- 1 FACT: All Anti-Snoring Devices have Side-Effects
- 1.1 Anti-Snoring Device/Mouthpiece Costs £$€…
- 1.2 Cutting out the Dentist to get an Anti-Snoring Device?
- 1.3 Think about the impact on your teeth
- 1.4 Consider your Gums
- 1.5 Your jaw joint is at risk with an OTC anti-snoring device
- 1.6 A Common Problem
- 1.7 Comfort & Bulk
- 1.8 Retention / Fit
- 1.9 Adjustability
- 1.10 Lifespan or ‘Cost-per-Wear’
- 1.11 Side-Effects
- 1.12 Summary
- 1.13 Related
- 1.14 Found this useful?
FACT: All Anti-Snoring Devices have Side-Effects
The unpleasant reality is that ALL Anti-Snoring Devices have side-effects. In this post, I review the key factors to look out for. I will make you aware of the risks, side-effects and financial hazards involved.
A Daily Mail article “Ten Snoring Cures” illustrated quite clearly, how poor your chance of success is, with OTC products despite a reputable sounding organisation promoting them…
The journalist concluded by quoting Dr Tom McKay, a Consultant Respiratory Physician from Edinburgh Royal Infirmary Sleep Centre, UK, as saying:
‘Sprays don’t have any great effect although nasal steroids have a small role if you’ve got nasal congestion. It can help to lose weight or avoid alcohol last thing at night or to sleep lying on your side. Various forms of gumshield are reasonably successful – maybe 50 or 60 per cent.’
In this post, I compare the cost, top-selling features and benefits of ‘Gumshields’ for snoring. I contrast ‘boil and bite’ (Over-the-Counter – OTC mouthguards) with dentist prescribed, mandibular repositioning/advancement devices (MRD/MAD).
Factors I will compare and explain include:
- Comfort and bulk
- Retention (how well it stays in place)
- Lifespan & cost-per-wear
And of course, the side-effects they all create for your teeth, gums and jaw-joints.
I’m a sleep industry insider with more than 20 years experience. Learn more about me: Adrian Zacher.
With multiple options to choose from, you may well be confused which to choose. Here’s an easy-to-understand, impartial review – beginning with the basics and then getting more advanced.
A sleep-trained dentist may refer to these as Mandibular Repositioning Devices (MRDs) or Mandibular Advancement Appliances (MADs) or even ‘splints’! (MAS). These custom-made devices are Medical Devices.
I cover the right way to get a mouthpiece/mouthguard, in greater detail in our Information Standard accredited, FREE, jargon-decoded and evidence-based ‘How to Choose a ‘Mouthpiece’ Guide’.
Lets dive right in!
The table below compares the features and benefits of Over-the-Counter (OTC) versus custom-made, prescription anti-snoring devices.
Anti-Snoring Device/Mouthpiece, top-selling features and benefits compared.
|Criteria||Over the Counter (OTC)||Prescription & Custom Made|
|Cost||50-250 GBP – self fit||200-500 GBP for the device plus perhaps the same again for the Dental Clinician’s fees.|
|Comfort/Bulk||Generally custom-made anti-snoring devices are more comfortable to wear and less bulky than OTC ones but there are some old tech custom ones still around.|
|Retention/Fit||Generally custom-made anti-snoring devices fit better (and stay in place on your teeth – known as ‘retention’) than OTC anti-snoring devices and if they don’t you can at least complain to the Dentist and get it either adjusted or replaced.|
|Adjustability||This depends upon how sophisticated the protrusion adjustment mechanism is (how far it pushes forward the lower jaw). Control of vertical opening (not letting the mouth fall open) is also essential to maximise the effect of the protrusion. See my earlier post about ChinStraps.|
|LifeSpan||Generally custom anti-snoring devices have a better lifespan than OTC devices but it also depends upon whether you ‘brux’ (grind your teeth), how well you clean it each morning and what materials it is made from. Warranties of 2 to 5 years are available with some custom anti-snoring devices.|
|Side-Effects||Don’t be Fooled! All Anti-Snoring Devices have side-effects. Its a matter of striking the right balance: Maximum bang for buck versus minimum risks and side effects.|
Anti-Snoring Device/Mouthpiece Costs £$€…
OTC gadgets and ‘treatments’ might appear cheaper than custom-made, prescription medical devices & dentist fees, BUT…
Are they a False Economy?
Cutting out the Dentist to get an Anti-Snoring Device?
Dentists know about teeth, gums and jaw joints. That is what they do.
If you have certain medical conditions, or grind your teeth, you might break an OTC mouthguard whilst you’re asleep.
When you are asleep you cannot spit out pieces of a broken device.
You could INHALE or SWALLOW pieces.
While Dentistry may initially seem expensive, the risks of not using an expert are considerable. Remember, you are relying on the gadget to hold your airway open while you sleep. Think carefully when you choose a device.
Some dentists are specially trained in snoring and sleep apnoea/apnea, known as sleep related breathing disorders (SRBD) and work closely with medics. Dentists with a special interest in sleep, can help you find the correct balance of benefits versus side-effects. You can find them on our Links page. In the UK, look for the British Society of Dental Sleep Medicine.
Think about the impact on your teeth
Fixing your teeth after using a gadget could far exceed any cost saving from choosing a ‘cheap’ OTC anti-snoring device rather than a sleep-trained dentist prescribed, custom-made mandibular repositioning/advancement device (MRD/MAD).
Over time your teeth may move. Its quite possible that an OTC anti-snoring device may place excessive load upon an individual tooth/teeth.
This will hurt and you will either stop wearing the device and accept the financial loss (good luck trying to get a refund on a used product), or under duress from your partner and family, continue wearing it and risk losing the tooth or an expensive crown/cap/bridge.
Custom mouthpieces on the other hand, can be designed to avoid certain teeth if they are at risk. An expert sleep-trained dentist can help identify (and save that tooth) if it could not withstand the lateral loading required. A dental technician would ‘block out’ the identified tooth and not include it in the device.
Consider your Gums
Anything you wear in your mouth, may aggravate your oral hygiene.
With gum disease (gingivitis) occurring in up to 90% of the adult UK population a mouthpiece could mean you lose your teeth! An expert sleep-trained Dentist will identify these risks and work with you to avoid making one problem while trying to solve another.
Your jaw joint is at risk with an OTC anti-snoring device
Jaw pain is truly horrible and once you have a jaw pain problem it persists. An anti-snoring device pulls your lower jaw forwards and the amount it does this to be effective, and not hurt too much, is specific to you.
Some OTC gadgets are only adjustable in large increments, while others you have to fit the device – rather than the device actually fit you (again you may lose your money).
If your jaw joint isn’t healthy before you start using an anti-snoring device then it may cause irreversible harm. (The exception is when a specialist sleep and jaw joint pain [Temporo-Mandibular Dysfunction TMD] dentist prescribes a device for BOTH issues.)
Issues around your jaw joint are where custom-made, adjustable, prescription devices really win. It’s possible, with some of the custom made ones to start off wearing it with no (or very little) change in your jaw position.
While of course it won’t initially stop your snoring, the dentist will gradually advance your jaw until you stop snoring over a matter of weeks. This gives you (and your jaw joint) time to get accustomed.
Which means you may STOP SNORING!
Your sleep-trained dentist will assess your teeth, gums and jaw joint. They will take X-rays and put things right beforehand if necessary. If it doesn’t look like having an anti-snoring device is a good idea, they’ll suggest you DON’T have one, explain why and direct you to appropriate help.
If everything is OK, they’ll monitor the effect the anti-snoring device has upon your teeth, gums, jaw joint and snoring.
A Common Problem
A common problem with OTC anti-snoring devices or ‘mouthpieces’ occurs when the device is adjusted forwards known as ‘protrusion’ (you might do this to try and increase the effect – and stop the snoring noise). The upper and lower device then come into contact ONLY on the back teeth.
This is like a ‘bit’ for a horse – it gives you something to chew on. It ‘gags’ open the bite and places enormous load on your jaw joints.
It would be even worse if this was on one side only, and as you close your mouth your jaw has to ‘rotate’ around this ‘premature contact’.
In short, don’t do it – you deserve better than an OTC anti-snoring device.
Comfort & Bulk
If you had a car that was so small you couldn’t get in it – you might as well not have that car. A gadget that is so uncomfortable to wear, soon ends up being thrown across the bedroom or just left in the bathroom at bedtime.
The design and clinical expertise in how an anti-snoring device is supplied, directly effects your likelihood of successfully wearing it (and therefore whether it stops your snoring) – particularly during the first two weeks of use.
This is when most people who aren’t going to get on with them, quit.
It might seem obvious:
but if you don’t wear it – it doesn’t work.
A sleep-trained dentist will ensure that the device fits you properly and doesn’t hurt. They will also ensure you know how to put the device into your mouth and get it out again.
Generally OTC gadgets that are “one-size-fits-all” have to be bulkier in size to adapt to your teeth than custom-made devices. This would mean it feels like you are squeezing a tennis ball into your mouth –
oh and then you are expected to sleep!
Retention / Fit
How well it fits is known in dental terminology as ‘retention’. This means how well the it keeps hold of your teeth, or to put it another way, how well it ‘clips on’ or stays in place.
Most anti-snoring device designs rely upon the ability of the device to do clip into place, because retention determines how well the device is able to keep your jaw forwards, while you are asleep.
So, the right amount of retention (or fit) is essential for it to work.
The ability to adjust the forward position of your jaw impacts upon both comfort and how well it works. The optimum position for you is unique to you. It has to be just far enough forward to stop your snoring, yet not so far forward it hurts your jaw joint.
Fixed devices (sometimes called ‘monobloc’ devices) take an arbitrary approach to the forward position of your lower jaw (known in dental terminology as ‘protrusion’). This primitive design (both OTC and some custom made ones) is likely to be less than ideal for comfort and effect.
The capability of the device to stop your mouth falling open, is essential to successfully stopping your snoring. You should NOT routinely need a chinstrap in addition to your anti-snoring device. If this is suggested then you need a different device.
Lifespan or ‘Cost-per-Wear’
Some early designs are made from a ‘gumshield’ material known as Ethylene Vinyl Acetate (EVA). This material absorbs saliva from your mouth (and also any cleaning chemicals that may then leak back out into your mouth overnight).
They are damaged if you grind your teeth because the material is quite soft and elastic. Typical lifespan is 6 months to 2 years before the EVA made device becomes too smelly and unpleasant to use. They also distort and place high lateral loads on your front teeth making them very sore in the morning.
Custom made devices are typically made from acrylic (polymethyl methacrylate) and as such are much stronger and less likely to absorb saliva than EVA materials. Some new variants are made from ‘Nylon’ (polyamide) and are very strong in thin section (see Bulk above). This means they will last longer and therefore the ‘cost per wear’ is reduced.
In the UK, it is also possible to obtain a custom anti-snoring device manufactured entirely from metal (known as ‘Chrome’ = Cobalt Chrome wiki link: http://en.wikipedia.org/wiki/Cobalt-chrome) While this type of manufacture may cost more (they are more time consuming to make) the material cross-section is extremely thin (fractions of a millimetre are possible) making the bulk in the mouth minimal (see Comfort and bulk above). The metal device does not absorb saliva or cleaning agents either. Adjustment of the ‘fit’ of these metal devices may be problematic.
As I have highlighted throughout this page, all anti-snoring devices have side-effects.
The most common side-effects observed initially are related to saliva. Some people find they dribble while wearing the anti-snoring device during the first few weeks of use. Others may find they have a dry mouth.
Next up is jaw ache:
This is normally transient and may arise during the ‘titration’ period (where the device is adjusted to gradually advance your lower jaw and stop you snoring). If this occurs, the correct advice is to speak with your Dental Clinician. It normally resolves itself but do not suffer in silence.
Longer term, changes in the position of your teeth may occur:
This is due to the weight of your lower jaw (think gravity) and the muscles attached to it, combining to attempt return of your jaw to its normal position. These forces are all transferred to your teeth and their roots.
This is why even the most wonderful anti-snoring devices are NOT suitable for children
– because they would act like an orthodontic device and move their teeth in uncontrolled ways (exceptionally an orthodontist may prescribe an anti-snoring device for certain children with particular needs).
The right mouthpiece for YOU, is one that stops your snoring, costs you the least money, creates the least side-effects and doesn’t ‘mask’ snoring that may in fact be Obstructive Sleep Apnoea/apnea (OSA) which would be better treated with another therapy.
The MAIN problem with OTC devices or cures is the process of HOW you get one!
OTC mouthguards are available without prescription, with no dental assessment checking your suitability and no assessment for obstructive sleep apnoea/apnea (OSA) prior to their use. Its wrong.
REMEMBER snoring may be a sign of Obstructive Sleep Apnoea/Apnea.
‘Diagnosing’ yourself and then ‘treating‘ your snoring with an OTC anti-snoring device is a mug’s game and any website that encourages you to ‘work out what kind of snorer you are‘ or similar is exploiting your ignorance of the risks (detailed above) to rip you off and make money from your naivety.
Exceptionally, in the UK, you can also find sleep-trained dentists who can screen and recognise Obstructive Sleep Apnoea/Apnea (OSA) symptoms and refer on for further investigation. They can also then prescribe a custom, adjustable Mandibular Repositioning Device (MRD) without a prior medical diagnosis.
Download our NHS England’s Information Standard accredited, FREE in-depth, evidence-based, expert-written and jargon-decoded Guide (thats a mouthful!): How to Choose a ‘Mouthpiece’ to Stop Snoring to understand your options and make more informed choices.
If you are worried about snoring and/or experience excessive daytime sleepiness consult your Doctor or a sleep trained Dentist.
Grab our GP Guide and take it with you.
You can find a sleep-trained Dentist on our Links page.
If contacting your Doctor about sleepiness is not an option for you consider the ASAP Anonymous Sleep Apnoea Process™.
Found this useful?
Let others know what you think.