Night guard vs sleep apnea mouth guard: what's the difference?

What’s going on

A night guard and a sleep apnea appliance both go in your mouth at night, and both are shaped to your teeth. That’s where the likeness ends. One protects your teeth. The other holds your airway open.

People mix them up for good reason. Grinding and snoring often show up in the same person, and both keep a partner awake. See teeth grinding and snoring for how they’re linked.

How they’re built

A night guard: one flat tray

A night guard, which dentists call an occlusal splint, is a single tray over your upper or lower teeth. Its biting surface is flat, so your teeth slide on it instead of grinding on each other.

AASM says a guard protects your teeth while you sleep. Some are soft plastic you boil and bite at home, but AASM notes a proper fit usually takes a dentist.

A night guard doesn’t move your jaw. It isn’t designed to reduce snoring or treat sleep apnea.

A sleep apnea appliance: two trays, jaw forward

A sleep apnea appliance, or mandibular advancement device, has an upper and a lower tray joined together. The link holds your lower jaw slightly forward.

That pulls your tongue forward and keeps the back of your throat more open. A custom, adjustable one Some is one treatment for obstructive sleep apnea.

The AASM and AADSM guideline suggests a custom, titratable appliance, meaning one that can be moved forward in small steps, over non-custom devices. The dentist adjusts it over several visits.

Store-bought snoring mouthpieces

Over-the-counter jaw-advancing mouthpieces Strong look like a simple version of the apnea appliance. They’re FDA-cleared only to reduce snoring in adults. The FDA file for ZQuiet Advance, for example, gives its use as “an aid in the reduction of snoring.”

No over-the-counter mouthpiece is cleared for sleep apnea. Skip one if you’re under 18, have central sleep apnea, loose teeth or gum disease, dentures or braces, jaw joint problems, or recent implants or major dental work. See who shouldn’t use a snoring mouthpiece and over-the-counter vs custom snoring mouthpieces.

Why a night guard isn’t apnea treatment

A flat guard doesn’t bring your jaw forward, so it does nothing to hold your airway open. It may even make breathing worse in some people with apnea.

In a 2004 pilot study, 10 people with sleep apnea slept one lab night without a guard and one with an upper night guard. Average apnea scores didn’t change significantly.

But in 5 of the 10, breathing events rose by more than half. Four moved into a worse apnea category, and snoring time rose by 40%.

This was a very small study with one night each, so it can’t tell you what will happen to you. The authors said clinicians should ask about snoring and apnea before recommending a guard. That’s sensible advice for anyone who grinds and snores.

Who orders what

	Night guard	Sleep apnea appliance
What it’s for	Protecting teeth from grinding	Keeping the airway open
Design	One flat tray	Two trays holding the jaw forward
Who diagnoses	A dentist spots grinding	A physician diagnoses sleep apnea
Who orders it	A dentist, or you buy one	A physician, after a sleep test
Who makes and fits it	A dentist, a lab, or you at home	A dentist, with follow-up visits

The ADA’s 2017 policy spells out the apnea side. Dentists screen for sleep-related breathing problems and refer people to a physician for diagnosis.

When a physician orders an oral appliance, a dentist decides whether one suits you and makes it. The ADA also calls for follow-up sleep testing by a physician to check that it’s working.

For insurance, see does insurance cover an oral appliance?

When you might need both

Some people grind and have sleep apnea. Here’s how to think about it:

• If you only grind, with no loud snoring, pauses or daytime sleepiness, a night guard is the usual choice. See custom vs over-the-counter night guards on our sister site.
• If you snore loudly or have apnea signs, get checked before you buy a guard. See snoring or sleep apnea?
• If you have both, one appliance may do both jobs. In a small 2009 lab study of 12 people who ground their teeth, an adjustable jaw-advancing appliance cut grinding episodes by 39% to 47% over a few weeks. A standard night guard cut them by 34%, which wasn’t statistically significant.
• If you use CPAP and grind, tell both your sleep team and your dentist. They can work out what fits under your mask.

That 2009 study was short and small, so treat it as a lead, not proof. A custom appliance for apnea still needs a physician’s diagnosis and order first.

What helps

• A night guard, if you grind and have no signs of apnea. It protects your teeth from wear and chips.
• A physician and a sleep test, if you might have apnea. CPAP Strong has the strongest evidence. A custom oral appliance is an option for many people.
• Less alcohol near bedtime. AASM says alcohol and caffeine before sleep may increase grinding. Less alcohol Some can also help snoring.
• Stress management. AASM says stress often causes or worsens grinding.

What a dentist or doctor can do

A dentist can look for worn or cracked teeth and jaw joint trouble, fit a night guard, and ask about your snoring. If you might have apnea, the dentist should refer you to a physician.

A physician can order a sleep test and, if you have apnea, talk through CPAP, an oral appliance and other options. AASM says a lab sleep study can also show grinding, though one is rarely needed for grinding alone.

What not to do

• Don’t use a night guard to treat snoring or apnea. It isn’t built for it, and in some people with apnea it may make breathing worse.
• Don’t use a store-bought snoring mouthpiece for grinding. It’s cleared only to reduce snoring. The ZQuiet FDA file lists a history of jaw pain or jaw joint disorder among the conditions that affect safe use.
• Don’t keep wearing a guard or appliance that hurts. Jaw pain, a changed bite or a sore tooth means stop and get it checked.