Mandibular advancement devices, also known as MAD’s, are a fantastic treatment for snoring and often a welcome alternative to CPAP if you have Obstructive Sleep Apnoea.
They are worn in the mouth over your upper and lower teeth like a brace, pulling your lower jaw forward. This opens up your airways, making them less able to collapse.
They can be more comfortable and less invasive than CPAP — but before you hastily abandon your CPAP machine and dash out to buy one, it’s important to understand they aren’t suitable for everyone. Here is my list of the 5 most important things you need to consider before swapping your CPAP machine for a mouthful of MAD:
1. They can’t fully treat severe sleep apnoea
A good MAD will reduce your apnoea-hyopnoea index by about 13 events per hour. That is, you will have 13 fewer apnoeas or hypopnoeas every hour you sleep when you wear the device. This is ideal for treating mild to moderate sleep apnoea as a decline of 13 events per hour is likely to resolve your sleep apnoea.
But if you have severe sleep apnoea with more than 30 events per hour a decline of 13 is hardly going to make a dent in your condition! Sadly this means that if you have severe sleep apnoea, CPAP is still your best chance of treatment.
2. Not all MAD’s are custom built – even though they really should be
Be wary of any devices you can buy which have not been built from a physical or digital impression of your mouth taken by a trained dentist. A quick Google search will bring up dozens of ‘boil and bite’ devices which you can buy online and fit yourself at home. They supposedly mould to your mouth after just a quick soak in hot water, but be warned — they generally don’t work and tend to fall out during sleep.
Instead ask your dentist or orthodontist for a custom-built, titratable device. ‘Custom-built’ means it has been made to fit your mouth perfectly and ‘titratable’ means it can be gradually adjusted to pull your lower jaw forward by just the right amount to treat your apnoeas.
Please note that your dentist will need to make manual adjustments to your MAD over the first few weeks of use until it is working optimally. Recent advances in MAD design suggest devices may adjust themselves automatically in the very near future. If and when these devices become mainstream they will substantially reduce the hassle and cost of titrating a quality MAD device.
3. They can fall out your mouth if you don’t have enough teeth
If you have less than 10 teeth on both your upper and lower jaw a MAD device won’t be able to grip hold of anything and will probably fall out your mouth. An incentive to brush your teeth regularly if you have sleep apnoea!
4. They can cause some really annoying side effects
The problems most people experience when using a MAD centre on the jaw and include:
- Sore teeth
- Gum problems
- Stiff or painful jaw muscles and joints
- Excessive salivation
- Difficulty chewing in the mornings
- Dry mouth.
Although these side effects can be troublesome at first, they normally settle down within the first few months of treatment. Most of the symptoms can also be minimised by careful titration of your device. Usually, your lower jaw only needs to be pulled forward by 1 to 3mm and if this is done gradually by your dentist, your side effects should be minor.
Regular dental check-ups are also needed so your dentist can nip any problems in the bud and they may advise jaw exercises to help relieve stiffness and pain.
It is also wise to attend your sleep follow-ups so that your sleep specialist can check when your MAD is working optimally and find the point when it need not be altered further.
In fact, some people experience similar problems with CPAP machines due to the position and pressure of the mask on their face. So irrespective of your treatment you can expect a few teething issues.
5. Keeping tabs on usage can be hard
Whether you use a CPAP machine or a MAD, your sleep apnoea will only be treated if you use your equipment regularly. This generally means you need to wear your device for at least 4 hours per night, 70% of the time.
It is easy to see how often you use your CPAP machine just by checking its usage logs — these are automatically generated by the machine, easily accessible and are very accurate.
Unfortunately keeping tabs on how often you use your MAD isn’t so straightforward. Unless you write down each time you wear the device, you won’t know how long you’ve used it for — this is especially true when trying to work out average usage over longer periods like a month or a year.
Having said that, people report using their MAD almost 2 hours a night more than people who use CPAP — they tend to find MAD’s more comfortable to use and easier to take with them on their travels.
MAD’s have just started to be fitted with Bluetooth technology that will allow you to monitor your usage automatically. This will be especially handy if you are a commercial driver and need to prove you are using your device regularly.
As you can see, MAD’s aren’t a magic silver bullet to replace traditional CPAP therapy. But if you have mild to moderate sleep apnoea and you select and use your MAD correctly, there’s a very good chance you can reduce your symptoms enough to avoid using CPAP.
Do you use an MAD? Please tell us your story in the comments section below.
I swear by my MAD. I tried CPAP for about a year and never really got on with it. Thankfully I managed to drop about 60lbs in excess weight and my AHI went from 31 to 15. My sleep therapist suggested I try using a MAD and I’ve never looked back. One tip for anyone thinking about getting one – get a custom built one. They cost more but work so much better.