Dental Sleep Medicine

Q: What happens if I do not treat my sleep apnea?

Untreated sleep apnea carries significant health risks that worsen over time. These include high blood pressure, as the repeated drops in oxygen during sleep put strain on your cardiovascular system. Heart disease, heart failure, and irregular heartbeat are 2 to 4 times more common in people with untreated OSA. Stroke risk is also significantly elevated. Untreated sleep apnea is linked to insulin resistance and type 2 diabetes, weight gain and difficulty losing weight, depression and anxiety, daytime drowsiness that increases your risk of motor vehicle accidents, and cognitive decline including memory problems. Treating sleep apnea can improve or even reverse many of these health risks.

Q: How do I know if I have sleep apnea?

Common warning signs of sleep apnea include loud, chronic snoring, observed pauses in breathing during sleep reported by a bed partner, waking up gasping or choking, excessive daytime sleepiness despite adequate time in bed, morning headaches, difficulty concentrating or memory problems, irritability or mood changes, and waking frequently during the night to urinate. However, many people with sleep apnea do not realize they have it because the breathing pauses occur during sleep. If you experience any of these symptoms, speak with your physician about getting a sleep study to determine whether sleep apnea is the cause.

Understanding oral appliance therapy and how qualified dental professionals treat sleep apnea and sleep-disordered breathing.

What Is Dental Sleep Medicine?

Dental sleep medicine is a clinical discipline focused on treating sleep-disordered breathing, primarily obstructive sleep apnea (OSA), using oral appliance therapy. An estimated 22 million Americans suffer from sleep apnea, and custom-fitted mandibular advancement devices offer a comfortable, CPAP-free alternative that repositions the lower jaw to keep the airway open during sleep. Most medical insurance plans cover oral appliance therapy for diagnosed OSA.

Last updated: February 2026 Medically reviewed by Dr. Richard Anderson, MD, FACS 12 min read

Understanding Sleep Apnea

Sleep apnea is a serious medical condition in which breathing repeatedly stops and starts during sleep. An estimated 22 million Americans suffer from sleep apnea, and many cases go undiagnosed. Left untreated, sleep apnea can contribute to high blood pressure, heart disease, stroke, diabetes, depression, and an increased risk of motor vehicle accidents due to daytime drowsiness.

There are three types of sleep apnea, each with different underlying causes:

Obstructive Sleep Apnea (OSA)

The most common type, accounting for approximately 84% of all sleep apnea cases. OSA occurs when the soft tissues in the back of the throat collapse during sleep, physically blocking the airway. As the airway narrows or closes, your body must briefly wake up to reopen it, disrupting your sleep cycle many times per hour, often without you being aware of it. This is the type of sleep apnea that oral appliance therapy is designed to treat.

Central Sleep Apnea (CSA)

A less common form in which the brain temporarily fails to send proper signals to the muscles that control breathing. Unlike OSA, there is no physical blockage of the airway. Central sleep apnea is typically treated with specialized breathing devices and medical management rather than oral appliances.

Mixed (Complex) Sleep Apnea

A combination of both obstructive and central sleep apnea. Patients with mixed sleep apnea have features of both conditions and may require a combination of treatment approaches.

22 million

Americans suffer from sleep apnea, yet approximately 80% of moderate-to-severe cases remain undiagnosed.

Source: American Academy of Sleep Medicine

2-4x higher

Risk of stroke and heart disease in patients with untreated obstructive sleep apnea compared to the general population.

Source: The Lancet Respiratory Medicine, 2019

~50% drop-off

Of CPAP users stop using their device within the first year, making oral appliance therapy a critical alternative.

Source: AASM Clinical Practice Guideline, 2015

Symptoms and Health Risks of Untreated Sleep Apnea

Sleep apnea affects far more than just your sleep. Because it disrupts the body's ability to achieve restorative sleep and causes repeated drops in blood oxygen levels, untreated sleep apnea has widespread effects on your health.

Common Symptoms

Loud, chronic snoring
Observed breathing pauses during sleep
Waking up gasping or choking
Excessive daytime sleepiness
Morning headaches
Difficulty concentrating and memory problems
Irritability and mood changes

Health Risks if Untreated

High blood pressure (hypertension)
Heart disease and heart failure
Stroke (2-4x increased risk)
Type 2 diabetes and insulin resistance
Weight gain and metabolic dysfunction
Depression and anxiety
Increased motor vehicle accident risk
Cognitive decline and dementia risk

The good news is that effective treatment of sleep apnea can improve or even reverse many of these health risks. Whether through oral appliance therapy, CPAP, or other treatment modalities, managing your sleep apnea is one of the most important steps you can take for your long-term health.

Oral Appliance Therapy Explained

Oral appliance therapy (OAT) uses a custom-fitted dental device worn during sleep to treat obstructive sleep apnea and snoring. The most common type is a mandibular advancement device (MAD), which looks similar to a sports mouth guard or orthodontic retainer. The appliance works by gently advancing the lower jaw (mandible) forward, which in turn moves the tongue and soft palate forward, opening the airway at the back of the throat and preventing the tissue collapse that causes obstructive sleep apnea.

Oral appliance therapy is recognized by the American Academy of Sleep Medicine (AASM) as a first-line treatment option for mild to moderate obstructive sleep apnea and as an alternative treatment for patients with severe OSA who cannot tolerate CPAP therapy. Over 100 different FDA-cleared oral appliances are available, and your provider, trained in dental sleep medicine, will select and custom-fit the best device for your anatomy and condition.

How an Oral Appliance Works

Jaw Advancement

The device holds the lower jaw in a slightly forward position, which prevents the airway from collapsing during sleep.

Airway Opening

By moving the jaw forward, the tongue and soft palate are also repositioned, widening the airway and allowing unobstructed breathing.

Restful Sleep

With the airway held open, breathing pauses are eliminated or dramatically reduced, allowing you to achieve deep, restorative sleep.

CPAP vs. Oral Appliance Therapy

CPAP (Continuous Positive Airway Pressure) has long been considered the gold standard treatment for obstructive sleep apnea. However, oral appliance therapy has emerged as an effective and often preferred alternative for many patients. Here is how they compare:

Feature	CPAP	Oral Appliance
How it works	Delivers continuous air pressure through a mask to keep the airway open	Advances the jaw forward to physically hold the airway open
Effectiveness	Very effective when worn consistently; reduces AHI to near-normal levels	Highly effective for mild to moderate OSA; comparable real-world outcomes due to higher compliance
Comfort	Mask can be uncomfortable; some patients struggle to sleep with it	Custom-fitted, compact device; most patients find it comfortable after brief adjustment
Portability	Requires machine, mask, tubing, and power source	Small, portable; fits in a pocket; no electricity needed
Patient compliance	Approximately 50% of patients stop using CPAP within the first year	Higher long-term compliance rates due to comfort and convenience
Noise	Machine produces some noise; may disturb bed partner	Silent; no machine noise
Best for	All severities of OSA; severe OSA in particular	Mild to moderate OSA; CPAP-intolerant patients; travelers

An important consideration is that the best treatment is the one you will actually use consistently. While CPAP may reduce the apnea-hypopnea index (AHI) to a lower number on paper, studies show that oral appliance therapy often produces equivalent health outcomes because patients wear their appliance more consistently. Your sleep medicine team will help you choose the option that is most likely to succeed for your lifestyle and needs.

Who is a Candidate for Oral Appliance Therapy?

Oral appliance therapy may be right for you if you have been diagnosed with mild to moderate obstructive sleep apnea, you have severe OSA but cannot tolerate CPAP therapy, you snore loudly and it disrupts your sleep or your partner's sleep, you travel frequently and need a portable treatment solution, or you prefer a non-machine-based treatment approach.

To be a good candidate for an oral appliance, you should have adequate dentition (enough healthy teeth to support the device), healthy temporomandibular joints, and the ability to advance your lower jaw forward. Your dental sleep medicine provider will perform a thorough oral examination and may take X-rays or impressions to ensure you are a suitable candidate.

Patients with central sleep apnea, very severe obstructive sleep apnea, or significant dental problems may not be ideal candidates for oral appliance therapy. However, many patients who have been told "you need CPAP" find that oral appliance therapy is a viable, effective alternative when supervised by a trained dental sleep medicine provider.

The Treatment Process

Diagnosis

Your journey begins with a sleep study, either an in-lab polysomnogram (PSG) or a home sleep apnea test (HSAT), ordered by your physician or sleep medicine specialist. The study measures your breathing patterns, blood oxygen levels, heart rate, and sleep stages to determine whether you have sleep apnea and how severe it is. Severity is measured by the apnea-hypopnea index (AHI), which counts the number of breathing pauses and reduced-breathing events per hour of sleep.

Consultation with a Dental Sleep Medicine Provider

Once diagnosed, you will meet with a dentist or dental professional trained in dental sleep medicine. They will review your sleep study results, examine your teeth, jaw, and oral structures, assess your temporomandibular joints, take impressions or digital scans of your teeth, and discuss treatment options and expectations.

Custom Fitting

Your oral appliance is custom-fabricated from impressions or digital scans of your teeth. Unlike over-the-counter "boil and bite" devices, a custom-fitted appliance from a dental sleep medicine provider is made from medical-grade materials, precisely fits your dental anatomy, and has adjustable mechanisms that allow your provider to fine-tune the jaw position for optimal results.

Delivery and Titration

When your appliance is ready, your provider will fit it, teach you how to insert and remove it, and set the initial jaw advancement position. Over the following weeks, you will return for adjustment appointments where the jaw advancement is gradually increased (titrated) until your symptoms are optimally controlled. This gradual approach maximizes comfort and effectiveness.

Follow-up Testing and Ongoing Care

After the appliance has been titrated to its optimal position, a follow-up sleep study is typically performed to verify that the device is effectively treating your sleep apnea. Your provider will then schedule regular follow-up appointments (typically every 6 to 12 months) to monitor your treatment, check the appliance for wear, and ensure your teeth and jaw remain healthy.

Insurance and Medicare Coverage

Oral appliance therapy for diagnosed sleep apnea is covered by most medical insurance plans, including Medicare. Here are the key details:

Medical Insurance

Most medical insurance plans cover custom oral appliances for diagnosed OSA. Coverage is typically billed through your medical insurance, not dental insurance, since sleep apnea is a medical condition. Requirements usually include a documented sleep study, a physician's referral or prescription, and sometimes prior authorization. Many plans cover 70% to 100% of the cost after deductible.

Medicare Coverage

Medicare Part B covers oral appliances for OSA when the patient meets specific criteria: a qualifying sleep study showing an AHI of 5 or greater with symptoms (or AHI of 15+ regardless of symptoms), the appliance is prescribed by the treating physician, and the device is furnished by a Medicare-enrolled dentist or provider. Medicare typically pays 80% of the approved amount after the Part B deductible is met.

Your dental sleep medicine provider's office will typically verify your insurance benefits, obtain any necessary prior authorizations, and handle billing on your behalf. Do not hesitate to ask about coverage during your initial consultation so you understand your out-of-pocket costs before beginning treatment.

Frequently Asked Questions

Is oral appliance therapy covered by insurance?

Yes, most medical insurance plans cover oral appliance therapy for diagnosed obstructive sleep apnea. Coverage is typically billed through your medical insurance rather than dental insurance. Medicare also covers oral appliance therapy when certain criteria are met, including a documented sleep study and a physician's prescription. Many insurance plans require prior authorization. Your dental sleep medicine provider can usually handle insurance verification and billing on your behalf.

Do I need a sleep study before getting an oral appliance?

Yes, a sleep study is required before oral appliance therapy can be prescribed. The study, called a polysomnogram when conducted in a lab or a home sleep apnea test when done at home, measures your breathing patterns, oxygen levels, and sleep disruptions to diagnose sleep apnea and determine its severity. Your physician or sleep medicine specialist will order the study, and the results guide treatment decisions. Home sleep tests have become increasingly popular as a convenient and cost-effective option.

How long does it take to adjust to wearing an oral appliance?

Most patients adapt to wearing their oral appliance within 1 to 2 weeks. During the initial adjustment period, you may experience temporary jaw soreness, increased saliva production, minor tooth discomfort, or a slight change in your bite that resolves shortly after removing the appliance each morning. Your provider will schedule follow-up appointments to make adjustments and ensure optimal comfort and effectiveness.

Can oral appliance therapy completely replace CPAP?

For many patients with mild to moderate obstructive sleep apnea, oral appliance therapy can fully replace CPAP. Research shows that while CPAP may produce slightly lower AHI numbers in controlled settings, oral appliances often achieve comparable real-world health outcomes because patients use them more consistently. The American Academy of Sleep Medicine recommends oral appliance therapy as a first-line treatment for mild to moderate OSA and as an alternative for patients with severe OSA who cannot tolerate CPAP.

What happens if I do not treat my sleep apnea?

Untreated sleep apnea carries significant and progressively worsening health risks, including high blood pressure, heart disease, stroke, type 2 diabetes, weight gain, depression, daytime drowsiness that increases your risk of motor vehicle accidents, and cognitive decline. The repeated drops in blood oxygen during sleep put chronic strain on your cardiovascular system. The good news is that effective treatment can improve or even reverse many of these health risks.

How do I know if I have sleep apnea?

Common warning signs include loud chronic snoring, observed breathing pauses during sleep, waking up gasping or choking, excessive daytime sleepiness, morning headaches, difficulty concentrating, irritability, and frequent nighttime urination. However, many people with sleep apnea are unaware they have it because the breathing pauses occur during sleep. If you experience any of these symptoms, speak with your physician about getting a sleep study to determine whether sleep apnea is the cause.

Sources & References

American Academy of Sleep Medicine (AASM). "Clinical Practice Guideline for the Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy: An Update for 2015." Journal of Clinical Sleep Medicine. 2015;11(7):773-827.
Benjafield AV, Ayas NT, et al. "Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis." The Lancet Respiratory Medicine. 2019;7(8):687-698.
Ramar K, Dort LC, et al. "Clinical Practice Guideline for the Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy." Journal of Dental Sleep Medicine. 2015;2(3):71-125.
National Heart, Lung, and Blood Institute (NHLBI). "Sleep Apnea." nhlbi.nih.gov
American Dental Association (ADA). "The Role of Dentistry in the Treatment of Sleep-Related Breathing Disorders." ADA Policy Statement, 2017.

Find a Dental Sleep Medicine Provider

Search our directory of dental professionals who have completed specialized dental sleep medicine training and are qualified to diagnose and treat sleep-disordered breathing with oral appliance therapy.

Find a Provider Near You