CPAP vs. Oral Appliance

Treating obstructive sleep apnea (OSA) is of utmost importance, because when it's left untreated, the disorder can cause an increased risk of developing serious health problems, including high blood pressure, type 2 diabetes, and heart disease. Positive airway pressure (PAP) therapy, such as CPAP therapy, is the most common treatment for OSA. For those who don’t tolerate CPAP, oral appliances provide an alternative.

In this article, we explore what CPAP therapy and oral appliances for sleep apnea are, compare the pros and cons of each treatment type, and outline when to talk to your doctor about how to decide between CPAP and an oral appliance.

Think You May Have Sleep Apnea? Try an At-Home Test

our partner at sleepdoctor.com

10% off Home Sleep Tests

Buy Now

“Truly grateful for this home sleep test. Fair pricing and improved my sleep!”

Dawn G. – Verified Tester

Simple and convenient

• Equipment delivered to your doorstep
• One overnight test in the comfort of your own bed

Uncover sleep apnea

• Quietly collects data while you sleep
• 98% effective in detecting sleep apnea

Affordable & ships fast

• Arrives in 2-4 business days
• In-lab sleep tests cost ~$3,000+ (this
one’s $189), HSA/FSA eligible

What Is CPAP Therapy?

Continuous positive airway pressure (CPAP) therapy is a sleep apnea treatment that works by delivering air from a CPAP machine, through tubing and a CPAP mask, into a person's airway. OSA is characterized by an excessive number of breathing disturbances during sleep caused by blockages in the airway. CPAP therapy prevents many of these blockages and the related lapses in breathing with a steady stream of air at a fixed pressure.

What Is an Oral Appliance for Sleep Apnea?

An oral appliance is a device worn in the mouth during sleep to treat mild to moderate obstructive sleep apnea. There are two types of oral appliances:

• Mandibular advancement devices (MADs): Also called mandibular advancement splints (MASs), these devices push against teeth to pull the lower jaw forward and are the most common type of oral appliance. There are multiple types of MADs. Some are custom-fitted by a medical professional, while others are sold over-the-counter. Some come in one piece, and others come in two pieces that link together.
• Tongue-retaining devices (TRDs): This type of oral appliance uses suction to pull the tongue forward and outside of the mouth into a hollow space in the device. TRDs haven't been studied as extensively as MADs have, but they can be useful for people who are missing teeth or who can't use MADs due to teeth- or jaw-related issues.

What Are the Differences Between CPAP and Oral Appliances?

Although they’re both used to treat sleep apnea, CPAP therapy and oral appliances are very different tools. Read the table below to see how they compare in terms of how they work, their effectiveness, comfort, cost, and maintenance.

Effectiveness

A meta-analysis of 80 research studies determined that, overall, CPAP therapy is more effective at treating sleep apnea than oral appliances are when measured using a tool called the apnea-hypopnea index (AHI). 

However, these studies analyze effectiveness across groups, and oral appliances could be the better option for specific individuals who can't tolerate CPAP therapy. Studies have also found that people are more likely to continue using oral appliances than CPAP therapy. And in general, the treatment type that a person can stick with is the one that will be most effective for them. 

It should be noted, though, that oral appliances can only treat mild to moderate OSA, while PAP therapy is used to treat all severity levels of OSA and, often, central sleep apnea (CSA) as well. They’re also not suitable for people with jaw disorders (like TMJ) or insufficient healthy teeth to properly support the device.

Comfort and Ease of Use

People rate oral appliances as more comfortable and easier to continue using than CPAP therapy. That said, over-the-counter oral appliances may not be as comfortable as custom-made MADs. When beginning CPAP therapy, side effects like a dry mouth, claustrophobia, and discomfort breathing against the air pressure may lead to a person not wanting to continue treatment. 

Not everyone who initially struggles with CPAP therapy needs to switch to another treatment, though. A follow-up doctor's appointment and adjustments to CPAP therapy may help reduce discomfort. An oral appliance usually isn't considered unless a person reaches a point where they’re no longer willing or able to try CPAP therapy.

Oral appliances aren’t without their drawbacks, though. They can cause side effects like jaw discomfort, tooth or gum soreness, excessive saliva or dry mouth, and, in some cases, changes in bite or tooth alignment over time.

Cost and Insurance Coverage

Almost all CPAP machines cost between $300 and $1,200, but more commonly, they fall between $500 and $1,000. The price varies depending on the brand name, features offered, and how recently the model was released. Health insurance, including Medicare, generally covers CPAP machines for people who’ve been diagnosed with sleep apnea. But to maintain coverage, a person has to use the machine regularly and attend follow-up doctor's visits.

Health insurance and Medicare may also cover an oral appliance for sleep apnea if a doctor deems it a necessary treatment. Usually, this means that the person has been diagnosed with sleep apnea through a sleep study. Only custom-made MADs are generally covered, not over-the-counter oral appliances. Custom MADs can cost hundreds or thousands of dollars, while over-the-counter oral appliances cost between $30 and $200.

Maintenance

Both CPAP accessories and oral appliances require regular maintenance. CPAP accessories must be cleaned regularly, usually at least weekly, as well as replaced on the schedule outlined by the manufacturer. Oral appliances must be cleaned daily, similar to a mouth guard or retainer.

CPAP vs. Oral Appliance: Which Should You Choose?

If you're diagnosed with obstructive sleep apnea, your doctor will likely recommend that you try CPAP therapy first, since it's considered a first-line or gold-standard treatment. But, you do have options, and oral appliances end up being a better choice for some people. Read on to learn the pros and cons of both treatment types.

Pros and Cons of CPAP Therapy

The primary advantage of CPAP therapy is that many research studies have consistently found it to be the most effective way to treat obstructive sleep apnea. The main drawback of CPAP therapy is that many people experience discomfort or have trouble when beginning therapy and might not want to continue it. But as previously mentioned, many issues and side effects can be addressed by talking with your healthcare provider

Pros and Cons of Oral Appliances

The main advantages of using oral appliances to treat obstructive sleep apnea are that many people find them to be more comfortable, and people are more likely to stick with them compared to CPAP therapy. A disadvantage is that oral appliances haven't been found to treat obstructive sleep apnea as effectively as CPAP therapy can.

When to Talk to a Doctor

If CPAP therapy causes you discomfort, or you want an alternative to CPAP therapy, talk to your doctor. They can help you compare CPAP and oral appliances based on factors like the severity of your sleep apnea, your comfort preferences, and how well you’ve been able to use your current treatment.

Your doctor may recommend trying adjustments to your CPAP setup, such as changing the mask type or pressure settings, or they may discuss whether an oral appliance is an appropriate alternative, especially for people with mild to moderate obstructive sleep apnea or those who have difficulty tolerating CPAP.

Your doctor's goal is help you receive adequate obstructive sleep apnea treatment, so don’t feel anxious about approaching them to discuss all of your options. Tell them that you're considering an oral appliance vs. CPAP therapy. Share your preferences or concerns, and ask for their professional opinion on the next steps you can take toward finding a treatment that fits your needs.

Written by

Jay Summer, NBC-HWC, Sleep Health Writer

Jay Vera Summer is a writer, editor, and wellness coach. She holds a Bachelor's of Science in psychology and Master's degrees in both writing and public policy. As a wellness coach, she's certified by the Mayo Clinic and the National Board for Health and Wellness Coaching (NBHWC). She's been writing about sleep and other health topics for six years. Previously, she taught undergraduate writing courses for five years at the University of South Florida.