short-lived. You could compare it to breaking in a new pair of shoes.
It’s not unheard of for new MAD users to find sleeping with a mouthpiece causes their teeth to feel a little sensitive. This is usually a temporary problem too but, if you have sleep apnea and are considering using a MAD, you need to have strong teeth.
If you have gum disease or frontal crowns, your teeth may not be able to take the strain.
Needless to say, the other disadvantage is you cannot use a MAD if you have dentures. Nor can you use one if you wear a retainer or braces at night.
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Other Solutions and Sleep Apnea Devices
Using a mouthpiece is one of the most popular ways to control sleep apnea but it’s not the only option. The most obvious one is CPAP. We’ve mentioned this type of treatment several times in this article already, so let’s take a look at that first.
CPAP! It sounds like a good name for a rapper, doesn’t it? The name is actually an acronym. It stands for continuous positive airway pressure.
CPAP treatment consists of three things: a machine that pumps air, a face mask, and a piece of tubing to connect them.
After you switch it on, the machine pumps a continuous flow of air. This enters the nose or mouth via the mask, pressurizing the airway.
Although it’s not severe, the pressure is sufficient to keep the airway open by preventing the soft flesh in and around the throat from sagging during sleep. You could compare it to the way a light breeze opens up a windsock and causes it to retain a tube-like state.
Because the incoming flow of air is constant, the lungs have to produce enough pressure to overcome it every time they exhale. This means the pressure in the airway is generally marginally greater when breathing out, giving the soft flesh no opportunity to sag.
CPAP is tremendously effective. The researchers that called it the gold standard were not wrong. However, some people find it difficult or uncomfortable to sleep in a mask. It’s also worth noting a minority of people don’t respond well to the treatment, meaning their doctor will need to suggest alternative options instead.
Pillow position has the potential to influence OSA, making the condition better or worse. Unless the condition is only very mild, changing to a more favorable pillow position alone is unlikely to be enough to prevent apneas from occurring.
However, when used alongside a suitable sleep apnea treatment, such as a mouthpiece or CPAP, adopting a better pillow position is a good way to maximize the existing benefits and lessen sleep problems.
When your pillows are too thick or you use several pillows at once, it can over elevate the head, causing a slant in the airway.
At the other end of the scale, if your pillow is too thin and does not offer enough support, it may have a similar effect. The best pillow position will help keep your airway straight.
It can also be advantageous to sleep on your side instead of your back. This makes your tongue less likely to drop back and obstruct breathing.
Nerve Stimulation Devices
Sometimes referred to as a pacemaker for the tongue, hypoglossal nerve stimulators sense when apneas occur and then open the airway by stimulating the hypoglossal nerve.
The hypoglossal nerve begins in the brain stem, passes through the neck, and then comes up to meet the tongue. It governs motor control in the tongue and aids important involuntary actions such as swallowing.
As with pacemakers, hypoglossal nerve stimulation devices are implanted in the chest. They contain a long-life battery that lasts for several years.
Again, in a similar way to pacemakers, the devices are attached to a stimulation lead. However, instead of stimulating the heart muscle, the device stimulates the tongue.
This type of device can work well for some people, but it’s an intrusive treatment and further surgery is required every time the battery needs changing.
Sleep Apnea Surgery
There are a number of surgical procedures for sleep apnea. Many of them involve removing flesh from the back of the throat and/or the tongue. Others involve permanent repositioning of the jaw.
One treatment (anterior inferior mandibular osteotomy) splits the chin bone in two to allow the tongue to move forward. Grim as it sounds, the treatment actually has a shorter recovery time than many of the other surgical options.
As with any type of surgery, sleep apnea treatments entail certain risks. Some of which are due to the procedure, others due to the anesthesia.
There are no guarantees any of the surgical procedures will work, but they help some sleep apnea patients to get the condition under control.
However, unless your doctor advises otherwise, it’s best to try and avoid surgery unless all the safer options have failed.
Diet and Exercise
If you are overweight or obese, the excess fat around your neck may contribute to OSA and make it worse. Needless to say, losing weight is a step in the right direction, and diet and exercise is the best way to achieve this aim.
If your OSA is very mild, losing weight could be action enough to prevent apneas from occurring. In more severe cases of OSA, a reduction in BMI may make it possible to stop using CPAP and manage the condition with a mouthpiece instead.
What is “boil and bite”?
Most of the mouthpieces for controlling sleep apnea are set up via boil and bite. Placing the device in boiled water softens the special plastic resin in the trays that hold the teeth. Then, when you bite, the plastic mold is a perfect fit for your teeth.
How do you clean the mouthpiece?
Although it’s possible to clean a mouthpiece by running it under a faucet, most people prefer to use a brush and some toothpaste. Some people soak their mouthpiece in denture cleaner instead.
How long does a mouthpiece last?
This can vary from one individual to the next. However, most MADs you set up at home are good for six months to a year.
If you pay your dentist to make a custom-built MAD, it may last for up to three years. However, with a cost of $1,000+, it’s hard to justify the additional expense.
Can Mouthpieces be used to stop snoring?
Yes, the original intention for mouthpieces is to stop or lessen snoring. In fact, a sleep apnea mouth guard is also one the best solutions for snoring.