How to adjust a snoring mouthpiece, one small step at a time

What’s going on

An adjustable mouthpiece lets you change how far it holds your lower jaw forward. Jaw-advancing mouthpieces as a group Strong can reduce snoring. The trick is finding the least advancement that quiets you without making your jaw or teeth sore.

Dentists call this step-by-step process titration. With a custom appliance, a dentist does it over follow-up visits. With a store-bought one, you do it yourself.

Before you start, make sure a mouthpiece is right for you. Skip it if you’re under 18, might have sleep apnea, or have loose teeth, gum disease, dentures, braces, jaw joint problems, or recent implants or major dental work. See who shouldn’t use a snoring mouthpiece.

How to adjust it

1. Fit it first. Mold it at the maker’s starting setting. See how to fit a boil-and-bite mouthpiece.
2. Start at the lowest setting. Some people need very little advancement.
3. Wear it for several nights before changing anything. Early drooling and mild soreness often settle, and one night tells you little.
4. Ask your partner, or use a snoring app. You need to know whether you still snore. Apps can track sound, but they can’t tell you whether you have sleep apnea.
5. Move forward one step, only if you still snore. Then wait several nights again.
6. Stop at the first setting that works. More isn’t better once the snoring has eased.

Go slower if your jaw complains. An expert panel of dental sleep specialists suggests slowing the rate of forward adjustment as a first step for jaw pain. In their example of a custom appliance, the pace drops from two small steps a week to one.

How far is too far

There’s no single right number. It depends on your jaw.

• Side effects rise past about half your reach. The expert panel says side effects can increase starting at 50% of your maximum forward jaw movement. It advises conservative titration.
• Benefit levels off. In a clinical study of custom appliances, the benefit rose as the jaw moved forward, then plateaued at about 70% of each person’s maximum reach.
• Many people need little. In that study, people with mild sleep apnea needed about 3.5 mm on average. That was with sleep testing and dentist care, not a store-bought mouthpiece for snoring.

The three mouthpieces below top out at 6 to 8 mm. Don’t treat the last setting as a goal. If you reach the end and still snore, a bigger push isn’t the answer; see a physician.

Morning bite checks

Your bite can feel slightly off when you take the mouthpiece out. That’s a known side effect of holding the jaw forward all night. Check it each morning:

1. Take the mouthpiece out and close gently on your back teeth.
2. Notice whether they meet the way they did before you started.
3. Check again after breakfast.

In one trial, jaw discomfort from a jaw device mostly faded within about 30 minutes of taking it out. The expert panel’s first steps for a bite that feels off are waiting, jaw stretches, and a morning bite guide from a dentist.

When to back off

Go back one step, and give it a few nights, if:

• Your jaw muscles or joints ache past mid-morning.
• A tooth feels sore to bite on.
• Your bite still feels off by lunchtime.

The expert panel calls pain persistent if it lasts or worsens through the day, lasts more than a few weeks, or gets in the way of daily life. That’s the point to stop and see a dentist. Stop at once if your jaw locks, won’t open fully, or a tooth feels loose.

How three adjustable mouthpieces adjust

SnoreRx Plus

Two trays fit over your upper and lower teeth and meet at the front, where you set the advancement. The maker says it moves in 1 mm steps. Its FDA file, filed under the name SnoreRx, describes up to 6 mm.

VitalSleep

The trays are joined by a flexible hinge, with a small screw on each side. The FDA file describes marks on the side of the device, so you can see how far each screw has moved the lower tray. The maker says it adjusts up to 8 mm in 1 mm steps with a small screw tool; the 2020 FDA file says 6 mm.

Turn both screws by the same amount. For jaw pain, the expert panel’s first steps include checking that the jaw sits centered. VitalSleep also comes in a smaller size, per the maker.

ZQuiet Advance

You change the advancement by swapping the side straps that join the trays. The maker lists a starting strap, then +2, +4 and +6 mm. The FDA file describes three positions, up to 6 mm.

Each strap change is a 2 mm jump. If a step feels like too much, go back to the previous strap rather than pushing through.

What a dentist or doctor can do

A dentist can check where your jaw sits with the mouthpiece in, and whether your bite is changing. Tell your dentist you wear one at your next checkup.

If you’re still snoring at a comfortable setting, or you feel tired in the day, see a physician. A physician diagnoses sleep apnea, and a store-bought snoring mouthpiece doesn’t treat it.