The Short Answer
Yes, some mouth guards work for sleep apnea, but only a specific kind. The kind that works is a custom oral appliance, made by a dentist, that holds the lower jaw slightly forward while you sleep. It is often called a mandibular advancement device (MAD). It is prescribed after a physician diagnoses sleep apnea. It is not the same as the mouth guard people wear to stop teeth grinding, and it is not the same as a boil-and-bite device from a store.
Here is the honest summary from the research. A custom appliance lowers the number of breathing pauses per hour, improves daytime sleepiness, and is easier for many people to keep using than CPAP. CPAP still lowers the AHI more. So the right choice depends on how severe your sleep apnea is, how you sleep, and what you will really wear every night.[1][2][4]
For a full guide to how these devices are made and fitted, see dental treatment for sleep apnea. This page answers the question people ask first: does it really work?
Three Kinds of Mouth Guard, and Only One Treats Sleep Apnea
The words "mouth guard" cover very different products. Knowing which is which can save you money and prevent you from missing a real diagnosis.
Night guards for grinding
A night guard, also called an occlusal splint, is a flat cover for your teeth. It protects enamel from grinding and clenching. It does not move your jaw forward, so it is not a treatment for sleep apnea. If you grind your teeth, see our page on the dental night guard. Some people have both grinding and sleep apnea, so mention any snoring or tiredness to your dentist.
Over-the-counter boil-and-bite devices
These are sold without a prescription. You soften the plastic in hot water and bite into it to mold it. They are meant for snoring. One FDA clearance document for an over-the-counter snoring mouthpiece lists its use as an aid to reduce snoring, and says the device was cleared for over-the-counter use.[8] That is a clearance for snoring, not for treating sleep apnea. For a deeper comparison, see custom vs over-the-counter snoring mouthpieces.
Custom oral appliances
A custom appliance is made from impressions or digital scans of your teeth, in a lab, and the dentist adjusts it in small steps over weeks. The AASM and the American Academy of Dental Sleep Medicine guideline suggests that a qualified dentist use a custom, adjustable appliance instead of a non-custom device when a sleep physician prescribes oral appliance therapy for sleep apnea.[1] This is the kind of device studied in most of the research below.
What the Research Shows
Compared with no treatment or a placebo device
An overview of systematic reviews found that, in the higher-quality reviews, mandibular advancement splints improved both daytime sleepiness and the AHI compared with inactive appliances.[5] That is the core evidence that a properly made appliance does something real.
Compared with CPAP
A 2017 systematic review found CPAP was significantly better than oral appliances at lowering the AHI and raising the lowest oxygen level during sleep. It found no significant difference in sleepiness scores, and concluded it is reasonable to offer an oral appliance to people who cannot or will not keep using CPAP.[4]
A randomized crossover trial of 126 people with moderate to severe sleep apnea tested one month of each treatment. CPAP lowered the AHI to about 4.5 events per hour, and the appliance to about 11.1. But people reported using the appliance about 6.5 hours a night, compared with 5.2 hours for CPAP. Blood pressure was not worse with the appliance, and sleepiness, driving simulator performance, and disease-specific quality of life improved by similar amounts on both. The authors suggested that CPAP's greater efficacy may be offset by lower use.[2] Note that the trial lasted one month, so it does not tell us about long-term differences.
What the Research Cannot Tell You Yet
Reviews of oral appliance research vary in quality. In the overview of systematic reviews, only two of eight scored as higher quality.[5] Many trials are short, such as the one-month crossover trial above, and follow small groups. Results also differ by device design, how far the jaw is advanced, and who was studied. So treat any single number as a rough guide. Your own repeat sleep test is the strongest evidence about your own appliance.
Which severity it works for
The AASM and AADSM guideline recommends that physicians consider an oral appliance for adults with sleep apnea who cannot tolerate CPAP or prefer another treatment.[1] The AASM surgical practice parameters state that oral appliances are more often appropriate in mild and moderate sleep apnea.[6] Medicare's coverage rules reflect the same idea. They cover a custom appliance for a documented AHI or RDI of 15 or higher, or 5 to 14 with certain symptoms or conditions, and for an AHI above 30 when a person cannot tolerate CPAP or CPAP is not an option.[7]
Why a Sleep Test Before and After Matters
Sleep apnea is diagnosed by a physician using a sleep study, done in a lab or at home.[9] A dentist cannot diagnose it from a mouth exam alone. Skipping the test can mean treating snoring while a serious problem goes undetected.
A second test matters just as much. A dentist can tell that the device is comfortable and that your partner hears less snoring, but only a repeat test with the appliance in place shows whether your breathing events actually dropped. The AASM and AADSM guideline suggests follow-up sleep testing to improve or confirm treatment success, and regular visits with both a dentist and a sleep physician.[1] The dentist checks the device and looks for tooth or bite changes.[1]
- Before: a sleep study and a physician's diagnosis and prescription
- During: a dentist adjusts the device in small steps over several weeks
- After: a repeat sleep test with the device in place
- Ongoing: regular dental checkups and periodic follow-up with your sleep physician
Who Mouth Guards Do Not Work For
An appliance is not right for everyone. It may be a poor fit in these situations:
- Severe sleep apnea, as a first choice. CPAP usually lowers the AHI more. Appliances are considered for severe sleep apnea mainly when CPAP is not tolerated or refused.[1][4]
- Not enough healthy, stable teeth. The device needs teeth to hold onto. Gum disease and loose teeth need to be treated first.
- Jaw joint problems. Pushing the jaw forward can worsen jaw joint pain. A dentist should examine your jaw joints first.
- Types of sleep apnea other than obstructive. The appliance treats blockage of the airway. Your physician decides which kind you have.
- Devices that do not fit well. In one trial, about one-third of people had a compliance failure with a boil-and-bite device, mostly because it did not stay in place.[3]
Possible side effects
Appliances can cause jaw soreness, extra saliva or dry mouth, and over time changes in how your teeth fit together. The guideline suggests dentist oversight of oral appliance therapy to watch for dental side effects and bite changes.[1]
Cost and Insurance
Costs vary widely by location, dentist, device, and case. Because sleep apnea is a medical condition, coverage typically comes from medical insurance, not dental insurance. Medicare's policy covers custom appliances that meet its criteria and are provided by a licensed dentist, and it states that prefabricated (store-bought style) devices are denied as not reasonable and necessary.[7] See our guide on oral appliance cost and insurance for more.
Next Steps and Finding a Dentist
If you snore, feel tired during the day, or have been told you stop breathing in your sleep, talk to your physician about a sleep study first. Once you have a diagnosis and a prescription, look for a dentist who provides oral appliance therapy and who will work with your sleep physician. You can start with our provider directory. A prosthodontist can be a good starting point, since prosthodontists are trained in making custom oral devices, though not every prosthodontist or general dentist provides this care. Browse our list of dentists who provide oral appliance therapy, grouped by state.
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