Aligners for Sleep Apnoea: An Unexpected Connection

Sleep apnoea is a medical condition wherein during your sleep, your breathing suddenly stops for a fraction of a second and then restarts. It happens when the airway is blocked (obstructive sleep apnoea, OSA) or the brain does not properly control breathing (central sleep apnoea). These pauses lower oxygen levels, waking you briefly to breathe again, which disrupts sleep and causes daytime fatigue. Over time, it can strain your heart, cause irregular heartbeats, increase stroke risk, and lead to daytime sleepiness or sudden heart failure.1
OSA is a more common issue and happens when your airway gets blocked because of the relaxation of your throat muscles. Risk factors for this include larger tonsils, tongues, or certain facial structures. Treatment options include CPAP machines, which gently blow air through a mask to keep your airway open while you sleep, and custom oral devices that adjust the jaw or tongue to prevent blockages during sleep.2 Interestingly, poor teeth alignment can also contribute to OSA.3
In this blog, we will explore how misaligned teeth can lead to sleep apnoea and the mechanics behind using aligners for teeth straightening in managing sleep apnoea. We will also learn about some other special devices that can be used to treat this condition.
The Science Behind Using Aligners to Manage Sleep Apnoea
Sleep apnoea can be caused or worsened by misalignment of the teeth and jaw; a condition known as malocclusion. Issues like overjet or overbite can lead to improper jaw positioning, which may result in mouth breathing. This can cause the tongue to fall back, narrowing the airway and increasing resistance, which can block airflow while sleeping. In severe cases, difficulties in closing the lips due to overjet further block the airway, increasing the frequency of apnoea episodes and disrupting sleep.3
Aligners are an effective method for addressing malocclusion, which can help reduce the impact of sleep apnoea. These clear, custom-made trays gradually move your teeth into their correct positions, using gentle pressure. With each new aligner, your teeth shift slowly into alignment. The use of advanced technology such as attachments helps with more complex cases and ensures your teeth move correctly over time.4
By correcting the alignment of teeth and the jaw, aligners help to create a wider, clearer airway. This can prevent the airway from collapsing during sleep, reducing the number and severity of sleep apnoea episodes. Addressing malocclusion early with aligners may help prevent the development or worsening of sleep apnoea, leading to better sleep and health outcomes in the long run.
Special Types of Aligners Used in Sleep Apnoea Patients
Along with the aligners for correcting malocclusion that can cause sleep apnoea, some other specialized oral appliances are also used to treat apnoea. These appliances work by repositioning your jaw or tongue so that your airways can remain open while you sleep. The main types of dental devices include:
- Mandibular Advancement Devices: These devices push the lower jaw forward to open the airway.5
- Palatal expansion devices: These are orthodontic tools that widen the upper jaw, creating more space in the airways. This improves airflow and reduces breathing problems, especially during sleep.6
- Tongue-Retaining Devices: These devices hold the tongue in place to prevent airway blockage during sleep.
These treatments are often recommended for people with mild to moderate sleep apnoea.5 However, traditional sleep appliances cannot be used together with clear aligners. But recently, a special device has been designed that allows these two therapies to be combined.
The FDA has approved a custom device called Complete Airway Repositioning and/or Expansion (CARE) appliance, which is designed to treat even severe obstructive sleep apnoea (OSA). Similar to a retainer, this appliance works by gradually expanding the roof of the mouth and repositioning the jaw. Thus, it reduces blockage during sleep by creating more room in your air passage. You can wear this at night and even during the day.7
This new approach allows doctors to straighten teeth, fix bite issues, and treat sleep apnoea, all with one device. This device fits comfortably over existing clear aligners, making it a simple and effective treatment option.
The teeth aligners cost can vary depending upon the brand, but with newer options like aligner sleep appliances, patients now have access to more comprehensive treatments for sleep apnoea.
Evidence Based Use: How Aligners can Help with Sleep Apnoea
Sleep apnoea can be challenging, especially with dental problems, but treatments using clear aligners and oral appliances have helped improve both airway function and dental health. The following study and case report are testament to these findings.
Evidence 1:
A retrospective study done on patients with constricted and normal airways, highlights the impact of clear aligners on airway function. Researchers examined the effects of clear aligners on two groups of individuals: one with constricted airways and the other without. The results showed a significant increase in airway volume for patients with airway constriction during treatment. Additionally, the tongue position shifted in 62.2% of cases. As the airway volume may be compromised in OSA patients, these findings seem promising for alleviating breathing issues, also potentially helping in the management of conditions like sleep apnoea.8
Evidence 2:
A 47-year-old man struggled with sleep apnoea and dental issues, making it difficult to sleep at night. He could not tolerate using a CPAP machine because it was uncomfortable. His treatment plan combined clear aligners with a special device designed to open his airway and straighten his teeth. The patient also underwent therapy to improve his breathing and received veneers to address worn-down teeth. After completing the treatment, he experienced less snoring and woke up feeling more rested. A follow-up sleep study showed a significant improvement in his sleep, confirming the success of the combined treatment.9
This evidence highlights the effectiveness of using clear aligners and aligner sleep appliances to treat both sleep apnoea and dental issues.
Conclusion
Aligners provide an effective solution for managing sleep apnoea, especially when combined with other oral appliances. By correcting malocclusion and improving airway alignment, they can reduce apnoea episodes and enhance sleep quality. With innovative treatments like the combined aligners with sleep appliances, individuals can experience better sleep, improved health, and overall well-being.