Are mouth guards an effective treatment for sleep apnea?

DEAR DOCTOR K:

I have sleep apnea, and I don’t particularly like the CPAP treatment. I’ve heard that night guards might be an effective alternative. What can you tell me?

DEAR READER:

One way or another, getting treatment for sleep apnea is really important. Untreated, sleep apnea increases your risk for high blood pressure, stroke and early death.

The airways of people with obstructive sleep apnea narrow as they sleep, and air struggles to get through. People with this condition may breathe shallowly or stop breathing several times an hour. Each time that happens, the amount of oxygen in their blood drops. As a result, all the organs of the body that need oxygen suffer temporarily. If low oxygen levels occur repeatedly, it can cause more persistent problems.

The most-tested treatment for sleep apnea is a breathing machine known as “continuous positive airway pressure” (CPAP). CPAP keeps airways open by increasing the pressure at which air travels through them. It’s effective, but it requires a pump to generate pressurized air, a conduction tube and a mask that must be worn over the nose.

Many people who try CPAP don’t stick with it. Those who abandon CPAP often say that the mask is claustrophobic, the tubing gets in their way as they sleep, or the hum from the machine is hard to tolerate.

For that reason, a number of alternative devices have been proposed. These are used inside the mouth and are designed to keep the airway open — without involving a compressor machine or tubing. A report published in JAMA Internal Medicine describes one such device, which is similar to a mouth guard. It positions the lower jaw slightly forward and down. This opens the airway. The device is simple, portable and silent.

For the study, researchers recruited 96 men and women with sleep apnea. Half used a custom-fitted oral device as they slept. The other half used a placebo night guard — one that didn’t correctly reposition the lower jaw. At the end of the four-month study, people who used the custom appliance had greater improvements in sleep apnea and snoring than those using the placebo device. Both groups had a little improvement in daytime sleepiness.

Interestingly, more than half of the people who used the placebo device found it so effective that they wanted to keep using it.

This was a study of a single device, and it lasted just for four months. So it is difficult to draw definite conclusions about the device’s value. And it is not possible to draw conclusions about other oral appliances. Yet, the report is encouraging for those who have trouble using CPAP.

If you have sleep apnea, try the following to counter the problem. First, sleep on your side. Though you’ll inevitably change position during the night, starting off on your side may help keep your airways open. Second, lose a few pounds if you are overweight. If these changes don’t work, talk with your doctor about other treatment options.