Oral Appliance Therapy
for Snoring & Sleep Apnea
Raleigh, NC
If you've been diagnosed with obstructive sleep apnea and you can't tolerate a CPAP machine, you have another option. At Stansell Dentistry Associates, we design and fit custom oral appliances to treat snoring and obstructive sleep apnea, and we work closely with your physician or sleep specialist to coordinate your care.An oral appliance is a small custom device you wear only while you sleep. It looks a little like a retainer, but it does something completely different. By holding your lower jaw slightly forward, it keeps your airway open so you can breathe steadily through the night.
One thing to know up front. Sleep apnea is a medical diagnosis, and only a physician can make it. Once you have that diagnosis and a prescription from your physician or sleep specialist, we handle the appliance side of your treatment and coordinate with them throughout. That's the part dentists are trained for.
What's happening while you sleep
Obstructive sleep apnea happens when the soft tissue at the back of your throat relaxes during sleep and blocks your airway. Airflow drops or stops entirely. Your oxygen level falls, your brain briefly wakes you up enough to reopen the airway, and you start breathing again. Then it happens again. In moderate to severe cases this cycle can repeat dozens of times an hour, all night, without you remembering any of it.
That's why the tiredness doesn't make sense to people who have it. You were in bed for eight hours. You just weren't asleep in any way that counted.
There's also a less common form called central sleep apnea, where the problem isn't a blocked airway but a breathing signal from the brain. Central sleep apnea needs different treatment, and an oral appliance won't help it. Your sleep study will tell you which type you have.
Signs worth paying attention to
Most people with sleep apnea don't know they have it. The signs usually show up in two places, overnight and the next morning.
Overnight, a partner may notice loud habitual snoring, pauses in your breathing, or gasping and choking sounds. You might wake up suddenly short of breath, or get up several times to use the bathroom.
During the day, the common signs are waking up unrefreshed no matter how long you slept, morning headaches, a dry mouth or sore throat first thing, trouble concentrating, irritability, and drowsiness while driving or sitting still.
Sleep apnea is more common in men, but it's badly underdiagnosed in women, partly because the symptoms often show up differently. Women are more likely to report fatigue, insomnia, morning headaches, or low mood than the loud snoring people expect. Risk also rises significantly after menopause. If this sounds like you and you've been told it's probably just stress, it's worth asking for a sleep evaluation.
Other things that raise your risk include excess weight, a larger neck circumference, smoking, nasal congestion, enlarged tonsils or adenoids, a family history of sleep apnea, and conditions like heart failure and type 2 diabetes.
How an oral appliance works
The most common type is a mandibular advancement device. It fits over your upper and lower teeth and holds your lower jaw in a slightly forward position while you sleep.That forward position does several things at once. It carries your tongue forward so it can't fall back into your airway. It creates more space behind the tongue. It puts gentle tension on the walls of your throat so they're less likely to collapse. And it reduces the soft tissue vibration that causes snoring in the first place.
Clinical guidelines recommend a titratable appliance, meaning one where the amount of forward advancement can be adjusted after it's delivered. That matters more than people expect. The right amount is different for everyone, and finding it usually takes a series of small adjustments rather than one perfect fit on day one. Ask about the specific device being recommended for you.
There's a second type called a tongue retaining device, which holds the tongue forward directly using suction instead of moving the jaw. It's used less often. For people who don't have enough healthy teeth to anchor a mandibular advancement device, it's one of the alternatives worth asking about.
Custom appliances and drugstore mouthpieces are not the same thing
You can buy a boil-and-bite snoring mouthpiece online for less than a hundred dollars. It isn't the same device and it isn't held to the same standard.
Clinical guidelines specifically recommend custom, titratable appliances over non-custom ones for treating sleep apnea. Medicare won't cover prefabricated appliances at all, on the grounds that there isn't sufficient evidence they work for sleep apnea. A custom appliance is made from impressions or digital scans of your own teeth, adjusted to fit your jaw, and monitored over time by a dentist who can catch problems before they become permanent.
If you've already tried an over-the-counter device and it didn't help, that doesn't tell you much about whether oral appliance therapy will work for you.
Who's a good candidate
Oral appliance therapy tends to work best for people with mild to moderate obstructive sleep apnea, and for people with severe sleep apnea who can't tolerate CPAP or have decided against it.Before oral appliance therapy begins, a few things need to be confirmed:
Enough healthy teeth to hold the appliance securely, since the device anchors to your teeth. Stable gum health, because the appliance puts steady pressure on the teeth it holds. Healthy jaw joints, which is why any history of TMJ trouble gets looked at first. And enough forward jaw movement to reach a therapeutic amount of advancement.
Oral appliance therapy usually isn't the right choice if you have central sleep apnea, very few or no natural teeth, active gum disease that needs treatment first, or significant temporomandibular joint pain. Some of those are temporary. If gum disease is the obstacle, periodontal care first may open the door.
Not everyone is a candidate, and that's better to find out before an appliance is made than after.
What treatment actually looks like
Here's the full path, including the parts that happen outside our office.
Recognizing the signs. Sleep apnea often surfaces at a dental exam, because a dentist sees things in the mouth and airway that point toward it. That's recognition, not diagnosis.
Sleep testing and diagnosis. Testing is either a home sleep apnea test or an in-lab sleep study, and a physician interprets the results and makes the diagnosis. Dentists can't do this part, and any dental office that tells you otherwise is overstepping.
Prescription. If oral appliance therapy is appropriate, your physician prescribes it. That prescription is also what makes medical insurance coverage possible.
Design and fitting. This is our part. Designing and fitting a custom appliance starts with an exam and impressions or digital scans of your teeth, and ends with a fitting appointment where you learn how to insert, remove, and clean it. Most people adjust within a few days to a few weeks.
Adjustment. Titratable appliances are adjusted gradually over the following weeks, balancing symptom relief against comfort. This is the part that determines whether therapy actually works, and it's worth being patient through.
Follow-up sleep testing. Clinical guidelines recommend follow-up sleep testing, arranged through your physician, to confirm the appliance is genuinely controlling your apnea. Feeling better is encouraging, but it isn't proof. This is the step most often skipped.
Ongoing care. Oral appliance therapy is long-term treatment, not a one-time appliance. Guidelines recommend periodic visits with both a dentist and a sleep physician, and appliances need replacing as they wear.
Oral appliance or CPAP?
This is the question most people arrive with, and the honest answer has two halves.Under controlled conditions, CPAP is more effective. It eliminates more breathing events per hour than an oral appliance does, and for severe sleep apnea it remains the standard.
In real life, the picture is closer than that. Many people can't or don't wear CPAP consistently, and a therapy only works during the hours you're actually using it. Research consistently finds better adherence with oral appliances and fewer side effects that cause people to quit. When researchers measure overall benefit using a metric that combines how well a therapy works with how much it actually gets used, oral appliances and CPAP come out broadly comparable, and studies find similar improvements in daytime sleepiness with both.
So the real question isn't which therapy is stronger on paper. It's which one you'll use every night. If CPAP works for you, keep using it. If it's sitting in a closet, an oral appliance you'll actually wear is better than a machine you won't.
Some people use both, with CPAP at home and an appliance for travel. Your physician can advise on whether that fits your situation.
Trade-offs worth knowing about
Every treatment has them, and we'd rather you hear these from us than find out later.
In the first few weeks, most people notice some combination of extra saliva or dry mouth, mild soreness in the teeth or jaw, and a bite that feels slightly off first thing in the morning. These usually settle as you adjust, and morning jaw exercises help.
The longer-term trade-off is more important. With years of nightly use, oral appliances can produce gradual changes to your bite. Research measuring patients over time has found small but real reductions in overbite and overjet, mostly from the front teeth tipping slightly, and these changes are generally permanent. Most people never notice them. They're still worth knowing about before you start.
This is exactly why ongoing dental monitoring matters, and why guidelines recommend periodic dental review while you're in treatment. Bite changes caught early are much easier to manage than bite changes found years later.
A note on night guards, because this comes up often. A night guard for teeth grinding is a different device made for a different problem, and it is not a treatment for sleep apnea. If you grind your teeth and you also snore, tell us both. It changes what we recommend.
What about insurance and cost?
This surprises almost everyone. Oral appliances for sleep apnea are usually billed to your medical insurance, not your dental insurance, because they're classified as durable medical equipment rather than dental treatment. Most dental plans won't cover them. Many medical plans will.
Medicare covers custom oral appliances for obstructive sleep apnea when specific criteria are met, and most private medical plans have their own coverage rules. Prior authorization is commonly required, and coverage depends on having a physician's diagnosis and prescription on file. Prefabricated appliances aren't covered.
Coverage varies plan to plan, so it's worth checking with your medical insurer before you commit to anything, and bringing your questions to your consultation. You can review our financial and insurance information, and if cost is a concern we offer payment plans through Cherry so you can spread it out.
If you snore but don't have sleep apnea
Not every snorer has sleep apnea. Primary snoring, meaning snoring without the breathing interruptions that define apnea, is its own condition and oral appliance therapy is an established treatment for it.
The catch is that you can't tell the difference from the couch. Loud, habitual snoring is also the most common sign of obstructive sleep apnea, and the only way to separate the two is a sleep study. If you snore most nights, get evaluated before assuming it's harmless.
Other treatments for sleep apnea
Oral appliance therapy is one option among several, and the right choice depends on your diagnosis and your priorities. Your physician will guide this decision. For context:
CPAP remains the standard therapy, particularly for severe sleep apnea. Weight management can meaningfully reduce severity for people whose sleep apnea is weight-related, and in December 2024 the FDA approved the first prescription medication for moderate-to-severe obstructive sleep apnea in adults with obesity, used alongside diet and activity changes. Positional therapy can help people whose apnea occurs mainly when sleeping on their back. Surgical options exist, including implanted nerve stimulation devices and airway surgery, generally for people who haven't responded to other treatments.
We're happy to talk through where oral appliance therapy fits alongside any of these.
Talk to us about sleep apnea treatment in Raleigh
If you've been diagnosed with sleep apnea and CPAP isn't working for you, or if you snore and you've been wondering whether it's something more, we can help you figure out the next step.
Call our Brier Creek office at 984-477-0177 or our Knightdale office at 984-733-0330, or request an appointment online. If you're new to us, here's what to expect at your first visit, and you can read more about our team.
If you don't have a diagnosis yet, a sleep evaluation through a physician is the first step, and we're happy to talk through what that involves.