Snoring, Sleep Apnoea, Mandibular Advancement Splints and the Role of Physiotherapy

Snoring is often treated as a harmless nuisance. Sometimes it is. But regular loud snoring can also be a sign that breathing is being interrupted during sleep.

One common cause is obstructive sleep apnoea, or OSA. This occurs when the upper airway repeatedly narrows or collapses during sleep, making breathing harder and disrupting normal sleep patterns. OSA can affect daytime energy, concentration, mood, blood pressure and long-term cardiovascular health. It is not just a noise problem. It is a breathing and sleep quality problem.

For some people, a mandibular advancement splint may be recommended as part of their care. These devices are also known as mandibular advancement devices, oral appliances or MAS. They are worn in the mouth during sleep and gently hold the lower jaw forward to help keep the airway more open.

For the right person, this can be very helpful. But because the jaw is being held in a different position for several hours each night, some people notice jaw stiffness, muscle tension, headaches or changes in how their bite feels in the morning.

This is where physiotherapy can play a useful supporting role.

What is a mandibular advancement splint?

A mandibular advancement splint is a custom dental appliance designed to bring the lower jaw slightly forward during sleep. This forward position can help reduce airway narrowing by influencing the position of the tongue, soft tissues and throat space.

Oral appliance therapy is commonly considered for snoring, mild to moderate obstructive sleep apnoea, or for some people who cannot tolerate CPAP. Current clinical guidelines recommend that oral appliances are provided and monitored by appropriately qualified dental and medical sleep professionals, with follow-up testing where needed to confirm that sleep apnoea is being adequately controlled (Ramar et al., 2015).

In other words, feeling better is important, but it is not the whole picture. OSA needs proper diagnosis, monitoring and medical oversight.

Why mandibular advancement splints can be helpful

For many people, a well-fitted mandibular advancement splint can reduce snoring and improve sleep quality. Some people also find oral appliances easier to tolerate than CPAP, which matters because a treatment only works when it can be used consistently.

Mandibular advancement splints may help by:

• Reducing snoring intensity

• Improving airway space during sleep

• Reducing breathing-related sleep disruptions supporting better daytime energy in selected patients

• Offering an alternative when CPAP is not tolerated

However, they are not a “one-size-fits-all” solution. The right appliance, the right amount of jaw advancement and ongoing monitoring all matter.

The jaw has to adapt

Although MAS treatment can be useful, it is not always easy for the jaw to tolerate at first.

The splint holds the lower jaw forward for several hours each night. That creates a new load on the temporomandibular joints, teeth, bite, jaw muscles, tongue and upper neck.

Some people adapt smoothly.

Others may notice:

• Jaw muscle tensionmorning jaw stiffness

• TMJ discomfort

• Headachestooth discomfort

• Gum irritation

• Dry mouth or increased saliva

• Neck tension

• Increased awareness of clenching

• A temporary change in bite sensation on waking

These symptoms are often most noticeable during the early adjustment period. They should still be taken seriously, especially if they persist, worsen or interfere with using the appliance.

Long-term monitoring is also important because oral appliances can contribute to dental and bite changes over time. These changes may include reduced overbite or overjet, changes in tooth position or altered tooth contacts (Ramar et al., 2015).

How physiotherapy may help before starting MAS treatment

At DentalPhysio in Buderim, we often see people whose jaw, neck and breathing patterns are closely linked. Before starting a mandibular advancement splint, a physiotherapy assessment may help identify whether the jaw system is already sensitive, stiff or overloaded.

A pre-splint assessment may look at:

• Jaw opening rangejaw deviation, clicking or locking

• TMJ irritability

• Masseter and temporalis muscle tone

• Neck mobility

• Upper neck sensitivity

• Headache patterns

• Tongue resting posture

• Breathing pattern

• Daytime clenching habits

If the jaw is already painful, guarded or restricted, suddenly holding it forward all night may be difficult. Physiotherapy can help calm and prepare the system before the appliance is introduced.

Treatment may include gentle jaw mobility treatment, soft tissue treatment for the chewing muscles, upper neck treatment, breathing retraining, relaxation strategies and exercises to improve jaw control.

The goal is simple: help the jaw become more adaptable before asking it to tolerate a new night-time position.

How physiotherapy may help during MAS use

Some people only seek help after their splint has started to irritate the jaw.

This may feel like tightness through the cheeks, temples, jaw joints or upper neck. Some people wake with jaw fatigue or headaches. Others notice that their bite feels different in the morning and takes time to settle.

Physiotherapy can help by reducing excessive muscle guarding and improving how the jaw moves during the day.

Useful strategies may include:

• Gentle morning jaw mobility exercises

• Controlled mouth opening drills

• Tongue-up resting posture

• Anti-clenching awarenes

• Soft tissue treatment for the masseter, temporalis and related jaw muscles

• Upper neck mobilisation

• Breathing and relaxation strategies

• Advice on pacing and adaptation in collaboration with the dental provider

The aim is not to replace the dentist or sleep physician. The aim is to help the jaw tolerate the treatment more comfortably.

Why gradual adjustment matters

Mandibular advancement splints are often adjusted gradually. This process is called titration.

The jaw is usually brought forward in small increments so the airway benefit can be balanced with comfort and jaw tolerance. More advancement may improve the airway for some people, but it can also increase load on the jaw joints, muscles and teeth.

A person with TMD, jaw locking, bruxism, headaches or high muscle tone may need a slower progression. Physiotherapy can help identify when the jaw is not coping well with the current position and can support communication with the dental sleep provider.

Signs that the jaw may be struggling include increasing morning stiffness, new headaches, joint pain, difficulty chewing, or symptoms that do not settle as the day goes on.

Long-term monitoring is essential

Mandibular advancement splints are not a “set and forget” treatment.

Regular review with a dental sleep provider is important to check comfort, appliance fit, tooth and bite changes, and whether the appliance continues to work as intended. Follow-up sleep testing may also be recommended, because reduced snoring does not always mean sleep apnoea is fully controlled (Ramar et al., 2015).

Physiotherapy can sit alongside this care. It can help manage symptoms, improve jaw function and support comfort, but it should not replace dental or medical monitoring.

The best outcomes usually come from teamwork: sleep physician, dental sleep provider, physiotherapist and patient all working together.

When to consider physiotherapy

Physiotherapy may be useful if you:

• Are about to start using a mandibular advancement splint

• Already have TMD or jaw pain

• Wake with jaw stiffness after using your splint

• Feel your jaw muscles are overworking

• Develop headaches after starting MAS treatment

• Have neck tension linked with jaw symptoms

• Struggle with daytime clenching

• Feel your bite is different in the morning

• Find it hard to relax your jaw or tongue

• Want help preparing your jaw before splint fitting

The key message

Mandibular advancement splints can be very helpful for snoring and obstructive sleep apnoea in the right patient. But they also ask the jaw to work in a new position for many hours every night.

For some people, that transition is smooth. For others, the jaw muscles, TMJs, neck and nervous system need support.

Physiotherapy can help prepare the jaw, reduce muscle tension, improve breathing patterns, teach relaxation strategies and support better adaptation to MAS treatment.

At DentalPhysio in Buderim, we provide hands-on, integrated care for people with jaw pain, headaches, neck tension and breathing-related jaw concerns. If you are starting a mandibular advancement splint, or your current splint is making your jaw uncomfortable, we would be happy to help you understand what is happening and how physiotherapy may support your treatment.

To book an appointment, contact DentalPhysio on 07 3532 8605 or visit

www.sunshinecoastdentalphysio.com.au.

By Simon Coghlan

References

Balasubramaniam, R., McCloy, K., Almeida, F. R., & Cistulli, P. A. (2025). Oral appliance therapy for snoring and obstructive sleep apnoea: A practical guide for clinical care. Australian Dental Journal, 69(S1), S84–S100. doi:10.1111/adj.13062

Camacho, M., Certal, V., Abdullatif, J., Zaghi, S., Ruoff, C. M., Capasso, R., & Kushida, C. A. (2015). Myofunctional therapy to treat obstructive sleep apnea: A systematic review and meta-analysis. Sleep, 38(5), 669–675. doi:10.5665/sleep.4652

Ramar, K., Dort, L. C., Katz, S. G., Lettieri, C. J., Harrod, C. G., Thomas, S. M., & Chervin, R. D. (2015). Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: An update for 2015. Journal of Clinical Sleep Medicine, 11(7), 773–827. doi:10.5664/jcsm.4858