For people with obstructive sleep apnea (OSA), finding a treatment that actually works—and feels comfortable—is critical. While continuous positive airway pressure (CPAP) therapy is widely prescribed, it’s not the only option. Mandibular advancement devices (MADs), a category of oral appliances, have emerged as a non-invasive alternative for certain types of sleep apnea.
If you’re wondering how these devices work, whether they’re right for you, and how to get them fitted properly, this guide is for you.
What Are Mandibular Advancement Devices?
Mandibular devices are custom-fitted oral appliances that shift the lower jaw (mandible) slightly forward during sleep. This forward position helps prevent the collapse of soft tissues at the back of the throat—a common cause of airway blockage in OSA.
While these devices are not suitable for everyone, they can be particularly effective for people with mild to moderate OSA, especially if they cannot tolerate CPAP machines.
According to the American Academy of Dental Sleep Medicine, mandibular devices are a proven treatment method when prescribed and monitored appropriately.
How Mandibular Devices Work
When you fall asleep, the muscles in your throat relax. In individuals with OSA, this can lead to partial or complete airway obstruction, especially if the tongue falls backward. Mandibular devices reduce this risk by physically repositioning the lower jaw forward, which helps pull the tongue away from the airway and opens the throat space.
Some devices also include tongue-retaining features or adjustable hinges that allow fine-tuning of the jaw position over time.
Pros of Using a Mandibular Device
1. Less Intrusive Than CPAP
Unlike CPAP machines, mandibular devices don’t involve tubes, masks, or air pressure. This makes them easier to tolerate for people who find CPAP uncomfortable or noisy.
2. Portable and Travel-Friendly
MADs fit in a small case and require no power supply, making them ideal for travel or overnight stays.
3. Improves Snoring in Many Cases
Because they keep the airway open, mandibular devices are also effective for reducing or eliminating habitual snoring—even in people without diagnosed OSA.
4. No Electricity or Equipment Maintenance
There’s no need for cleaning tubing or replacing filters. You simply rinse and store the device as directed.
A 2023 systematic review from the Journal of Clinical Sleep Medicine confirms that many patients report greater satisfaction and adherence with oral appliances compared to CPAP, especially within the first year.
Cons to Be Aware Of
1. Not Effective for All Types of Sleep Apnea
Mandibular devices are less effective in people with severe OSA or those whose apnea is central (CSA), where the brain fails to signal the muscles to breathe.
2. Possible Jaw and Tooth Discomfort
Mild jaw soreness or tooth pressure is common during the initial adjustment period. Long-term use can sometimes result in changes to bite alignment or dental discomfort.
3. Requires Dentist Supervision
These aren’t over-the-counter mouthguards. Proper fitting involves working with a sleep-trained dentist who can monitor jaw positioning and make adjustments as needed.
4. Cost and Insurance Variability
While some insurance plans cover mandibular devices with a confirmed OSA diagnosis, others don’t. Out-of-pocket costs can range from $1,800 to $2,500.
Who Is a Good Candidate?
Mandibular devices work best for:
- Adults with mild to moderate OSA
- People who cannot tolerate CPAP
- Individuals who sleep on their back or side
- Patients without extensive dental issues or temporomandibular joint disorder (TMJ)
Your eligibility will be determined through diagnostic testing, often starting with a home sleep study or polysomnography. From there, your sleep specialist may refer you to a dentist experienced in dental sleep medicine for evaluation.
How to Get the Right Fit
A mandibular device is only as good as its fit. Poorly fitted appliances can lead to pain, ineffectiveness, or even worsening symptoms. Here’s how to get the best fit:
Work with a Qualified Sleep Dentist
Choose a provider who’s familiar with American Academy of Sleep Medicine (AASM) standards. They’ll take impressions of your teeth and adjust the advancement angle of the lower jaw for optimal results.
Don’t Skip Follow-Ups
Your jaw alignment, comfort, and symptom control should be assessed regularly. Adjustments can improve outcomes and reduce side effects.
Use Calibration Tools When Provided
Some MADs come with adjustable dials or bands that allow for gradual titration of jaw positioning. These should be changed incrementally under your provider’s guidance.
Monitor Your Progress
Use a home sleep test post-fitting to confirm that your apnea-hypopnea index (AHI) is improving with the device in place. This step is often required for insurance reimbursement too.
Tips for Maintaining Your Device
- Clean daily with a soft toothbrush and non-abrasive cleaner
- Soak weekly in a denture-safe solution
- Avoid boiling water or dishwashers, which can deform the material
- Store in a ventilated case to prevent bacterial buildup
If you grind your teeth or clench your jaw, inform your dentist. Some appliances may not be suitable in those cases, or may require reinforcements.
When to Try Something Else
Mandibular devices aren’t a one-size-fits-all answer. If your AHI doesn’t improve or symptoms return (like daytime sleepiness, choking at night, or morning headaches), revisit your options. In some cases, combination therapy—such as using positional therapy or EPAP in addition to an oral device—may work better.
Explore alternatives on how CPAP, EPAP, and positional therapies compare for mixed and central apnea types.
Key Takeaways
- Mandibular advancement devices offer a non-invasive alternative for many with mild to moderate OSA.
- Proper fit, consistent follow-ups, and hygiene are essential for long-term success.
- They are not ideal for every sleep apnea patient—especially in severe or complex cases.
- Work with a sleep-trained dentist and track your progress with post-fit testing.
Next Steps: Explore Your Options
Wondering if you’re a candidate for a mandibular device? Start by identifying your sleep apnea risk with a 60-second AI scan or take a STOP-Bang screening quiz. From there, schedule a consultation with your sleep specialist to discuss whether a MAD might be the right step forward.
