Alternatives to CPAP
Oral Appliances for Sleep Apnea: Who They Help
An oral appliance is a custom mouthpiece that holds your lower jaw forward to keep the airway open. The AASM and the American Academy of Dental Sleep Medicine recommend considering one for adults with obstructive sleep apnea who cannot tolerate CPAP or prefer another therapy, using a custom, titratable device from a qualified dentist with follow-up sleep testing.
How oral appliances work
Mandibular advancement devices fit over your upper and lower teeth and move the lower jaw slightly forward, which pulls the tongue forward and widens the airway. Titratable versions can be adjusted gradually.
They are prescribed by a physician and made and fitted by a dentist trained in dental sleep medicine.
What the guideline says
The 2015 AASM and AADSM guideline recommends that sleep physicians consider prescribing oral appliances, rather than no treatment, for adults with obstructive sleep apnea who are intolerant of CPAP or prefer alternate therapy. It suggests a qualified dentist use a custom, titratable appliance over non custom devices.
It also suggests that qualified dentists provide oversight for dental side effects, that sleep physicians conduct follow-up sleep testing to confirm the appliance is working, and that patients return for periodic visits.
Who tends to do well
Oral appliances are often considered for mild to moderate obstructive sleep apnea or for people who cannot use CPAP. They generally lower AHI less than CPAP, so a follow-up sleep test matters.
You need enough healthy teeth to anchor the device, and jaw joint problems may limit how far it can be advanced.
Side effects
Possible side effects include jaw soreness, tooth discomfort, excess saliva or dry mouth, and gradual changes in your bite over time. That is why the guideline recommends dental follow-up.
Tell your dentist about persistent jaw pain or bite changes.
Over the counter mouthguards
Boil and bite snoring devices sold online are not the same as custom titratable appliances. The guideline favors custom, titratable devices for obstructive sleep apnea.
Snoring relief does not prove your apnea is treated. Only a sleep test can show that.
Frequently asked questions
Do oral appliances work for sleep apnea?
They can for many people, especially with mild to moderate obstructive sleep apnea or those who cannot use CPAP. The AASM recommends a follow-up sleep test to confirm effectiveness.
Is a mouthguard as good as CPAP?
Generally CPAP lowers AHI more. But a device you use every night can be better than a CPAP you do not use. Discuss tradeoffs with your clinician.
Do I need a prescription for a sleep apnea oral appliance?
A sleep physician prescribes it and a qualified dentist makes and fits it. That is the pathway the AASM guideline describes.
Can I use an oral appliance with CPAP?
Some people use both, for example an appliance for travel. Your clinician and dentist can advise whether combined use makes sense for you.
Sources
Last reviewed October 11, 2026. How we research · Report an error