Choosing between an oral appliance and CPAP can feel overwhelming, especially if you’re navigating sleep-disordered breathing, obstructive sleep apnea treatment, or sleep dysfunction for the first time. Both therapies are effective—but they work in very different ways. Understanding the mechanisms, evidence, adherence data, and potential side effects can help you make an informed decision alongside your healthcare team.

This guide explains how each treatment works, who benefits most, and where therapies like myofunctional therapy, airway therapy, and breathing treatment fit into a complete care plan.

How Each Treatment Works: Mechanisms

CPAP (Continuous Positive Airway Pressure)

CPAP delivers pressurized air through a mask to keep the upper airway open during sleep. By splinting the airway, CPAP prevents collapse associated with obstructive sleep apnea. It is considered the first-line sleep apnea therapy for moderate to severe OSA.

Oral Appliances

Oral appliances—often called mandibular advancement devices—reposition the jaw forward to increase airway space and reduce collapse. They are custom-fitted by trained dental professionals and are frequently paired with oral myofunctional therapy or orofacial myofunctional therapy to improve long-term stability, tongue resting posture, and muscle function.

Where Myofunctional Therapy Fits

Many patients benefit from combining their device with myofunctional therapy, especially those experiencing mouth breathing, tongue thrust patterns, TMJ dysfunction treatment needs, bruxism, or chronic nasal congestion. Improving the strength and coordination of the upper airway muscles enhances treatment outcomes with both modalities.

Effectiveness by Severity

Mild to Moderate OSA

For mild and many moderate cases, oral appliances and CPAP show similar reductions in AHI (Apnea-Hypopnea Index). Patients with positional obstructive sleep apnea, UARS (upper airway resistance syndrome), symptoms of UARS, or sleep apnea symptoms in women often respond particularly well to oral appliances.

Moderate to Severe OSA

CPAP remains the standard due to its ability to deliver high pressures consistently. However, adherence is often the limiting factor. A perfectly used oral appliance may outperform poorly used CPAP, which is why real-world outcomes depend on comfort and consistency.

Special Considerations

• Bruxism and teeth grinding: Oral appliances can help stabilize the jaw and reduce nighttime clenching or grinding teeth in sleep.
  
• TMJ therapy needs: Individuals with temporomandibular joint dysfunction may require modified appliance designs or concurrent TMJ treatment.
  
• Chronic nasal congestion or constant cough and chest congestion: Untreated nasal obstruction reduces CPAP tolerance. Addressing chronic nasal congestion treatment and airway dysfunction can improve CPAP success.

Comfort and Adherence

CPAP Adherence

Despite excellent efficacy, CPAP adherence is a major barrier. Mask discomfort, air leaks, pressure intolerance, chronic nasal congestion, chest pain when breathing, and anxiety and chest pain can reduce nightly use.

Oral Appliance Adherence

Oral appliances tend to have higher long-term adherence. They’re quiet, portable, comfortable for most patients, and do not require electricity or tubing. Patients who struggle with continuous positive airway pressure often find oral appliances easier to incorporate into their sleep routines.

Behavioral and Functional Support

Speech therapy, sleep hygiene coaching, breathing therapy, and airway-focused exercises often improve tolerance to either device. This includes therapy for swallowing problems, dysphagia therapy, pharyngeal dysphagia treatment, and breathing problems that affect nighttime stability.

Side Effects

CPAP

Common side effects:

• Nasal dryness
  
• Mask pressure sores
  
• Aerophagia (air swallowing)
  
• Chest discomfort
  
• Eustachian tube dysfunction (occasionally), especially in patients with TMJ and eustachian tube dysfunction or chronic congestion

Oral Appliances

Potential side effects:

• Jaw discomfort
  
• Temporary bite shifts
  
• Exacerbation of TMJ symptoms without proper titration
  
• Excessive salivation or dryness

These side effects are typically manageable with proper fit, titration, and supportive TMJ therapy or temporomandibular joint dysfunction therapy.

Titration and Monitoring

CPAP Titration

CPAP titration usually occurs during a sleep study or at home using auto-titrating devices. Regular downloads allow providers to monitor apnea events, leaks, and pressures.

Oral Appliance Titration

With oral appliances, titration occurs incrementally until symptoms, snoring solutions, and oxygen saturation improve. Follow-up sleep studies—at home or in-lab—are required to confirm optimal effectiveness.

Why Ongoing Monitoring Matters

Patients with shifting symptoms (such as weight changes, chronic congestion, chest pain after eating, or evolving TMJ dysfunction) require periodic reassessment. Monitoring is also essential for individuals with ADHD symptoms, where sleep disordered breathing can worsen attention, mood, and daytime performance.

FAQ

If CPAP failed, can I try an oral appliance?

Yes. Oral appliances are evidence-based sleep apnea solutions for patients who cannot tolerate CPAP. Many individuals with sleep disordered breathing, UARS therapy needs, or mild–moderate OSA do extremely well with appliances.

Will an oral appliance change my bite?

A temporary bite shift is common in the morning, but it typically resolves within minutes using exercises or bite-repositioning tools. Persistent bite changes are uncommon when devices are fitted and monitored properly, especially when supported by myofunctional therapy and TMJ treatment.

Can I combine CPAP and an oral appliance?

Yes. Combination therapy is effective for patients needing lower CPAP pressures or those with persistent snoring, mouth breathing treatment needs, or airway collapse. It is also helpful for individuals with severe OSA who want improved comfort and stability.

Additional Support for Whole-Patient Care

For patients with complex airway challenges—such as chronic nasal congestion treatment needs, bruxism therapy, temporomandibular joint dysfunction, or difficulties with swallowing therapy—BreatheWorks provides comprehensive care that includes:

• Myofunctional therapy
  
• Breathing treatment
  
• Dysphagia treatment
  
• TMJ dysfunction treatment
  
• Speech and language therapy for adults
  
• Pediatric speech and language therapy
  
• Teletherapy service options

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