Treating Sleep Apnea & Snoring with a Custom-Made Narval Oral Device

Can’t stop snoring? Afraid you have sleep apnea? Your dentist in downtown Los Angeles has the information you need on finding relief in this week’s blog post.

Sleep Apnea: An Overview

  • Obstructive sleep apnea is a potentially serious sleep disorder causing breathing to intermittently stop and start during sleep.
  • Symptoms include: Daytime sleepiness, snoring and episodes of intermittent sleep, see below.
  • Treatments may include: Lifestyle changes, Continuous Positive Airway Pressure (CPAP), and oral mouthpieces.
  • Research has shown that oral mouthpieces, such as the Narval device, are effective for treating mild to moderate obstructive sleep apnea.

Signs of Sleep Apnea

Obstructive sleep apnea occurs when the muscles in the back of the throat periodically relax closing the airway during sleep. Breathing can be impaired, limiting the amount of oxygen entering your blood. These episodes can occur multiple times per hour, all night, preventing you from achieving restful sleep. Studies suggest that this disorder affects 2%-7% of adults with increased prevalence in middle age males.

Signs associated with obstructive sleep apnea:

  • Loud snoring
  • Episodes of intermittent sleep
  • Excessive daytime sleepiness and increased risk of vehicle accidents
  • Difficulty concentrating during the day
  • Headaches
  • High blood pressure
  • Cardiovascular disease

How to Prevent Sleep Apnea

  • Stay in Shape. Studies show that obese individuals have four times greater risk of developing sleep apnea. Fat deposits around your neck can narrow the airway which may obstruct breathing.
  • Reduce alcohol intake. Alcohol can relax the muscles of the throat contributing to airway narrowing.
  • Quit Smoking. Tobacco and other ingredients in cigarettes can contribute to airway inflammation, thickening of the throat muscles and narrowing of the airway. In addition, smoking cessation appears to be beneficial for overall sleep quality as compared with continued smoking.
  • Treat Nasal Congestion: Difficulty breathing through your nose can contribute to sleep apnea. This may be due to anatomic problems or allergies. Use of decongestants and allergy medications may be beneficial. Evaluation by an ear nose & throat or allergy specialist may also be necessary.

Diagnosis of Sleep Apnea

wearing narval 1Your physician will perform a physical examination and may refer you to a sleep specialist to diagnose the severity of your condition. A sleep specialist may recommend a sleep study where your sleep quality is evaluated overnight. Your heart, lung, breathing patterns, neurological activity and oxygen levels will be monitored during this overnight examination. Once a diagnosis is made, sleep apnea treatment in downtown Los Angeles may include the following:

  1. Lifestyle changes. This includes weight loss if you are overweight, regular exercise, reducing alcohol intake especially before bedtime, smoking cessation and use of nasal decongestants.
  2. Continuous Positive Airway Pressure (CPAP). Treatment involves a CPAP machine to force air through a mask to open the airway while you sleep. This is a successful treatment to prevent apnea and snoring.
  3. Oral mouthpiece. Also called a Mandiublar Repositioning Device. These devices are specifically designed to move the lower jaw forward to open the airway. This can lead to more consistent breathing and can relieve snoring and sleep apnea.

Treatment of Sleep Apnea: The Custom-Made Narval Oral Device

close up of narval 1Many patients have trouble tolerating the CPAP mask and use of a mandibular repositioning device can be a very effective alternative for treatment of mild-to-moderate obstructive sleep apnea. The Narval device is a custom-made appliance that fits over the upper and lower teeth (See picture above). Flexible/adjustable straps are used to move the lower jaw forward thereby opening the airway in the back of the throat. The Narval is made through CAD/CAM technology using a lightweight, flexible, and biocompatible polymer.

A recent study in the journal of Sleep Medicine1 investigated the success in treating obstructive sleep apnea and tolerability of the Narval device. 369 patients were included in the study. Narval treatment was successful in reducing sleep apnea in 76.2% of the participants. 38% had complete symptom resolution. The study found that the Narval device significantly decreased sleepiness and improved quality of life. In addition, the Narval device reduced snoring duration and the number of snoring events per hour. The device was well tolerated in patients who refuse or do not tolerate the CPAP. 


There are many oral mouthpieces on the market that are used to treat snoring and obstructive sleep apnea in Los Angeles. In my opinion, the Narval is one of the lightest and least bulky devices available. Patient’s seem to tolerate this device very well with good compliance. Research also shows that the Narval device is successful in treating sleep apnea and snoring.

Many of my patients are busy professionals in Downtown Los Angeles and will tell me that their significant other complains of snoring. Loud snoring can be a major problem preventing you and your partner from achieving restful sleep. Lifestyle modification along with the use of a custom-made Narval device can be an excellent approach to treating this disorder.

If you or your partner notices loud snoring, gasping during the night, episodic pauses in breathing during sleep and/or excessive drowsiness during the day, contact your physician or dentist for evaluation.

Your medical insurance plan may cover oral devices for treatment of sleep apnea. Our office can help you determine if this treatment is covered. Give us a call for more information.


1. M.-F. Vecchierini et al. A custom-made mandibular repositioning device for obstructive sleep apnoea-hyponoea syndrome: the ORCADES study. Sleep Medicine 2006;19:131-140.

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