Device Recommendation for Sleep Apnea & Snoring
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Obstructive sleep apnea (OSA) is a condition that affects millions of people worldwide, causing disrupted sleep, daytime sleepiness, and other health issues. With its increasing prevalence, it’s crucial to find an effective treatment that suits each individual’s needs.
Tongue-stabilizing devices (TSDs) and mandibular advancement devices (MADs) are two options that have gained attention in recent years. But which one is the better solution for OSA? Let’s put them head-to-head in a “TSD vs MAD” comparison and find out.
Key Takeaways
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In the best-known head-to-head trial, TSDs and MADs reduced sleep apnea events by similar amounts, but far more people kept using the MAD: 82% used it every night, against 27% for the TSD.
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Patient acceptance and adherence should be considered when selecting a treatment option due to potential side effects such as discomfort, excessive salivation, dry mouth or pain/discomfort in teeth.
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Alternative treatments include CPAP therapy, positional therapy & lifestyle modifications. Consulting a doctor is recommended for best results.
Understanding TSD and MAD
TSDs and MADs are innovative devices designed to alleviate snoring and sleep apnea by enlarging the airway, thus improving sleep quality and reducing daytime sleepiness.
The best-known head-to-head comparison is a randomized crossover trial by Deane and colleagues, published in Sleep in 2009. It recruited 27 adults with obstructive sleep apnea, and 22 completed it. Each person used both a tongue-stabilizing device and a custom mandibular advancement splint, in random order, with four weeks to get used to each device and then an overnight sleep study.
Tongue-Stabilizing Devices (TSDs)
A tongue stabilizing device, or tongue-retaining device, is a non-invasive treatment option. A small bulb holds the tip of the tongue forward by suction, preventing it from falling back into the throat and obstructing the airway. The TSD in the Deane trial was the AVEOtsd, which the researchers describe as a preformed, non-adjustable silicone appliance. It was not titrated: patients controlled how far their tongue protruded and how much suction they used.
The TSD did reduce breathing events, but it was much harder to live with. Only 27% of patients reported using it every night for six hours or more, compared with 82% for the jaw splint, and 86% removed the TSD in their sleep without meaning to (9% did so with the splint).
Mandibular Advancement Devices (MADs)
Mandibular advancement devices, also known as mandibular advancement device mad, are another type of oral appliance used to treat OSA. They work by physically shifting the jaw forward, increasing the size of the airway and enabling better airflow. One such device is the mandibular advancement splint. MADs often require a prescription and are custom-made to fit the patient’s mouth. Oral appliance therapy, specifically using mandibular advancement devices, has proven to be an effective treatment option for many patients.
In the Deane trial, the MAD was a custom-made two-piece splint used in a non-adjustable version, set at about 75% of each patient’s maximum forward jaw position. Its most common side effects were jaw discomfort (59% of patients) and dry mouth (50%), mostly mild and gone within one to two weeks.
Efficacy of TSD vs MAD
Both devices lowered the apnea-hypopnea index (AHI) by similar amounts in the Deane trial: from about 27 events per hour at baseline to about 12 with the MAD and 13 with the TSD.
Response rates leaned toward the MAD: 68% of patients had a complete or partial response with it, against 45% with the TSD, although that difference was a trend rather than a statistically significant result. The authors favored the MAD because of its higher complete-response rate, acceptance and compliance, and suggested a TSD for people who tolerate it or can’t use a MAD.
Acceptance was where the devices really differed. By three weeks, 64% of patients had stopped using the TSD, while 86% were still using the MAD. About 91% preferred the MAD at the end of the study; every patient was satisfied with it, against about 59% for the TSD. The study was short, and the authors note it did not settle long-term clinical effectiveness.
Patient Acceptance and Adherence
Patient acceptance and adherence are important factors to consider when comparing TSD and MAD therapies. The clinical trial found that patients achieved different results with these therapies:
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TSD users had a lower acceptance rate and self-reported adherence when compared to MAD users
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TSD users experienced adverse effects more often than MAD users
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This was reported by the users themselves
The low acceptance rate of TSD therapy was, in part, due to the discomfort experienced by the patients. This discomfort had a damaging effect on the rate of acceptance.
Commonly reported adverse effects among TSD users included discomfort due to the device not remaining in place, excessive salivation, and a strong sensation on the tongue. MAD users voiced dryness of mouth and teeth discomfort or pain as the most common adverse effects. This is in contrast to other reports..
Evaluating patient preferences and the potential for discomfort is key when selecting an OSA treatment option. The trial results suggest that the choice between TSD and MAD therapies may depend on individual tolerance and the ability to cope with potential side effects.
Side Effects and Risks
Both TSD and MAD therapies come with potential side effects and risks that patients should be aware of before choosing a treatment option. For TSD therapy, the most commonly reported adverse effects were discomfort due to the device not remaining in place, excessive salivation, and a strong sensation on the tongue. Users of MAD often reported dry mouth and pain or discomfort in teeth as the main unpleasant side effects. However, these patients still tend to use it as the preferred solution..
Consider the potential risks and side effects of each option, and discuss them with your healthcare provider before deciding.
Cost and Accessibility
The costs and accessibility of TSD and MAD therapies may also be a determining factor for patients seeking OSA treatment. Over-the-counter TSDs and MADs generally fall between $50 and $150, while custom-made MADs can range from $1,800 to $3,000, including the appliance, dental visits, and post-treatment follow-ups.
While costs can vary, remember that health insurance may cover the expense of TSD or MAD devices. However, coverage is not guaranteed, and it is advisable to contact your insurance provider to determine what coverage is available.
Cleaning and Longevity
Maintaining and caring for your TSD or MAD device is key to ensuring its effectiveness and longevity. The recommended cleaning procedure for both devices involves sterilizing them with hot water after each use and cleaning them regularly to avoid the accumulation of harmful bacteria.
Lifespans depend on the product. Over-the-counter tongue devices and boil-and-bite MADs usually last from several months to a year or two with nightly use, while dentist-made MADs often last several years. Proper care helps, and any device should be replaced when it cracks, loosens or stops holding the tongue or jaw in place.
Choosing the Right Treatment Option
When selecting the most appropriate treatment option for OSA, considering factors such as:
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the severity of the condition
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patient preference
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effectiveness of the treatment
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potential side effects
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lifestyle factors
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cost and accessibility
is vital. Consulting with your doctor before acquiring a TSD or MAD device is important, as they can help determine the most suitable treatment for your individual needs.
The severity of OSA is a key factor in determining the most appropriate treatment. For mild cases, a broader range of treatment options is available, while for moderate to severe cases, continuous positive airway pressure (CPAP) therapy is usually the preferred choice. However, alternative treatments, such as TSD and MAD therapies, can also be considered depending on the patient’s preferences and individual circumstances.
Alternative Treatments for Obstructive Sleep Apnea
Aside from TSD and MAD therapies, there are other treatment options available for sleep disordered breathing, such as OSA. Continuous positive airway pressure (CPAP) therapy is the most commonly prescribed treatment for moderate to severe OSA, which is one of the sleep related breathing disorders. It involves wearing a mask over the nose and/or mouth, which delivers a constant stream of air to keep the airway open during sleep.
Positional therapy can also be effective for some OSA patients, particularly those who experience worsened symptoms when sleeping in certain positions. This therapy involves using specialized pillows or devices to maintain a specific sleep position that reduces airway obstruction.
Lifestyle modifications that may help reduce OSA symptoms include:
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Weight loss
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Abstaining from smoking
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Reducing alcohol intake
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Sleeping on one’s side to improve sleep breath
Discussing all available treatment options, including innovative health technologies, with your healthcare provider to determine the best course of action for your specific needs is crucial.
Summary
In conclusion, both TSD and MAD therapies offer potential benefits for individuals suffering from OSA. In the head-to-head Deane trial, both reduced breathing events by similar amounts, but the MAD was preferred by most patients and used far more consistently.
Ultimately, the choice between TSD and MAD therapies depends on individual factors, including patient preference, tolerance of potential side effects, and financial considerations.
By carefully evaluating all available options, patients can make an informed decision and find the most effective treatment for their OSA.
Frequently Asked Questions
What is the difference between mad and TSD snoring?
MAD and TSD snoring mouthpieces both offer solutions to stop snoring, but they work differently. The MAD is worn like a denture and advances the lower jaw forward to widen the airway, while the TSD gently pulls out the tongue to open up the pathway.
What is the difference between mad and TRD?
MADs move the jaw forward while TRDs hold the tongue in place, making them two distinct anti-snoring solutions. Whether you should opt for one of these devices is something you can determine after researching both.
How effective is mad for sleep apnea?
MADs have been proven to be an effective solution for sleep apnea, with effectiveness being about 65-80% that of a CPAP device. In studies comparing user-compliance rates between the two, MADs come out on top every time.
Can health insurance cover the cost of TSD and MAD devices?
Health insurance may cover the cost of TSD or MAD devices, but it is best to contact your provider to determine what coverage is available.
How often should TSD and MAD devices be replaced?
It depends on the device. Over-the-counter tongue devices and boil-and-bite MADs usually last from several months to a year or two with nightly use; dentist-made MADs often last several years. Replace a device when it cracks, loosens or stops working.
References
- Comparison of Mandibular Advancement Splint and Tongue Stabilizing Device in Obstructive Sleep Apnea: A Randomized Controlled Trial. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2675900/
- Comparative Effects of Two Oral Appliances on Upper Airway Structure in Obstructive Sleep Apnea. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3065257/
- The Tongue-Retaining Device: Efficacy and Side Effects in Obstructive Sleep Apnea Syndrome. https://jcsm.aasm.org/doi/full/10.5664/jcsm.27598
2026 Update
Updated for 2026. See our top mandibular devices in the best anti-snoring mouthpieces guide and the best tongue stabilizing devices.
