Oral appliance vs CPAP for sleep apnea: which fits you?

What’s going on

This page is for adults with a sleep apnea diagnosis, or waiting on one. If you haven’t been tested, start with a physician. Only a physician can diagnose sleep apnea and prescribe either treatment.

CPAP Strong blows a gentle stream of air through a mask to hold your airway open. A custom oral appliance Some is a mouthpiece made from your teeth. It holds your lower jaw forward so your airway stays more open.

Both are real treatments. They differ in how well they work on a sleep test, how often people wear them, and what they ask of you.

Efficacy vs adherence

On a sleep test, CPAP does more

The AASM and AADSM joint guideline pooled the research. CPAP lowered breathing pauses (AHI) more than oral appliances, by about 6 events an hour on average. In moderate to severe apnea, people were more likely to reach the target AHI with CPAP.

The AASM’s patient site calls CPAP the most effective treatment for sleep apnea. It says oral appliances help most in mild to moderate apnea.

In daily life, people often wear an appliance more

A treatment only works on the nights you use it. The same guideline found people reported sticking with oral appliances more than CPAP, and fewer stopped because of side effects.

A 2013 randomized trial tested both in 108 people with moderate to severe apnea, one month each. CPAP lowered AHI more. People reported wearing the appliance about 6.5 hours a night, compared with about 5.2 hours for CPAP.

Sleepiness, driving-simulator scores and quality of life improved about equally on both. The authors suggest CPAP’s stronger effect was offset by less use. That was a short trial, so it can’t show long-term results.

Who is a candidate for each

CPAP is usually the first choice. The AASM strongly recommends it for adults with obstructive sleep apnea and excessive sleepiness.

An oral appliance is an option when:

• You can’t tolerate CPAP, or you prefer another treatment. The guideline recommends an appliance over no treatment for these adults.
• Your apnea is mild to moderate, where the AASM says appliances help most.
• You have enough healthy teeth to hold it, and healthy gums and jaw joints. A dentist checks this before making one.

Side effects

CPAP

The AASM lists the common ones:

• Mask leaks, or straps that rub and leave marks or sores
• A dry or stuffy nose, dry mouth or throat
• Air pressure that feels too strong at first

Most have a fix: a different mask, a heated humidifier or the ramp setting. See CPAP alternatives for troubleshooting steps. If you sleep on your side, see CPAP masks for side sleepers.

Oral appliance

The AASM lists frequent, usually minor side effects:

• Extra saliva, or a dry mouth
• Tooth and jaw discomfort
• Temporary bite changes in the morning

Less often, people get jaw pain, jaw joint (TMJ) symptoms or a lasting change in how their teeth meet. The guideline notes that most appliance side effects are dental. That’s why it suggests a dentist keep an eye on your teeth and bite over time. See CPAP, dry mouth and your teeth for the mouth side of both.

The follow-up sleep test

With CPAP, your machine records use and how well it’s working, and your care team reviews that data. The AASM advises follow-up and troubleshooting after you start.

An appliance has no built-in data like that. So the guideline suggests a follow-up sleep test with the appliance in, once the dentist has finished adjusting it. The AASM’s 2009 guideline says the same: test after final adjustments to confirm the benefit.

Snoring going quiet isn’t proof. An appliance can soften snoring while breathing pauses continue, so the test is the only way to know.

What a dentist or doctor can do

Your sleep physician reviews your test, symptoms and health, then prescribes CPAP, an appliance or something else. They order the follow-up test and decide whether the treatment is working.

A dentist trained in dental sleep medicine makes the custom appliance on that prescription. They fit it, move your jaw forward in small steps over several visits, and watch for changes in your teeth and bite. The AASM says most people take a few weeks to get used to sleeping with one.

Both the guideline and the AASM recommend regular visits with each of them over time. See what a custom appliance costs and does insurance cover an oral appliance?

What about a store-bought mouthpiece?

An over-the-counter snoring mouthpiece is not a sleep apnea treatment. No store-bought oral appliance is FDA-cleared for sleep apnea; they’re cleared to reduce snoring in adults. The AASM says over-the-counter devices are not recommended for snoring or sleep apnea.

A night guard for grinding isn’t one either. It doesn’t move your jaw forward. See sleep apnea appliance vs night guard.

What not to do

• Don’t swap CPAP for an appliance on your own. Make the change with your physician, and plan the follow-up test.
• Don’t judge by snoring alone. Quiet nights don’t prove your apnea is treated.
• Don’t ignore jaw or bite changes. Tell your dentist early; adjustments are easier then.