Skip to content
How It Works
Explore
Resources Ask a Question
Who It's For
Patients
Decode results, prep for appointments, weigh options.
Caregivers & advocates
Carry the research load for someone you love.
Providers & clinicians
Resources for patients in your practice.
Log In Ask a Question
PubMed This is a summary of 32 peer-reviewed journal articles Updated
Sleep Medicine · Obstructive Sleep Apnea

Do Mandibular Advancement Devices Work for Sleep Apnea?

At a Glance

Custom mandibular advancement devices (MADs) are a highly effective treatment for mild-to-moderate obstructive sleep apnea. By gently moving the lower jaw forward, these mouthguards keep the airway open, offering a proven alternative for patients who cannot tolerate a CPAP machine.

In this answer

4 sections

01

How MADs Work (and When They Don’t)

02

Are You a Good Candidate?

03

Why You Need a Custom-Fitted Device

04

What to Expect: The Fitting Process and Side Effects

Yes, custom mouthguards—medically known as Mandibular Advancement Devices (MADs) or oral appliances—are a highly effective, evidence-based treatment for sleep apnea [1][2]. For people who cannot tolerate a CPAP machine, a MAD is often the best alternative to ensure you get restful, continuous sleep.

While CPAP is generally better at completely eliminating breathing pauses, studies show that patients often wear their MADs for more hours per night because they find them much more comfortable [3][4]. Because they are used more consistently, MADs can provide similar improvements in daily symptoms and overall quality of life [5][6].

How MADs Work (and When They Don’t)

A MAD works by gently holding your lower jaw forward while you sleep [7]. By moving the jaw forward, the device pulls your tongue and the soft tissues of your throat away from the back of your airway, keeping the passage open so you can breathe [8][9].

Because of how they work, MADs are highly effective for obstructive sleep apnea (OSA), where the airway physically collapses [10][11]. They are most commonly prescribed for mild-to-moderate OSA, though they can also be an option for severe OSA if you absolutely cannot use CPAP [12][13].

However, a MAD will not treat central sleep apnea (CSA) [14][15]. In central sleep apnea, the brain temporarily stops sending the signal to breathe—there is no physical blockage to clear, so moving the jaw forward doesn’t help. If you have mixed sleep apnea (a combination of both), a MAD may only help the obstructive part of your condition.

Are You a Good Candidate?

While MADs are a great option for many, they require physical support from your mouth to work properly. To safely use a standard MAD, you generally need a healthy number of strong teeth and good periodontal (gum) health, because the device anchors to your teeth and places mechanical stress on them [16][17].

You will need a careful evaluation by a dentist if you:

  • Wear full dentures or are missing many teeth: While this used to mean you couldn’t get a MAD, some specially modified devices can now work for people with dentures or missing teeth [18].
  • Have TMJ issues: If you have severe, active temporomandibular joint (TMJ) disease, it must be addressed first. However, some people with mild TMJ pain actually find that an oral appliance helps alleviate their symptoms [19].
  • Have extensive, untreated dental decay or severe gum disease: These issues must be treated before you can safely anchor a device to your teeth [16].

Why You Need a Custom-Fitted Device

It might be tempting to buy a cheaper “boil-and-bite” mouthguard over the counter, but these are not recommended for long-term sleep apnea treatment [20][21]. Proper treatment requires a custom-made MAD [22][23]. Here’s why:

  • Adjustability (Titration): Custom devices have mechanisms that allow the dentist to adjust the jaw position by millimeters. This ensures the jaw is moved exactly enough to open the airway, but not so much that it causes severe pain [22].
  • Comfort and Adherence: Custom appliances are made from exact impressions of your teeth, making them far less bulky and generally much more comfortable, which makes you more likely to actually wear them [24].

What to Expect: The Fitting Process and Side Effects

To get a custom MAD, you will need to see a qualified sleep dentist—a dentist with specialized training in dental sleep medicine. Your sleep doctor can usually provide a referral.

The Process:
First, the dentist will take digital 3D scans or traditional physical impressions of your teeth. The device is then fabricated in a lab. Once it arrives, you will have a fitting appointment. You won’t find the perfect fit on night one; the dentist will gradually adjust (titrate) the device over several weeks to find the balance between comfort and effectiveness. Finally, you will typically need a follow-up sleep study with the device in place to confirm it is actually lowering your apnea events [25].

Managing Side Effects:

  • Initial Adjustments: When you first start using the device, both dry mouth and excessive salivation (drooling) are very common [26]. These typically resolve as your mouth gets used to the appliance. Moving the jaw all night can also cause short-term jaw muscle pain or tooth soreness, which your dentist will help manage through gradual adjustments [27][28].
  • Long-term Bite Changes: Long-term use can cause your teeth to shift slightly and change your bite [29][30]. To manage this, your sleep dentist will monitor your bite closely and will likely give you a “morning repositioning device” or prescribe specific morning jaw stretching exercises [31][32]. These morning routines help reset your bite and muscles each day, significantly reducing the risk of permanent changes.

Common questions in this guide

Can a mandibular advancement device replace my CPAP?
For many people with mild-to-moderate obstructive sleep apnea, a custom oral appliance is an effective alternative to CPAP. While CPAP is often better at completely eliminating breathing pauses, many patients find mouthguards more comfortable and wear them more consistently.
Do oral appliances work for central sleep apnea?
No, mandibular advancement devices do not treat central sleep apnea. In central sleep apnea, the brain temporarily fails to send the signal to breathe rather than the airway physically collapsing, so moving the jaw forward will not resolve the issue.
Can I use an over-the-counter mouthguard for sleep apnea?
Over-the-counter or boil-and-bite mouthguards are not recommended for treating sleep apnea. A properly fitted custom device is necessary so a qualified sleep dentist can adjust the jaw position precisely to open your airway without causing severe pain or dental issues.
What are the side effects of wearing a sleep apnea mouthguard?
When you first start using a mandibular advancement device, you may experience dry mouth, drooling, or temporary jaw and tooth soreness. Long-term use can sometimes cause your bite to change, which is typically managed with a morning repositioning device and jaw exercises.
Can I get a sleep apnea mouthguard if I have missing teeth or dentures?
While a healthy number of strong teeth is generally required to anchor a standard device, having missing teeth or full dentures does not automatically rule you out. There are specially modified mandibular advancement devices designed to safely accommodate patients with extensive dental work.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Given my sleep study results, am I a good candidate for a Mandibular Advancement Device?
  2. 2.Do I have enough healthy teeth and bone support to anchor a custom device?
  3. 3.Can you refer me to a qualified dental sleep medicine specialist to get fitted?
  4. 4.Do I have any central sleep apnea events that would make an oral appliance less effective?
  5. 5.How and when will we do a follow-up sleep study to measure if the device is actually reducing my apnea events?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

Related questions

Are Ozone and UV CPAP Cleaners Safe to Use? FDA WarningsCan Menopause Cause Sleep Apnea? Symptoms ExplainedCan Opioids & Medications Cause Central Sleep Apnea?Does Sleep Apnea Cause Teeth Grinding?Difference Between AHI and RDI on a Sleep Study ReportCPAP vs. BiPAP: What is the Difference?Why Am I Waking Up Gasping: Sleep Apnea or Panic Attack?Does Sleeping Elevated or in a Recliner Help Sleep Apnea?Does Weight Loss Cure Obstructive Sleep Apnea?Home Sleep Test vs In-Lab Sleep Study: Which Do I Need?How to Prevent CPAP Mask Skin Irritation and BreakoutsHow Does the Inspire Sleep Apnea Implant Work?What Is Treatment-Emergent Central Sleep Apnea (TECSA)?

References

References (32)
  1. 1

    Mandibular Advancement Devices in Obstructive Sleep Apnea and Its Effects on the Cardiovascular System: A Comprehensive Literature Review.

    Polecka A, Nawrocki J, Pulido MA, Olszewska E

    Journal of clinical medicine 2024; (13(22)) doi:10.3390/jcm13226757.

    PMID: 39597901
  2. 2

    Update on oral appliance therapy.

    Marklund M, Braem MJA, Verbraecken J

    European respiratory review : an official journal of the European Respiratory Society 2019; (28(153)) doi:10.1183/16000617.0083-2019.

    PMID: 31554705
  3. 3

    Comparative Efficacy of Continuous Positive Airway Pressure and Mandibular Advancement Devices in the Treatment of Obstructive Sleep Apnea: A Systematic Review.

    Dipalma G, Inchingolo AM, Avantario P, et al.

    Journal of sleep research 2026; (35(3)):e70192 doi:10.1111/jsr.70192.

    PMID: 40921722
  4. 4

    Oral Appliances in Obstructive Sleep Apnea.

    Dieltjens M, Vanderveken O

    Healthcare (Basel, Switzerland) 2019; (7(4)) doi:10.3390/healthcare7040141.

    PMID: 31717429
  5. 5

    Comparing efficacy of the mandibular advancement device after drug-induced sleep endoscopy and continuous positive airway pressure in patients with obstructive sleep apnea.

    Gogou ES, Psarras V, Giannakopoulos NN, et al.

    Sleep & breathing = Schlaf & Atmung 2024; (28(2)):773-788 doi:10.1007/s11325-023-02958-2.

    PMID: 38085497
  6. 6

    Effectiveness of Continuous Positive Airway Pressure Versus Mandibular Advancement Device in Severe Obstructive Sleep Apnea Patients With Mandibular Retrognathia: A Prospective Clinical Trial.

    Lai H, Huang W, Chen W, Wang D

    Ear, nose, & throat journal 2022; (101(9)):606-615 doi:10.1177/0145561320969251.

    PMID: 33147061
  7. 7

    Diagnosis and Management of Obstructive Sleep Apnea: A Review.

    Gottlieb DJ, Punjabi NM

    JAMA 2020; (323(14)):1389-1400 doi:10.1001/jama.2020.3514.

    PMID: 32286648
  8. 8

    Three-dimensional craniofacial characteristics associated with obstructive sleep apnea severity and treatment outcomes.

    Gurgel M, Cevidanes L, Pereira R, et al.

    Clinical oral investigations 2022; (26(1)):875-887 doi:10.1007/s00784-021-04066-5.

    PMID: 34273012
  9. 9

    Three-dimensional upper airway changes with mandibular advancement device in patients with obstructive sleep apnea.

    Shete CS, Bhad WA

    American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 2017; (151(5)):941-948 doi:10.1016/j.ajodo.2016.09.025.

    PMID: 28457272
  10. 10

    Oral appliance therapy for the management of obstructive sleep apnea in adults: an umbrella review.

    Ghosh P, Janakiram C, Nk SV, et al.

    JBI evidence synthesis 2025; (23(5)):876-919 doi:10.11124/JBIES-23-00539.

    PMID: 40159944
  11. 11

    Treatment choice in mild to moderate sleep apnoea in the European Sleep Apnea Database.

    Fridriksson B, Hedner J, Zou D, et al.

    ERJ open research 2025; (11(6)) doi:10.1183/23120541.00360-2025.

    PMID: 41473545
  12. 12

    Evaluating the effectiveness of mandibular advancement devices in treating very severe obstructive sleep apnea: a retrospective cohort study.

    Leibovitz S, Levi S, Hanut A, et al.

    Sleep & breathing = Schlaf & Atmung 2025; (29(1)):84 doi:10.1007/s11325-025-03249-8.

    PMID: 39833552
  13. 13

    Severe obstructive sleep apnea treatment with mandibular advancement device: A case report.

    Guimarães MLR, Hermont AP, Guimarães TM, et al.

    Sleep science (Sao Paulo, Brazil) 2018; (11(2)):118-122 doi:10.5935/1984-0063.20180022.

    PMID: 30083300
  14. 14

    Use of mandibular advancement devices for the treatment of primary snoring with or without obstructive sleep apnea (OSA): A systematic review.

    De Meyer MMD, Vanderveken OM, De Weerdt S, et al.

    Sleep medicine reviews 2021; (56()):101407 doi:10.1016/j.smrv.2020.101407.

    PMID: 33326914
  15. 15

    Never say never: circumventing a contraindication to control apnoea-induced epileptic events with a mandibular advancement device.

    Fenton JE, Fitzgerald C, Dillon PJ, O'Shea D

    The Journal of laryngology and otology 2018; (132(11)):1036-1038 doi:10.1017/S0022215118001858.

    PMID: 30394239
  16. 16

    Periodontal effects of two Somnodent oral devices for the treatment of OSA: A finite element study.

    Zalunardo F, Bruno G, Caragiuli M, et al.

    Cranio : the journal of craniomandibular practice 2024; (42(4)):400-410 doi:10.1080/08869634.2021.1985209.

    PMID: 34605375
  17. 17

    Mandibular advancement device: prescription in adult dental sleep medicine - guideline of the German Society of Dental Sleep Medicine.

    Bernhardt O, Giannakopoulos NN, Heise M, et al.

    Sleep & breathing = Schlaf & Atmung 2023; (27(1)):389-397 doi:10.1007/s11325-022-02601-6.

    PMID: 35349009
  18. 18

    Modified Mandibular Advancement Device Is Effective in Patients With Insufficient Teeth: A Systematic Review.

    Yong CW, Quah B, Chung QY, et al.

    Journal of oral rehabilitation 2026; (53(1)):246-256 doi:10.1111/joor.70061.

    PMID: 40999836
  19. 19

    Comparison of monoblock and twinblock mandibular advancement devices in patiens with obstructive sleep apnea and temporomandibular disorder: effects on airway volume, polysomnography parameters, and sleepiness scale scores.

    Özköylü G, Saraç D, Sasany R, Umurca DG

    BMC oral health 2024; (24(1)):1026 doi:10.1186/s12903-024-04653-4.

    PMID: 39215302
  20. 20

    Factors associated with treatment adherence to mandibular advancement devices: a scoping review.

    van der Hoek LH, Rosenmöller BRAM, van de Rijt LJM, et al.

    Sleep & breathing = Schlaf & Atmung 2023; (27(6)):2527-2544 doi:10.1007/s11325-023-02862-9.

    PMID: 37386300
  21. 21

    Dropout and adherence of obstructive sleep apnoea patients to mandibular advancement device therapy: A systematic review of randomised controlled trials with meta-analysis and meta-regression.

    Bortolotti F, Corazza G, Bartolucci ML, et al.

    Journal of oral rehabilitation 2022; (49(5)):553-572 doi:10.1111/joor.13290.

    PMID: 34865235
  22. 22

    Effectiveness of Customized Oral Appliances in Mild-to-Moderate Obstructive Sleep Apnea: A Systematic Review of Randomized Controlled Trials.

    Panthee A, Chaulagain R, Paudyal KP, et al.

    Oral diseases 2026; doi:10.1111/odi.70351.

    PMID: 42108628
  23. 23

    CPAP or mandibular advancement devices or both: the balance between efficacy and compliance.

    Verbraecken J, Randerath W

    The European respiratory journal 2025; (65(4)) doi:10.1183/13993003.02252-2024.

    PMID: 40180358
  24. 24

    Factors influencing adherence to oral appliance therapy in adults with obstructive sleep apnea: a systematic review and meta-analysis.

    Tallamraju H, Newton JT, Fleming PS, Johal A

    Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine 2021; (17(7)):1485-1498 doi:10.5664/jcsm.9184.

    PMID: 33660611
  25. 25

    Effectiveness of Narval CC™ device in the treatment of obstructive sleep apnea.

    Therchilsen JH, Kirketerp P, Homoe P

    Sleep medicine: X 2023; (6()):100076 doi:10.1016/j.sleepx.2023.100076.

    PMID: 38162591
  26. 26

    Determinants of Objective Compliance During Oral Appliance Therapy in Patients With Sleep-Disordered Breathing: A Prospective Clinical Trial.

    Dieltjens M, Verbruggen AE, Braem MJ, et al.

    JAMA otolaryngology-- head & neck surgery 2015; (141(10)):894-900 doi:10.1001/jamaoto.2015.1756.

    PMID: 26402736
  27. 27

    Short- and long-term effects of mandibular advancement device therapy for obstructive sleep apnea on temporomandibular disorders: A systematic review and meta-analysis.

    Liu S, Ishiyama H, Angkulmahasuk S, et al.

    Journal of prosthodontic research 2026; (70(2)):159-172 doi:10.2186/jpr.JPR_D_25_00034.

    PMID: 40707237
  28. 28

    Oral Appliance Therapy and Temporomandibular Disorders.

    Mehta NR, Correa LP

    Sleep medicine clinics 2018; (13(4)):513-519 doi:10.1016/j.jsmc.2018.08.001.

    PMID: 30396445
  29. 29

    3-D changes in tooth position after treatment with mandibular advancement devices -a retrospective study in a non-university setting.

    Linsen SS, Meyer A, Daratsianos N, Kares A

    BMC oral health 2025; (25(1)):543 doi:10.1186/s12903-025-05914-6.

    PMID: 40217211
  30. 30

    Side effects of mandibular advancement splints for the treatment of snoring and obstructive sleep apnea: a systematic review.

    Martins OFM, Chaves Junior CM, Rossi RRP, et al.

    Dental press journal of orthodontics 2018; (23(4)):45-54 doi:10.1590/2177-6709.23.4.045-054.oar.

    PMID: 30304153
  31. 31

    Focus of dental sleep medicine on obstructive sleep apnea in older adults: A narrative review.

    Okuno K, Wang L, Almeida FR

    Journal of prosthodontic research 2024; (68(2)):227-236 doi:10.2186/jpr.JPR_D_23_00047.

    PMID: 37648523
  32. 32

    Mandibular advancement splints for obstructive sleep apnoea - a cautionary tale.

    Spencer S, Goss A, Cheng A, et al.

    Australian dental journal 2019; (64(4)):359-364 doi:10.1111/adj.12712.

    PMID: 31372998

This page provides educational information on oral appliances for sleep apnea. Consult your sleep doctor and a qualified dental sleep medicine specialist to determine if a mandibular advancement device is the right treatment for your specific condition.

Get notified when new evidence is published on Sleep Apnea.

We monitor PubMed for new peer-reviewed studies on this topic and email a short summary when something meaningful changes.