On a sleep study, CPAP usually brings breathing interruptions down further than a mandibular advancement splint does. In everyday life, though, many people wear a splint for more of the night than they manage with a CPAP mask, and the treatment that is actually used is the one that helps. That trade-off, more than the price tag, is what decides between the two. Severity of sleep apnoea comes first, then comfort, then cost.
Snoring and sleep apnoea need a diagnosis before a device
Loud snoring can be harmless vibration of the soft palate, or it can be a sign of obstructive sleep apnoea (OSA), where the airway repeatedly narrows or closes during sleep and oxygen levels dip. From the outside the two can sound identical. Only a sleep study can tell them apart and measure severity, usually reported as the apnoea hypopnoea index (AHI), the number of breathing events per hour.
That number, together with symptoms such as daytime sleepiness, morning headaches, witnessed pauses in breathing and conditions like high blood pressure, is what a sleep physician uses to recommend a treatment. Our article on telling snoring apart from sleep apnoea explains the testing. Fitting a splint without a diagnosis risks quietening the snoring while leaving significant apnoea untreated.
A splint moves the jaw; CPAP pushes air
Mandibular advancement splint
A mandibular advancement splint (MAS), also called a mandibular advancement device, is a pair of custom trays that fit over the upper and lower teeth and are linked so the lower jaw is held a few millimetres forward during sleep. Bringing the jaw forward draws the tongue base and soft tissues away from the back of the throat, making the airway less likely to collapse.
A dentist makes it from a scan or impressions of your teeth, then adjusts the amount of advancement in small steps over several weeks. Too little may not open the airway enough; too much can make the jaw and teeth ache. A follow-up sleep study with the appliance in place is usually advised to confirm it is working.
CPAP
Continuous positive airway pressure uses a small bedside pump connected by a hose to a mask over the nose, or nose and mouth. The steady air pressure holds the airway open from the inside. CPAP has the strongest evidence of any OSA treatment and is usually recommended first for moderate to severe sleep apnoea. Many people take a few weeks to get used to it, and changing the mask style, adding humidification or adjusting pressure with a sleep technician often helps.
What the research says about choosing between them
The American Academy of Sleep Medicine and American Academy of Dental Sleep Medicine guideline (Ramar and colleagues, Journal of Clinical Sleep Medicine, 2015) recommends oral appliances for adults with OSA who cannot tolerate CPAP or who prefer an alternative, and for primary snoring, with the appliance made and adjusted by a qualified dentist rather than bought off the shelf. The RACGP Handbook of Non-Drug Interventions also describes mandibular devices as an option for mild to moderate OSA.
An Australian randomised crossover trial in people with moderate to severe OSA (Phillips and colleagues, American Journal of Respiratory and Critical Care Medicine, 2013) compared the two over one month each. CPAP lowered the AHI more, but people reported wearing the splint for more hours a night. Neither treatment lowered blood pressure overall, while daytime sleepiness, driving simulator performance and sleep-related quality of life improved by similar amounts on both. Findings like these are why splints are a reasonable choice for many people with mild to moderate OSA, while CPAP generally remains first choice when apnoea is severe or oxygen levels drop markedly.
Practical differences day to day
| Mandibular advancement splint | CPAP | |
|---|---|---|
| Usually suited to | Snoring, mild to moderate OSA, or CPAP intolerance | Moderate to severe OSA |
| Travel | Fits in a small case, no power needed | Needs power and more luggage room |
| Common early complaints | Jaw or tooth soreness in the morning, extra saliva | Mask leaks, dry nose or mouth, feeling of air pressure |
| Longer term watch points | Gradual bite changes, jaw joint symptoms | Mask fit and replacement parts |
| Who reviews it | Dentist, with the sleep physician | Sleep physician and sleep technician |
Splints are not suitable for everyone. Not having enough healthy teeth to anchor the appliance, active gum disease, significant jaw joint problems or a very limited ability to move the jaw forward can rule one out or call for closer monitoring. Long term splint wear can also shift the bite slightly, which is one reason for regular dental reviews.
How the costs compare
Prices across the Australian market vary with the provider, the device design and how much adjustment is involved. As a general guide, custom splints are commonly quoted somewhere around $1,500 to $3,000, and a CPAP machine with mask and setup in a similar range of roughly $1,200 to $3,000. These are broad market figures, not a quote from Lumi Dental.
The costs fall differently over time. A splint is mostly an upfront cost, plus reviews and an eventual replacement after some years. CPAP adds ongoing costs for masks, cushions, filters and tubing. Many sleep services offer CPAP hire so you can trial it before buying, and private health extras cover may contribute toward either, depending on your policy. Avoid choosing on price alone, and an over the counter boil and bite device is not a substitute for a custom appliance when sleep apnoea has been diagnosed. Whatever you choose, you can ask for a written treatment plan with fees first; our article on informed financial consent explains what it should include.
When the first choice is not working
If snoring or tiredness continues on a splint, or you cannot get comfortable with CPAP after trying different masks, go back to your sleep physician rather than giving up. Weight change, sleeping position, nasal blockage and alcohol can all affect results, and some people end up using both, for example a splint for travel and CPAP at home. Jaw soreness, clicking or a bite that feels different while using a splint should be checked by your dentist, and our article on grinding, clenching and headaches may be useful if jaw tension is part of the picture. If anxiety about new equipment or dental visits is holding you back, our guide to managing dental anxiety has practical ideas.
What patients ask about splints and CPAP
Can I choose a splint just because I prefer it?
Preference does count, and guidelines support a splint for people who prefer one, but your sleep physician will weigh it against how severe your apnoea is.
Who diagnoses sleep apnoea, the dentist or the doctor?
A doctor, usually a sleep physician, after a sleep study. A dentist then makes and adjusts the oral appliance and works with your medical team on follow-up.
Will a splint stop my snoring completely?
It often reduces snoring considerably, but results vary with jaw shape, airway anatomy and weight, so it cannot be promised.
How long does a custom splint last?
Often several years with good care, though heavy grinding, cleaning habits and dental changes can shorten that.
If you snore, have been told you stop breathing at night, or have struggled with CPAP, the first step is a proper assessment. Once you have a diagnosis, the team at Lumi Dental can talk through whether a custom mandibular advancement splint may suit you. See our current deals or book with our general dentist team.
