My Experience With MADs (Part 2): Pros and Cons
Last updated: March 2022
As I wrote about in an earlier installment, I used an oral appliance called a mandibular advancement device (MAD) for several years. By pulling my lower jaw forward, it expanded my airway slightly. That reduced my snoring and helped relieve my sleep apnea. Specifically, I used a custom-fitted Thornton Adjustable Positioner (TAP®) that I received at the office of the inventor himself.
Getting my custom MAD
The first step of getting a custom-fitted TAP is having a mold made. It wasn’t particularly comfortable to have trays of plaster goo pressed up against my upper and lower teeth and jaw and allowed to dry, but it wasn’t painful. I did feel slightly alarmed at how hard the technician had to twist it to remove it from my mouth, though! I was afraid some of my teeth would come along with it! But it made for a perfect fit when I got the finished device.
There’s something else you get fitted for, too, and this is very important: a morning repositioner. This is a small piece of plastic that you must place on your teeth in the morning to coax your lower jaw – which has been pulled forward for 8 hours or so – back into its normal position. (Using the jaw by eating breakfast also helps return it to its working position.)
Things I liked about the TAP
As with any medical intervention, there are pros and cons to using it. These are some reflections solely from my experience. On the plus side:
Good for mild-moderate OSA
It can work if you have mild-moderate sleep apnea. You will probably be able to get a hook length that enables you to move the jaw forward enough for results. I was able to adjust mine within just a week to the point I was no longer waking the dead with my snoring (and stopping breathing for several seconds at a time!). (Note: for some people, it can take longer.) I still made a bit of heavy breathing noise, but my husband was able to sleep through it. This thing saves marriages!
It’s portable and discreet. It comes in a nice little plastic case that you can (and should always) put in your carry-on bag when you travel. You don’t have to display it at TSA like a CPAP machine. Lots of people wear bite guards or retainers at night, so to someone else, that’s what they would assume it is. You pop it into your mouth at bedtime, adjust it, and doze off.
It’s easy to take care of. I brushed mine daily with a little toothpaste and used fizzing denture cleaner tabs once a week. If it still smelled a little funky, some mouthwash at bedtime helped. During the day, I kept it in its case.
No power required
It requires no power source – you “plug it in” just by putting it in!
Things I didn't like about the TAP
Now, for some real talk:
Jaws clamped together
It’s discomfiting initially to have your jaws clamped together. People talk about how wearing the CPAP mask feels claustrophobic – there’s something claustrophobic about having your jaws hooked together too. Especially when you’ve used a key to pull the lower jaw so far forward that you have to use the key to release it again. You can still breathe, of course, but you can’t really talk. You can sip water, though, which I often do at night when thirsty.
If you advance the jaw forward too fast, it can give you muscle aches or headaches. Your muscles eventually learn to relax in the advanced position, but it’s important to adjust slowly.
In the beginning, you’ll probably drool a lot. While your mouth gets used to having something constantly in there, it may produce extra saliva. I slept with a towel on my pillowcase for a while because of this. It’s annoying, but for me, it subsided over time.
Weird. Dreams. These occurred pretty much the entire time I used the device. In my dreams, I either couldn’t talk at all, or I was continually pulling chunks of rubber or foam or even peanut butter out of my mouth, as the physical sensation of having a full mouth seeped into my psyche. A few times, I physically removed the device in my sleep!
You MUST keep the appliance clean and dry when you’re not using it, or it gets stinky and gross. Regardless, it will go from clear to yellowish over time; it’s just how the material is. Also, because I didn’t keep it dry enough, my key rusted over time and essentially got “stripped” so it didn’t work anymore.
Teeth and bite alignment
If you don’t use the morning repositioner RELIGIOUSLY every day, you will likely have big problems with your teeth and bite alignment. Even if you DO use the morning repositioner every day, you may still have big problems with your teeth and bite over time. That’s something I talk about in Part 3.
“Real talk” aside – if you’re just starting your sleep apnea journey, I recommend looking into an oral appliance! I was happy with mine for a very long time.
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