Choosing The Best Snoring Mouthpiece: A Comprehensive Guide

find-mouthguardIf you are reading this then you probably fall into one of two categories of snorers. The first is the group of people who have had a snoring problem as far back as they can remember.

If this sounds like you then you are likely familiar with some anti-snoring devices, and may have even tried a few with little or no success. The second group is the people who have recently discovered that they snore.

Maybe you have been told by a new partner that your snoring is unbearable, and you were mortified because you had no idea. Perhaps due to aging or weight gain you have found yourself very tired in the mornings, and assume it must be because your sleep is being interrupted.

Whatever the case is, you want a solution that is actually going to work, and you probably have a lot of questions.

If you are like most you have heard of anti-snoring mouthpieces, but have no idea that there is such a huge selection of them available.

Snoring mouthpieces fall under mandibular advancement device (MAD) and tongue retaining device (TRD) categories. These are very different. Plus, many have unique features that distinguish them from the others.

If you are starting to feel even more confused, take a deep breath and relax. It is common to feel overwhelmed. You will find all the answers to your questions here as well as a number of reviews on products I have used myself.

The last thing I want anyone to do is just purchase the first product they stumble upon. Choosing the right one will give you the best chance for a positive outcome. Otherwise, you simply waste your money and feel discouraged.

I have made the chart to make it easy to compare products side-by-side. I don’t know about you, but I have a hard time comparing similarities and differences unless I see the information lined up in a chart format.

As you browse this site and read about certain products you may want to try, use this as a reference point. Alternately, you might want to review the chart first to get a basic idea of which devices you want to become a bit more educated on.

The Basics

Some find is quite surprising that a simple device can handle such a monumental problem. Well, believe it, because the right one certainly can. I am a loud snorer, but my wife’s snoring makes mine sound like a whisper, and we are both happily snore-free using these appliances.

There are a lot of products on the market for snoring. However, in my opinion, mouthpieces are the best option. When you have a quality one that fits properly it will be comfortable and effective. You really cannot ask for anything more than this.

You may not know it, but these devices can even be beneficial to your health. See, when you snore, your sleep cycle is interrupted all night. It is absolutely impossible to be completely healthy, if your body is not getting enough quality sleep. In fact, long-term health effects of consistent inadequate sleep cycles can include heart disease, high blood pressure, and stroke.

Most snorers will find that the right mouthpiece is an effective solution. It is important to understand that not all devices are the same, and just because one claims to be 98 percent effective does not mean that it actually is. Some manufacturers base their effective rating on the number of people that actually return the product. In all fairness, there are always going to be people that just cannot be bothered to package it up and go to the post office.

How many times have you kept something because you couldn’t be bothered to return it? I am almost embarrassed to admit how many times I have. So, just keep this in the back of your mind when you see those over-achieving statistics.

That being said, mouthpieces are proven to be quite effective. In 2005, a study was done on 20 heavy snorers, and it was found that a low-cost fabricated MAD was a well-tolerated option for not only snoring, but mild cases of obstructive sleep apnea, as well.

Going back a little further, a large case study was done in 1999 on 134 patients. The mouthpieces were so well-accepted and effective that 86 percent of the patients revealed they were still using them a year later. Only 2 percent stated they were dissatisfied.

So, the question you are probably asking right now is, “Which one should I choose?” Well, before you get too far ahead of yourself you will want to become familiar with the unique features and differences of TRDs and MADs.

Mandibular Advancement Devices (MAD)

snorerxMADs work by holding your jaw in a forward position. You are probably thinking this sounds a little crazy, right?

Rest-assured, it is not an overly exaggerated or awkward position. It is simply an “awake” position that stops your jaw from falling backward while you sleep.

You may not even realize that gravity weighs down every element of your body while you are sleeping, and this includes your jaw. Even being permitted to fall back ever so slightly is enough to allow your tongue to cause an obstruction in your airway that leads to snoring.

An MAD holds your jaw while you sleep so gravity can’t affect its positioning.  Since your jaw is advanced the tissues and muscles in your upper airway remain tightened, as if you are awake. This keeps your airway free of obstruction.

How MAD works (click to enlarge)

How MAD works (click to enlarge)

Your First Experience

The first time you use an MAD you have to expect it to feel a little weird. After all, there is a foreign object in your mouth, so you are going to notice it. However, with time you will get used to it, and may not even notice it at all.

If you wear contacts then you can understand this. The first time the eye doctor placed them in your eyes you may have yelled to take them out and said you would just wear glasses forever. Then, a week later you were falling asleep with them in because you forgot you were even wearing them. The point is that you have to give your mouth an adjustments period. You may experience:

  • Drooling – Nearly everyone drools when they start wearing an MAD. Your mouth is just responding to its presence.
  • Soreness – When you start exercising, or if you do a lot of heavy lifting helping your buddy move, you really feel it the next couple days because you used muscles that are not used to being worked. This same concept applies to your mouth. It is holding your jaw in an awake position all night, so you can expect some soreness at least for a few days while these muscles strengthen.
  • Pain – Some MADs cause facial and jaw pain because you are required to bite down on them all night. Although you should expect soreness you should not be dealing with extreme pain that does not even allow you to sleep. Quality products offer a better fit, especially those that let you make micro adjustments to jaw positioning.
  • Gag Reflex – If you do not already have a noticeable gag reflex then there is little chance an MAD is going to actually make you gag. If you do have issues in this area then some appliances may instigate this reflex. This is especially true of cheaper models that cover your molars.
  • Decreased Teeth Grinding – If you have bruxism you may be pleasantly impressed that as an added bonus, your MAD could stop it. It should be noted though that if you are an extreme teeth grinder, this could decrease the life of your mouthpiece, so it will need to be replaced sooner. This is a small price to pay for a device that can stop both the snoring and grinding though.

Fitting

One of the most common questions that arise regarding MADs is regarding sizing. Many people expect there to be several options. Some do not even consider using these appliances because they cannot figure out how to measure their mouth. Well, you do not have to!

Most mandibular advancement devices are sold as one-size, but use a simple fitting process known as the boil-and-bite method. Do not let this intimidate you. It literally only takes minutes to do, and if you do not get it right the first time you can always try again.

You simply drop the mouthpiece in boiling water for a specified amount of time. Then, you allow it to cool a few seconds to a safe temperature, insert in your mouth, and bite down.

The pliable material forms a mold of your mouth for a custom fit. If you see the word “thermoplastic” in a product description you can count on it needing this process done:

There are some products that have a hinged design. These devices still hold the jaw forward to keep the airway clear of obstruction, but they allow unrestricted breathing and natural mouth movement. The hinged design lets you open and close your mouth, which makes them suitable for mouth and nose breathers. Some also have air spacers to ensure your mouth does not close completely in your sleep.

"Hinged Design" Mouthpiece

“Hinged Design” Mouthpiece

The simplicity decreases the chance of product malfunction, and since there are no fragile components they tend to have a long lifespan. Also, the simple design means there are not crevices that can harbor bacteria, making them easy to clean.

Hinged devices apply pressure to the stronger front teeth of your upper jaw rather than applying more pressure to weaker, lower teeth like other MADs. This design complimented by the soft, pliable material makes them very comfortable.

Tongue Retaining Devices (TRD)

gmssTongue retaining devices do not share the popularity of their MAD relatives. This is not because they are not effective; they simply have not been on the market as long. These smart appliances are considered a second generation invention, and there is a lot to love about them!

Unlike an MAD that holds your jaw forward, a TRD achieves the same goal by holding your tongue forward instead. Since there is no pressure applied to your jaw the safety risks are virtually nonexistent.

Some people snore simply because their tongue blocks their airway when they sleep. By holding the tongue forward, the airway remains open all night, thereby allowing your body to receive all the oxygen it needs. A TRD has a small suction element that gently but firmly holds onto your tongue, thereby keeping it in place.

You Want to Do What With My Tongue?

The first time you see a TRD you may feel a hint of panic. How comfortable can it possibly be to have something attached to your tongue all night? Well, you may be pleasantly surprised. These devices are typically made of silicone or some type of very soft plastic. Since you do not have to bite down to hold it in place, you do not feel an object on your teeth.

This means your jaw is not getting sore, and you do not have to worry about that gag reflex I mentioned earlier. Since you do not have to bite on anything, it allows you to relax your mouth, and as you know, relaxation is a pretty important component to sleep.

How does a TRD work?

Similar to an MAD, a tongue retaining device also gets inserted in your mouth before bed. It fits on the tip of your tongue. When you first look at one you will notice that it resembles a pacifier. There is a small bulb that you squeeze before inserting your tongue into the designated area of the device.

Once your tongue is in place you release the bulb and suction is created. Now when you fall asleep your tongue cannot fall back toward your airway.Generally, you squeeze a bulb on the device before you position your tongue against it.

Most of these oral devices have a couple of tabs that protrude from the outer lips. This helps keep your tongue and the device in the proper forward position. Although not quite as popular as MADs, in many cases they can be just as effective at stopping snoring.how-trd-works

Is it Effective?

If you are just starting to accept the bizarre fact that a simple MAD could help you stop snoring then the thought of a TRD being just as effective might be too much for you to process right now. This is understandable. It’s pretty exciting.

Tongue retaining devices truly shine when it comes to effectiveness. Some devices are said to be at least 80 percent effective. This is pretty impressive.

There are a lot of anti-snoring oral appliances available, but they are not all effective.  I have done enough trial-and-error to know what actually works. I can say firsthand that a quality TRD can help you stop snoring.

Since I am here to educate then it is important that I also say that a TRD is not for everyone. If you cannot breathe through your nose for medical reasons, you should not wear one of these devices.

If you traditionally breathe through your nose but cannot temporarily because of allergies or a cold, then stop wearing your device until your congestion clears. Nasal strips or essential oils, such as bayberry root, neroli, and eucalyptus can be helpful.

My Experience

Although MADs are the most popular option on the market, the TRD is my personal preferred snoring solution. I know how effective and comfortable countless products are, and the TRD just stands out above the rest for me.

When you finish reading this overview, make sure you read my review about Good Morning Snore Solution, also known simply as GMSS. It solved my snoring problem and is the appliance I now use daily. It is my wife’s favorite mouthpiece, as well.

One of the things that makes me so excited about this product is that it treats a variety of snoring cases. Most treatments tend to focus on one cause, but TRDs are different. Not only does it keep your airway clear of obstruction; it keeps your mouth from falling to a wide open position while you sleep, too. TRDs hold everything where they should be.

Are you having a hard time understanding how a TRD is effective? Try to keep your jaw stationary while you move your tongue. It is virtually impossible. Even the slightest movement affects the positioning of the jaw. This is why TRDs are so effective, and this proves that this option can work extremely well for a variety of people.

Characteristics to Get Familiar With

Although there are a lot of low-cost anti-snoring mouthpieces that are all quite similar, you will find that the higher quality ones have a defining characteristic trait.

You will want to compare the characteristics of different devices to make sure you are choosing the right one for you. If you are looking for a very budget-friendly option, it may not have the frills of the others, but there are still characteristic traits you need to examine.

Adjustability

Adjustability and comfort go hand-in-hand. The more you are able to adjust the positioning of your MAD the more comfortable you will be. Some people look at a product and think those tiny adjustments could not possibly make much of a difference in the fit, so they buy a cheap appliance instead. You will be quite surprised at what a difference the slightest adjustment will make.

Another element of adjustability is fit. If you choose an MAD you should be able to achieve a custom fit with it.

TRDs are traditionally one-size-fits-all because they sit primarily outside your mouth. An MAD is inside your mouth so there is no way a one-size fits all option will work or be comfortable for most people. So, when choosing one of these products you should be able to either use the boil-and-bite method on it, or it should come with a mold kit that you send to the manufacturer where a custom appliance is made for you in a laboratory.

Keep in mind that the ones you send to the manufacturer can take a few weeks to be returned to you, so you will need to be patient. Those that you fit at home can be worn as soon as they are completely cooled and hardened.

Material Makes a Difference

If an appliance is going to touch your delicate gums for several hours it better be soft, right? Well, obviously you want an oral appliance that will not irritate, but the actual material is equally important.

Look for one that is BPA-free. This will ensure that it does not have bisphenol A in it. BPA is a toxic chemical often used in the production of plastic. This estrogen-mimicking drug does indeed get into your system. It is linked to diabetes, cancer, miscarriage, birth defect, heart disease, aggressiveness, and other health concerns.

Most oral anti-snoring devices today are BPA-free, but you do have to be cautious of some cheap ones made overseas out of mystery material. Also, if you know you are allergic to latex you will need to choose an appliance that is latex-free.

How Do You Plan to Breathe?

If you always breathe through your nose then you can wear any TRD and MAD without even considering this characteristic. If you breathe through your mouth even part-time, you will want a device with a breathing hole.

This is such a small characteristic that it is often overlooked during the purchasing process. Many people do not even think to look for one, and then they try to use their mouthpiece for the first time and realize it is not a good match.

Devices with breathing holes will ensure that your mouth is not permitted to close all the way so oxygen can still flow through. Understand that bigger is not necessarily better. You may see an appliance with a huge air hole and assume that it is your best option, but in all fairness, keeping your mouth open that wide could be uncomfortable and unnecessary. Alternately, a tiny hole will not be large enough to allow air to pass through. Try to find a happy medium.

Budget, Value, and Life Expectancy

A cheaper device may fit better in your budget, but if its life expectancy is very short then it is definitely not a good value. All mouthpieces need to be replaced at some point. So, although you cannot expect the one you choose to last forever, it should work long enough for you to get your money’s worth out of it.

Most products will cost somewhere between $35 and $200. This is quite low when compared to those fitted by a dentist that can cost thousands of dollars. If you are concerned that the one you choose may not be the best value for the price then make sure it has a money-back guarantee, so you at least have 30 days to evaluate how well it is holding up.

As mentioned earlier, if you grind your teeth an MAD will wear out faster. Therefore you may need to lower your standards when evaluating life expectancy.

So, how long should one last? If you look at the chart I prepared, you will see that 6 to 12 months is average. Those that state they have a three-month life expectancy are not a good value because you will be paying for a new one at least four times a year.

Important Things to Know

I know that when I started looking into anti-snoring mouthpieces many years ago I had so many questions running through my mind I had to literally create a list so I would not forget any I wanted answers to. Below are answers to some questions you may be asking right about now.

What causes snoring?

That snoring sound that is driving your partner crazy is actually caused by vibration. There is a piece of tissue at the back of your mouth called the uvula that can cause an airway obstruction when it makes contact with throat tissue. As air is forced through your airway to get to your lungs it causes the throat tissues and uvula to vibrate.

Other underlying causes can include being overweight, sleeping pills, excessive alcohol consumption, enlarged tonsils, deviated septum, nasal polyps, or being in a very deep sleep.

How long will my anti-snoring appliance last?

There is no way to predict exactly how long every device will last for each individual. The average life expectancy is 6 to 12 months, which you may think is quite a huge difference. There are factors that will affect the lifespan.

If you grind your teeth and sleep at least eight hours a night your device is probably not going to last as long as one worn by someone who sleeps only five hours on average per night and does not grind their teeth.

The type and quality of material is always going to play a major role in longevity. If you are looking for one that will last a couple years then you will need to spend a few thousand dollars on a prescribed appliance.

Can I wear a mouthpiece with my dentures?

Most MADs are not recommended for denture wearers. Since you have to bite down to hold them in place it is just not practical. There are some manufacturers that state their product can be worn by someone with partial dentures, but the dentures need to be worn while sleeping.

This does not mean that a mouthpiece is not an option for you though. If you wear dentures you will want to consider a TRD. You do not have to bite down, so it can be worn whether you have your dentures in or not. This also applies to those with crowns and bridgework.

How much is this going to hurt?

Some look at anti-snoring devices and assume they must be painful to wear. Others figure that in order for one to be effective they will have to endure at least some level of pain. After all, we are programed with the “No pain, no gain!” mentality. Well, this is not weightlifting! You do not have to endure a large amount of physical pain to enjoy results.

Will there be discomfort? Probably! However, it generally only lasts three to seven days as your facial tissues and muscles strengthen. You are essentially working a body part that is used to resting during these hours so there will be an adjustment period. If the discomfort persists, you should discontinue use and consult your dentist. As mentioned above, a device that allows you to make adjustments will provide the highest level of comfort.

Will it stop my teeth from grinding?

Most people do not even think about how their bruxism will be affected by wearing an MAD. Then, they discover that the mouthpiece has not only stopped their snoring; it also stopped the grinding as a nice added bonus. If you are hoping for this benefit be sure to choose one that is inserted between the lower and upper teeth so the grinding action can’t take place.

Will a mouthpiece help my obstructive sleep apnea?

This is a very delicate topic because some people do not realize there are two types of sleep apnea. The condition does not simply fall under one generic category, so if you have not been professionally diagnosed it is important that you do so. Obstructive sleep apnea (OSA) is the result of an upper airway obstruction. Central sleep apnea (CSA) occurs when the brain does not tell the lungs to breathe. Both are considered serious, but CSA can lead to very serious health complications, and even death. If you know you have OSA, you should not wear a device without consulting your physician.

Do I have to breathe through my nose while wearing one?

This will depend on the type of device you choose. If you cannot breathe through your nose you will want to buy a device with breathing holes or a hinged design.

Is there a choking hazard, or could I swallow it?

To ensure the highest level of safety, choose a product that has been cleared by the United States Food and Drug Administration, Australian Register of Therapeutic Goods, or Canada’s Therapeutic Products Directorate. These products should not present such hazards. However, it is important to note that there are products that have been approved that end up deemed dangerous and recalled. This is often seen with food, toys, and medication.

How do I clean my mouthpiece?

These are pretty low maintenance products. Most can be cleaned using toothpaste and a toothbrush, but some will require a specific cleaning solution. A device with more nooks and crannies will obviously take longer to clean because you want to make sure every trace of bacteria is gone.

What is the boil-and-bite process?

When browsing the selection of MADs you will see this term a lot. Boil-and-bite is a process used to achieve a custom fit in the privacy of your own home. Most of these products come as one universal size.

When you receive it, you place it in boiling water for a specified amount of time, which is rarely longer than a few seconds. Then, it gets inserted in your mouth, so you can bite into the softened material. This shapes it to your mouth. When you remove it you will place it in ice water to speed up the cooling process. It will harden into a customized device.

Can the boil-and-bite process be repeated?

Some people are nervous that they will not succeed at achieving a custom fit the first time. This is not a problem. The material is typically fine to heat three times before it starts becoming distorted.

Can children wear these mouthpieces?

MADs and TRDs are not recommended for children to wear. Since their mouth is still developing, the presence of an oral appliance would hinder this development.

What does FDA-approved mean?

If a product is FDA-cleared then it has been approved to be safe by the U.S. Food and Drug Administration. The FDA puts products through extensive testing before awarding this label, as the organization’s responsibility is to protect public health.

If I have TMJ can I wear a mouthpiece?

Most MADs and TRDs are not recommended to wearing if you have TMJ because symptoms can be worsened. This may be a question you want to ask your dentist or doctor.

Do I need to get a prescription from my dentist first?

“Class II Medical Device” is a label given to MADs and TRDs by the FDA. This would require a prescription. However, there is a bit of a loophole thanks to the Code of Federal Regulations that allows you to get one without a prescription. The “adequate directions for use” clause allows you to order your oral appliance online, but this should not be considered a replacement for your dentist or doctor.

I found a cheap one on eBay! Should I order it?

It is easy to get excited about the bargains you can often find on eBay that are shipped from overseas. Although a cheap pair of knock off sunglasses, clothes, or other gadgets may be fine, this is not a gamble you want to take with your mouth. Chances are pretty good that there is basically no description, and it probably does not say what the material is made of or if it is BPA-free. Not to mention, there is little chance that these cheap products are cleared for safety by any public health organization.

Do they really work as a snoring solution?

Anti-snoring mouthpieces can be very effective. However, when you see manufacturers claim to be as much as 98 percent effective you should know that this number is likely based on customer satisfaction. How do they determine customer satisfaction? It is based on returns.

Of course, not every unsatisfied person is going to return a product they are unhappy with, especially if they have to pay for shipping.

A pilot study was done in Belgium on the effectiveness of low cost MADs. The results indicated that 65 percent of users experienced positive results. Other studies have shown even more impressive results.

Why is the manufacturer requesting that I fill out a questionnaire to place an order?

Some manufacturers will ask you a few basic oral health questions. Do not get offended or alarmed; this is a good thing. It means that they probably genuinely care about your oral health and want to make sure the product is a good fit for you. Of course, it does offer them a form of legal protection, as well.

Is it safe to wear?

There are three conditions that determine if an oral appliance is safe to wear. These include:

  • The FDA or other regulatory agency has cleared the device.
  • You do not have a medical condition that can be worsened by wearing one. TMJ and gum disease are two examples.
  • You only wear the appliance for its intended purpose and follow the manufacturer’s instructions.

Which device should I choose?

conclusionNo one can answer this question for you. Your mouth and needs are unique, so one that I love or that your neighbor swears by may not be the best solution for you.

There are numerous products available to choose from, so if you are feeling overwhelmed this is perfectly normal. I have written several reviews on products I have personally tried and you can always use the chart I compiled for comparison purposes.