Sleep Apnea
Does Insurance or Medicare Cover a Sleep Apnea Mouthguard?
Why oral appliances are billed to medical insurance, and what Medicare usually needs.
3 min readBy Hiral Desai, DDS, MDS, D. ABDSM
Oral Appliance vs CPAP: Which Sleep Apnea Treatment Fits You?
CPAP works very well for sleep apnea, but only if you can wear it. If the mask, noise or hose keeps you from using it, a custom oral appliance may be an option. Here is how the two compare, from a dentist who is a Diplomate of the American Board of Dental Sleep Medicine.
The short answer
CPAP is the most effective treatment for severe sleep apnea, but many people struggle to wear it. A custom oral appliance holds the lower jaw forward to keep the airway open, and is a recognised option for mild to moderate sleep apnea and for people who can't tolerate CPAP. Your sleep physician and dentist decide together.
Key takeaways
- You need a sleep apnea diagnosis first
- CPAP is the most effective option for severe cases
- Oral appliances suit many mild to moderate cases and CPAP-intolerant severe cases
- Appliances are custom-made and adjusted over a few visits
- A follow-up sleep test confirms it is working
How do CPAP and oral appliances work?
Both keep your airway open while you sleep, in different ways.
CPAP
A machine blows gently pressurized air through a mask, which keeps the throat from collapsing. It is the most effective treatment for many people with sleep apnea, especially severe cases.
Oral appliances
A custom mouthpiece, similar to a sports guard, holds the lower jaw slightly forward. That keeps the tongue and soft tissue from blocking the airway. The American Academy of Sleep Medicine supports oral appliances for adults with mild to moderate obstructive sleep apnea and for patients with severe obstructive sleep apnea who can't tolerate CPAP or prefer another option.
How do they compare?
| CPAP | Oral appliance | |
|---|---|---|
| Comfort | Mask and hose take getting used to | Small mouthpiece, no mask |
| Travel | Machine, power and supplies | Fits in a small case |
| Noise | Quiet hum from the machine | Silent |
| Upkeep | Clean mask, hose and water tank | Brush and rinse daily |
| Effectiveness | Most effective, especially for severe sleep apnea | Effective for many mild to moderate cases and severe CPAP-intolerant cases |
Who is a good candidate for an oral appliance?
- Adults with a sleep apnea diagnosis from a sleep physician.
- People who have tried CPAP and can't keep using it, or prefer not to use a CPAP or are looking for a CPAP alternative.
- Many people with mild to moderate sleep apnea or CPAP-intolerant patients with severe sleep apnea.
- People with enough healthy teeth to hold the appliance.
Your sleep physician and Dr. Desai decide together what is right for you.
Struggling with CPAP? Book a sleep consultation with Dr. Desai.
Book a consultationHow is an appliance made and fitted?
It usually takes a few visits.
Referral and sleep test
You need a diagnosis first. If you haven't had a study, we can refer you for a home sleep test or an in-lab study.
Scan and fitting
Impressions or a digital scan of your teeth are used to make a custom appliance that is FDA-cleared and PDAC-verified.
Adjustments
The appliance is adjusted in small steps to find the position that keeps your airway open comfortably.
Follow-up sleep test
A follow-up test confirms the appliance is working. We coordinate with your physician on the results.
Can I use both?
Some patients use CPAP at home and an oral appliance when traveling or camping. Others use both together if their physician recommends it. Patients with severe sleep apnea can benefit from an oral appliance as combination therapy, which allows lower CPAP pressures and makes CPAP more tolerable.
What are the side effects?
Most are mild and settle as you get used to it.
Jaw soreness
Possible in the first weeks, usually easing in the morning soon after you take it out. Simple jaw exercises we recommend will help overcome any jaw soreness.
Bite changes
Bite changes are more likely if you have loose teeth or gum disease. Good oral hygiene, regular checkups and cleanings help keep your bite stable.
Dry mouth or drooling
Often temporary while you adjust. Read Can Dry Mouth Be a Sign of Sleep Apnea?.
Sleep apnea care in Tustin for Orange County
Sleep apnea care is provided through SnoozX-AI, our dedicated sleep apnea center, here at Larwin Square in Tustin. Patients come from Irvine, City of Orange, Santa Ana and the rest of Orange County. We're open Monday to Wednesday and Friday from 9:00 AM to 5:30 PM, and every Saturday from 8:00 AM to 2:30 PM. Call (714) 505-9462 or book online.
Questions patients ask
Do I need a sleep study first?
Yes. Sleep apnea must be diagnosed by a sleep physician. We can refer you for a home or in-lab test.
How long does an appliance last?
Several years with good care. We check it at your regular visits.
Is there a warranty on the oral appliance?
Yes. All our oral appliances come with a 2 to 3 year warranty. Ask our team for more warranty information.
Which oral appliance brands do you offer?
Dr. Desai mainly provides SomnoMed and ProSomnus oral appliances. Every device we use is custom-made, FDA-cleared and PDAC-verified.
Will it stop my snoring?
For many people it reduces snoring a lot. A sleep test confirms whether your sleep apnea is controlled.
Do you accept medical insurance for the oral appliance?
Yes. We accept all PPO medical insurance plans and Medicare. If you have HMO insurance, let our front desk know and they will check whether it is covered under your plan. See our coverage guide.
Can I travel with it?
Yes. It fits in a small case and needs no power.
How soon will I sleep better?
Some people notice a difference within days. It can take a few weeks of adjustments to find the best position.
Talk to a dental sleep specialist
Dr. Desai is a Diplomate of the American Board of Dental Sleep Medicine and works alongside your physician. A consultation is the first step to finding out whether an appliance suits you.
Sources: AASM and AADSM clinical practice guideline on oral appliance therapy (J Clin Sleep Med, 2015) · NHLBI: What Is Sleep Apnea?
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This guide is general information, not a diagnosis. Book a visit for advice about your own teeth.