Mandibular Advancement Device: How Does It Help You Sleep Better?

When you asked your sleep apnea doctor for a change from CPAP therapy, you were advised to switch over to a mandibular advancement device – something you are not too familiar with. What exactly is the device all about? How does it work and most importantly, how does it help in getting better sleep?

What is a mandibular advancement device? 

It is a type of laboratory fabricated, custom-made and adjustable oral or dental appliance that is used in the treatment of mild to moderate sleep apnea. According to the American Academy of Sleep Medicine such dental appliances are viable treatment options for such stages of severity of sleep apnea and for patients who are not the right candidates for CPAP or may have not got the desired results from this therapy option. A special dentist or an orthodontist is needed for fitting these devices as they need frequent and regular adjustments.

There can be two types of dental devices:

  1. Mandibular advancement device (MAD): one of the most commonly used, it looks like a mouth guard used by sports personnel.
  2. The Tongue retraining device (TRD) that keeps the tongue in place during sleep so that the airways remain open to allow free breathing.

How do the devices work? 

Also known as ‘sleep apnea oral appliances’ and “sleep apnea mouth guards” the devices work by moving the lower jaw slightly which in turn, tightens the upper airway muscles. This prevents airway obstruction. Snoring is reduced since tightening of the muscles prevents vibration of the upper airway tissues with the passage of air over them.

Some reasons for their popularity are: they are non-invasive; reversible; noiseless and usually user-friendly. There have been a lot of design improvisations of these devices with the aim to ease jaw movement like yawning, speaking, etc and to allow users to breathe through their mouths.

Who should use them? 

–          The mandibular advancement device is recommended for women with sleep apnea and men who sleep on their backs and their apnea-hypopnea index is < 10

–          Snorers without sleep apnea

–          Who are not able to use a CPAP or have failed other treatments.

–          As an initial treatment for primary snoring and upper airway resistance syndrome

–          Mild to moderate obstructive sleep apnea [apnea hypopnea index (AHI) up to about 25/h] 

 Those who should NOT use the devices are: 

–          Having problems with Temporomandibular joint (TMJ).

–          Having Oral/facial pain.

–          Patients without teeth; only a few remaining teeth or with loose or diseased teeth.

In terms of efficacy these devices improve of sleep apnea symptoms in 50 to 60% of patients and snoring is eliminated in almost 90% of users.

What are the drawbacks of a mandibular advancement device? 

–          Some patients find it cost-prohibitive (some devices cost over $2000)

–          Though less cumbersome than CPAP, some still find them uncomfortable.

–          Improper fitting can cause dislocation of the device over time resulting in many dental problems.

–          Not as effective as CPAP.

–          Nighttime pain

–          Dry lips

–          Discomfort with teeth

–          Excessive salivation

–          Some patients have reported permanent changes in the teeth or jaw position.

–          Worsening of apnea.

–          Changes in bite, lasting for sometime in the morning

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