While CPAP is an excellent treatment for OSA, not everyone can tolerate it or may not be physically capable of using it.
There are new oral appliances that can be used to treat sleep apnea. Sometimes they can also be used in conjunction with CPAP to treat severe cases of OSA (commonly known as combination therapy).
Oral appliances may resemble snore guards, but it's important to know that OAT is different from snore guard therapy in terms of treating sleep breathing disorders such as snoring, upper airway resistance syndrome (UARS), and sleep apnea.
Let's first make one thing clear: It's a mistake to think that snore guards can also treat sleep apnea. This is simply not true. Oral appliances are considered medical devices that require a prescription, while snore guards are not considered medical devices and, therefore, do not require a prescription. While most oral appliances approved to treat OSA will also likely "stop the snore," the reverse cannot be assumed.
Someone who decides to self-treat their sleep apnea using a snore guard may not only fail to treat it, but they may also suffer new side effects from an ill-fitting and inappropriate device. Side effects can include the development of oral blisters and irritation, TMJ disorders, pain in the jaw and neck, headaches, and even the loss of teeth.
What are the key differences between snore guards and oral appliances?
These devices do share common features, which explains why some people will make the mistake of choosing one over the other in order to save money or to "self treat" their problems.
Both are worn over the teeth, however, and both are used to treat sleep breathing disorders. But don't be fooled; some only treat snoring, whereas the others typically treat all forms of sleep breathing dysfunction.
Here are some ways to differentiate between these two therapies.
The FDA is the chief watchdog when it comes to approving the specific uses of medical devices. This is because medical devices, like medications, can come with side effects. FDA approval shows that the device has been examined for safety in its intended use.
Snore guards can be extremely effective, and for those people who snore—but do not have OSA—they can be terrific for silencing the] night and putting an end to the problematic side effects of snoring.
Dentists trained in sleep medicine will have access to the best products on the market when they reach for snore guards as a therapeutic approach to snoring. Likewise, when discussing the use of an oral device to treat your OSA with your sleep physician, you can be assured that they will only prescribe FDA approved devices.
Caveat: You are best advised to avoid over-the-counter oral products that have not earned FDA approval. Many hit the market without approval but tend to exist only until the FDA discovers them and pulls them from the market. These products may not provide the therapy you need and may be unsafe to use.
How they're built
Both kinds of devices are typically built from sturdy, hygienic materials proven to be safe for use in the oral cavity. They can usually take a lot of wear and tear (both snorers and people with OSA can do a lot of tooth grinding and jaw clenching as a result of their sleep breathing problems). Even the mechanisms that make them work are similar: the lower jaw is advanced slightly to create more space in the upper airway for the passage of airflow during sleep. (Another kind of oral appliance retains the tongue through a suction device at the front of the mouth, but these are rarely prescribed.)
However, a snore guard is usually simpler to build, with fewer moving parts. Some are prefabricated and may not be customizable at all. The reason why these aren't approved for treating OSA is that they aren't easily adjustable, which may be necessary to treat sleep apnea effectively.
They may also not be constructed strongly enough to maintain the greater jaw advancement that can be necessary for treating OSA. Finally, the typical lifespan of a snore guard is 6 to 24 months.
Meanwhile, an oral appliance is built to advance the jawbone using a fortified hinge mechanism for support. This hinge mechanism often uses a "key" to titrate, or adjust, the level of advancement to ensure the best fit and most effective treatment for the user.
This adjustability makes it possible to test its effectiveness in a controlled environment (such as a sleep center lab) in order to prove the therapy is working. Oral appliances are built to last as well, with a lifespan of 5 to 10 years.
Who builds them
Some snore guards are easily built right at the dentist's office. They can be made from a "boil and bite" method similar to that used for sports mouthguards, in some cases. Usually the dentist provides these to the patients who then take them home and use them, without much followup except to check for comfort issues and to determine whether the incidence, frequency, and volume of snoring has changed.
As for oral appliances, only skilled sleep medicine dentists who are trained to build them can do so in their clinics.
Those without training will instead take molds of their patient's teeth and gums and send these to a specialty lab. The dentist then receives the finished and customized oral appliance (this could take a few weeks) fits the patient with it, giving the usage and maintenance instructions.
After that, they work with the patient to maintain long-term progress in therapy and to look for problems with side effects.
Snore guards are not as complicated to build and don't require as many moving parts. They also do not require the close observation of sleep specialists and sleep medicine dentists to ensure they are working. For these reasons, they tend to be far less expensive than oral appliances prescribed to treat OSA.
The cost of an oral appliance, however, is more on par with the cost of CPAP, even though OAT usually only involves the device and its adjusting key (or some latex bands to hold it in place). Sometimes a temporary oral appliance, which is less expensive, is built so the patient may give it a "test run". This temporary device is used until it breaks or the sleep specialist has determined that it's working, and then a more expensive, permanent device can be presribed and built.
The good news is that insurance companies are getting wise to the benefits of oral appliances to curb OSA, regardless of its severity. Medical plans are now coming on board with reimbursements to cover the appliances as first-line approaches to treating sleep apnea.
Insurance will often now cover all the visits necessary to fit, maintain, and test these devices for therapeutic effectiveness, as well.
Positive outcomes for medical treatments are now the name of the game for patients, doctors, and insurance payers. Treating OSA in this patient-centered care environment is no different. If a patient cannot tolerate the more commonly prescribed CPAP, OAT could now be the therapy that saves them. But it's important to make sure these patients work with healthcare professionals to get the appropriate diagnostics and FDA-approved treatments for their specific problems.
Sound Sleep Health has been working with several skilled, certified sleep medicine dentists to provide this popular alternative to CPAP for years now. If you're a CPAP user and find you are struggling with your machine and mask, please call us for a free sleep assessment. At our sleep center, we may be able to help you "trade up" to an oral device to better treat your OSA.
Alaska Sleep Education Center
American Academy of Dental Sleep Medicine
SomnoSure Education Center
The United States Food and Drug Administration (FDA)