Increasingly, dental sleep apnea patients are given a morning aligning tool to help combat the side effects of oral appliance therapy.
What morning aligners are called
These various aligning tools may be called:
- A.M. Aligners
- morning aligners
- morning repositioners
- morning reprogrammers
- …and more
What is a morning aligner in oral appliance therapy?
AM or morning aligners are tools worn in the mouth after an oral appliance is removed to counteract the dental device’s side effects in snoring, apnea, and other sleep-disordered breathing treatments.
It is important to know that there are a variety of morning aligners being made. Some AM aligners cover an entire arch of your teeth.
More recently, many AM aligners are made to cover only the front several teeth, exposing the back teeth.
Also, a variety of different materials may be used to make a morning aligner. Some materials are of a stiffer material, others may provide a more pliable material.
How long do I wear the morning aligner?
If you have been provided a morning aligner, wear it as demonstrated by your dental sleep apnea dentist for approximately 10-15 minutes each morning or later in the day.
If you feel your teeth and jaws are back to a normal feeling, you may remove them sooner.
If you feel your teeth are not in normal contact after 15 minutes, you may need to wear the AM aligner longer.
Always talk through the details of using an aligner with your sleep apnea dentist before using it.
Front teeth only AM Aligners
AM aligners that fit several of the front teeth only are becoming more common.
These morning aligners give the advantage of the patient feeling the back teeth coming together, which is an important goal of AM aligners.
How to use front teeth AM Aligners
- Seat the aligner onto your bottom teeth
- Look in the mirror and bite your top teeth onto the AM Aligner grooves
- The goal is for your upper teeth to move all the way into the imprints of your teeth
- Bite firmly but slowly until you feel all of your upper and lower teeth are in the original indentations of the material AND that your back teeth touch together
- Do not force your bite into the imprinted grooves if there is discomfort
- Slowly and in intervals is best as not to injure internal jaw fibers
- Bite and squeeze together gently
- Repeat until your teeth easily fit into all grooves and you feel your back teeth touching as normal
For some patients, AM aligners may fit snugly and feel secure. For others, they may not. This depends on the alignment of the teeth, the amount of overbite and the size of the individual’s teeth.
This is demonstrated in this video – “AM Alinger.”
Full arch type AM Aligners
You may have received a Full Arch AM Aligner tool.
This type of AM aligner has imprints from all of your upper and lower teeth in a ‘normal’ or most back position when they come together tightly instead of the front teeth only.
In the case of full arch aligners, you will not be able to feel your back teeth contacting.
You would use the tool the same way as for the front teeth only aligners, but instead, you would be able to feel your back teeth in contact after using the aligner and removing it.
This is demonstrated in this video – “AM Aligner Sleep Apnea Device Repositioner.”
Helpful resources for dental oral appliance providers
Make sure to watch My Sleep Device’s video – “How to Make a Morning Aligner for Oral Sleep Apnea Appliance User.”
It is helpful for telehealth patients who were provided the material necessary to make their own AM aligner and their sleep appliance. This video can also help teach dental sleep medicine team members how to make a morning aligner too.
Other Types of Morning Re-aligning Retainers/Tools
Your dental sleep apnea provider may have provided you with an alternate tool or stretches to use to help reestablish your normal bite and alleviate jaw discomfort.
There are quite a few different tools that may be helpful that are not included in this article.
It is important to note, there is no one perfect tool for these actions. Discuss with your sleep apnea dentist options and find what works best for you.
Common aligner questions I get asked from my patients
What to expect to achieve when using an AM aligner and jaw stretches in oral appliance therapy?
Ideally, you should feel free of jaw soreness by regularly performing jaw stretches and using morning aligner tools to prevent or minimize potential bite changes during oral appliance therapy.
What happens if I do not use the recommended morning aligner?
Many patients rarely think at all about their morning routine after they remove their oral sleep appliance.
These same individuals may wear their device for years and have absolutely no bite changes nor jaw soreness.
Others may be diligent with recommendations and still may have bite changes.
In general, performing jaw stretches and using AM aligners of some sort minimizes undesirable side effects of oral appliance therapy.
TIP: It is best to visit your sleep apnea dentist annually or sooner if recommended once you have completed your initial set of appointments and your device effectiveness has been confirmed. While there, they can confirm if you are at high risk for bite changes.
What if bite changes occur and do not reverse quickly?
Again, it is important to note that some patients follow all oral appliance therapy recommendations and still may develop bite changes.
In most cases, dental sleep apnea patients either do not notice these subtle changes or have chosen to accept them because they feel so much benefit from wearing their oral sleep appliances.
In many cases, just stopping the use of your oral appliance for a couple of weeks may help recover your ‘natural’ bite. In these cases, your sleep apnea dentist can help you through your next steps.
The next steps may often include more prudent use of the above stretches and tools moving forward.
Also, sleeping a night or two a week out without your appliance inserted may be recommended.
Additionally, minor changes in your bite rarely cause long-term problems. If the patient’s eating or speech is not affected, many oral appliance patients choose to continue wearing their oral appliance.
Which of the above is the best choice depends on many factors such as:
- Severity of apnea
- CPAP acceptance
- Amount of symptoms when not treating apnea and what daily impact this has
- Impact on sleeping partner
- Potential impact on teeth that are touching together
- Esthetic concerns of the patient
Which of these routes are chosen is best to discuss with your sleep apnea medical and dental providers.
In this circumstance, I often remind patients of 100% CPAP compliance (as set by insurance companies): 4 hours of nightly use, for 7 of 10 nights in a row.
As listed above, most oral appliance patients wear their oral devices much more than what is considered CPAP compliant.
So taking off several hours of oral device usage here and there or skipping a few nights is often okay as long as this is discussed with your medical and dental sleep apnea providers.
If you decide to stop wearing your oral dental device altogether, it is important to consider CPAP therapy, surgery, or alternate therapy.
Typically, apnea will become more severe over time as you age and negatively affect your overall health.
Be aware of your correct bite at the beginning of treatment
Because your sleep apnea dentist is not at your side daily and most general dentists or hygienists won’t notice bite changes until they are severe, patients need to be aware of their bite at the onset of oral appliance therapy.
In many cases, your bite is not perfect before you start wearing your oral appliance. The patient may feel things have changed because they become more aware of the teeth in general once they start therapy.
However, many of these small changes actually may have been present before oral appliance therapy was initiated.
Once you are aware of your normal bite and jaw positions before treatment, take the responsibility of getting involved in adhering to recommendations given by your sleep apnea dentist and get help early on once you notice early changes.
CPAP therapy can move your teeth
Although the research is limited on the effect of CPAP on teeth alignment changes (likely because dentists are not involved directly with CPAP follow-up), some CPAP masks are highly suspect for causing the side effect of bite changes.
I have come across this when a patient decides to stop wearing their oral appliance and attempts CPAP therapy unsuccessfully.
After months or longer of trying CPAP therapy, they give up and wish to return to oral appliance therapy. But their device no longer fits.
During these times, it is likely that the pressure from their masks caused tooth alignment changes.
Becoming aware of your natural bite, performing daily jaw stretches and using prescribed morning realigning tools are great ways to help reduce jaw soreness and bite changes.
If you have followed the above recommendations and still experience jaw soreness or bite changes, contact your sleep apnea dentist for further guidance.
This article will be updated as new tools or recommendations for oral appliance therapy side effect preventions become available.