Sleep apnea disrupts the quality of life for millions. The disorder is marked by interrupted breathing during sleep, often leading to excessive daytime fatigue, decreased cognitive function, and a higher risk of heart disease. Treatment for apnea is a pressing matter, leaving patients with two main oral appliances to consider.

Continuous Positive Airway Pressure (CPAP) machines and specialized mouthpieces for sleep apnea, also known as oral appliances. Having suffered from sleep apnea and researched CPAP machines versus oral appliances, I share this article to help others save time and make informed decisions.

Key Takeaways

• Sleep apnea treatments include CPAP machines for severe cases and oral appliances for mild to moderate conditions.
• Oral appliances are portable, comfortable, and easy to use, making them a preferred option for many.
• CPAP machines are effective but can be uncomfortable and expensive.
• Starting with a mouthpiece is recommended due to its affordability and convenience. If ineffective, consider consulting a specialist for a CPAP machine.

What Are Mouthpiece Appliances For Sleep Apnea? 

Mouthpiece appliances treat sleep apnea by keeping the airway open. They achieve this either by moving the lower jaw forward or by holding the tongue in place, preventing obstruction of airflow during sleep.These oral appliances work best for individuals with mild to moderate cases of OSA.

Oral appliance therapy is when a mouth or dental device is used to treat various patient disorders – bruxism, crooked teeth, TMJ and sleep apnea. Mouthpieces for apnea fall primarily into two categories along with some hybrid variants that combine elements of both.

Mandibular Advancement Devices (MADs) function by positioning the lower jaw forward. This action directly widens the airway, making it easier to breathe and reducing the incidence of snoring and apnea episodes. They are most effective for individuals suffering from mild to moderate sleep apnea and frequent snoring.

Tongue-retaining devices (TRDs), by contrast, hold the tongue forward to ensure it doesn’t fall back and obstruct the airway. These are best suited for apnea patients who find jaw advancement uncomfortable or have gag reflex issues.

Hybrid devices offer both tongue retention and jaw advancement. For example, a strap can prevent the tongue from falling back into the throat while a mandibular advancement feature repositions the jaw forward. However, these oral appliances are less common due to their complex design and higher costs.

After suffering from sleep apnea and snoring issues, I turned to Mandibular Advancement Devices. The device effectively repositioned my lower jaw, opening my airway and significantly reducing both snoring and episodes of sleep apnea disorders. The result was improved sleep quality and increased daytime alertness.

Pros Of Mouthpiece Therapy

One of the most appealing aspects of mouthpiece therapy is its ease of use, especially compared to CPAP devices. Simply place the device in your mouth before sleep and let it work its magic. This convenience encourages consistent use, which is vital for effective apnea treatment. Unlike bulky CPAP appliances, mouthpieces are small, lightweight, and easy to carry.

This portability is particularly beneficial for frequent travelers. A mouthpiece can easily fit into a carry-on bag or even a purse, just like any other dental appliance. It’s a practical choice for a patient on the go.

Oral appliance therapy offers a less intrusive treatment option compared to CPAP machines, which can be loud and may require sleeping in a specific position. Unlike a CPAP, a mouthpiece doesn’t generate noise and allows for greater freedom of movement during sleep. It’s simply a dental device that ensures you get enough air during the night.

Cons Of Mouthpiece Therapy

The most commonly reported drawback of oral appliance therapy is potential jaw discomfort or pain. This issue arises primarily when adjusting to a new device or if the device is not properly fitted. However, most patients find that any initial discomfort fades with consistent use.

In my own experience with top snore-reducing mouthpieces, the initial discomfort was gone after a few weeks of therapy. Even if it stayed, this drawback is outweighed by the significant improvements in sleep quality and daily function. Also, it’s nothing compared to patients wearing a bulky CPAP overnight.

What Is a CPAP?

CPAP stands for Continuous Positive Airway Pressure. It is an oral appliance designed to aid individuals with sleep apnea by providing a continuous stream of air, thereby keeping the airways open. CPAP machines have been around since the early 1980s and have been a cornerstone in sleep apnea treatment.

An Austrian doctor first invented CPAP machines when testing them on dogs. He further adapted CPAP use to work in preventing the collapse of tissues that cause breathing problems in various patients. It took a lot of time for CPAP devices to become quieter, and more convenient to use, and for doctors to provide CPAP therapy services.

The primary use of these oral appliances today is in treating moderate to severe forms of sleep apnea. For such severe apnea cases, a CPAP machine is often considered the best option but it’s essential to consult a sleep specialist or a doctor before starting to use one. There are three primary types of CPAP machines

 Fixed-air CPAP machines deliver air at a constant pressure setting throughout the night. They are simple and often less expensive, suitable for patients who require a consistent pressure level to treat apnea

Auto-titrating CPAP adjusts the pressure automatically in real-time based on patients breathing patterns. This CPAP increases the pressure when you’re having difficulty breathing and decreases it when you’re breathing normally. It is ideal for patients who need different oxygen levels during the night for successful apnea treatment with a CPAP.

BiPAP (Bi-level Positive Airway Pressure) machine, unlike standard CPAP machines, offers two levels of airway pressure: one for inhalation and a lower one for exhalation. This type is often used for more complex cases of sleep apnea or other respiratory issues.

I have personal experience using a fixed-air CPAP machine. While it was highly effective in keeping my airways open, it felt like overkill for my less severe sleep apnea. Also, using the machine required sleeping in an uncomfortable position, which made it hard to get a restful night’s sleep. It kind of defeats the purpose of oral therapy.

Pros Of CPAP

The primary advantage of CPAP machines is their effectiveness. They are often the best option for severe sleep apnea, working by maintaining an open airway, thus preventing apnea episodes where breathing stops or becomes shallow.

Once properly adjusted, CPAP machines provide consistent and reliable treatment. They deliver a constant stream of air pressure, thereby ensuring that the breathing pathway remains unobstructed throughout the night.

Additionally, modern CPAP machines come with a range of advanced features. These can include built-in humidifiers to prevent dry mouth or throat and sleep-tracking capabilities monitoring patients sleep patterns and quality over time.

Cons Of CPAP

The requirement to sleep in a specific position can make the use of CPAP machines uncomfortable. This was my experience with CPAP. You might have specialized pillows or headgear, making it easier to find a comfortable sleeping position. But without them, I found myself lying on my back, which wasn’t the most comfortable position.

Another significant downside of CPAP machines is the many expenses involved. The CPAP machines themselves are not cheap. Standard CPAP machines start from $500, while you can buy a mouthpiece for as low as $50. Additionally, effective apnea treatment requires more than one appointment for therapy and analysis, which further adds to the overall cost.

Which Oral Appliance I Recommend For Sleep Apnea? A Comparison

Both CPAP machines and mouthpieces have their merits and use cases. In my search for sleep apnea and snoring treatment, I have prioritized four main factors – expenses, effectiveness, comfortability, and ease of use.

CPAP costs a lot, ranging from $500 to over $3000. Insurance may cover some of these costs, but that often involves tedious paperwork and wait times. Oral appliance therapy, on the other hand, can cost as little as $100 for a professionally fitted oral device. Over-the-counter or online versions are even cheaper and, in some cases, can come with custom fitting too.

Mouthpieces are highly effective, especially for mild to moderate sleep apnea. Of course, CPAP is more effective in treating all levels of sleep apnea but comes with use issues due to their bulkiness and noise level. Many patients, including myself, start skipping nights with a CPAP as it’s inconvenient to sleep with a bulky device on your face.

CPAP machines require a prescription and usually involve a sleep study, making them less readily available. Oral appliance therapy can be obtained over the counter or through simple online orders. Their ease of use — simply insert before sleeping — outshines the complex setup of a CPAP machine, which may involve tubes, masks, and electricity.

Patients using CPAP complain about the discomfort caused by the mask, making it harder to fall asleep. Mouthpieces offer a more natural sleep experience, allowing for freedom of movement and various sleep positions. The only comfort drawback is a slight jaw ache during first uses, but it has gone away after a few weeks.

Considering these factors, I recommend trying a mouthpiece for apnea before purchasing a CPAP. Oral appliances are easily available, and you don’t need to undergo any sleep therapy studies or visit a doctor for a prescription. Most importantly, there’s a high chance of a mouthpiece improving your sleep apnea symptoms and overall well-being.

If you try a mouthpiece for a few weeks and find no relief, then consider investing in a CPAP machine and consult a sleep care specialist. But for most patients, a mouthpiece for apnea is one of the most cost-effective, comfortable, and readily available solutions for treating apnea.

Wrapping Up

Mouthpieces provide a balanced combination of cost-efficiency, effectiveness, availability, and comfort. I recommend starting your sleep apnea treatment journey with a mouthpiece. Try it out for a few weeks and gauge its impact on your symptoms. If it proves ineffective, consider the more expensive alternative of a CPAP machine and consult a sleep specialist. But considering all the details and the price of a CPAP, a mouthpiece is a low-risk investment.