Do Tongue Retaining Devices Work to Decrease Snoring?
Treatments for snoring fall into three categories: anti-snoring devices; snoring treatments; and surgical solutions.
Within the category of anti-snoring devices, there are hundreds of products, yet mouthpieces make up the largest portion of devices by far.
Mouthpieces can be further broken down into two types, Mandibular Advancement Devices (MAD’s) and Tongue Retaining Devices (TRD’s) sometimes referred to as Tongue Stabilizing Devices (TSDs). MAD’s, named after the mandible, move the jaw slightly forward to maintain a greater separation of the vibrating throat elements.
TRD’s pull the tongue forward, or hold it down, producing a wider gap between the back of the throat and the tongue.
Types of TRD’s
A tongue retaining device is typically made from a soft and smooth medical-grade material, either a piece of flexible plastic or silicone resin, usually BPA (bisphenol A.) free, to eliminate irritation to the tongue, lips, or gums. Similar to baby pacifiers and sports mouthguards, TRD’s are shaped to fit comfortably in the mouth.
TRD that holds the tongue in place with suction.
A TRD that holds the tongue in a fixed position.
A TRD with a depressor pivot to enable swallowing.
A combination mandibular advancement device + TRD.
Fixed TRD’s have a bar across the mandibular area which the tongue sits under and cannot move during the night.
Most TRDs do not require any fitting, and manufacturers offer “one size fits all” models.
An Analysis of Five Clinical Studies for TRD’s
Many TRD manufacturers claim their devices will eliminate snoring completely. While the advertising is encouraging, several clinical studies on TRD devices show good, but not excellent, results.
1. Toward a Treatment Logic For Sleep Apnea: The Place of the TRD.
Published in Behaviour Research and Therapy, Volume 26, Issue 2, 1988, Pages 121-126.
Twenty-four males with a variety of weights, sleep positions, and apnea severity tested. 83% of patients had a positive outcome. The TRD was successful when the apnea was more severe in the supine position, and when obesity levels were not > 50% of ideal.
2. The Tongue-Retaining Device: Efficacy and Side Effects in Obstructive Sleep Apnea Syndrome.
Published in J Clin Sleep Med 2009;5(5):431-438.
84 apneic patients were retrospectively analyzed for five years. The study revealed encouraging results with a snoring intensity decrease of 68%. Age and jaw protrusion were factors negating results. Tongue-retaining device performance tended to be similar to that of a mandibular advancement device.
3. Predicting Response to the TRD for Sleep Apnea Syndrome.
Arch Otolaryngol. 1985 Jun;111(6):385-8.
The study tested the effectiveness of a TRD on 16 male patients with OSA and other factors that contribute to sleep disorder: obesity, the supine sleep posture, and age. The results showed a 69% positive response. Similar to other clinical studies, the TRD was most successful when snoring severity was greater in the supine position (sleeping on the back).
4. The Effects of a Nonsurgical Treatment for Obstructive Sleep Apnea.
JAMA. 1982 Aug 13;248(6):705-9.
A study of 20 male patients with OSA and fitted with a TRD demonstrated a significant reduction in apnea episodes. The mean apnea plus hypopnea index while wearing the TRD was comparable with patients who have been treated surgically for snoring.
5. Comparison of Mandibular Advancement Splint and Tongue Stabilizing Device in Obstructive Sleep Apnea: A Randomized Controlled Trial.
Sleep. 2009 May 1; 32(5): 648–653.
Objective testing showed the MAS and TSD had similar efficacy on 27 male and female patients regarding apnea-hypopnea index (AHI) reduction. 45% showed a response to the TRD. Patients reported a preference for MAS when both devices were used.
Summary of Clinical Studies
While the test group size is small in 4 out of 5 clinical studies, as a whole the results are positive. None of the studies contradicts another. Study #5 showed that TRD’s can be as successful as mandibular advancement. The largest study of 84 patients and longest time-frame of 5 years showed positive results and snoring volume decreases of 68%, which is significant. Overall, clinical studies show TRD success rates as high.
Manufacturer-Sponsored Clinical Studies
The one available sponsored clinical study was by Good Morning Snore Solution and published in the Journal of Sleep and Breathing in May 2008. The clinical study involved 32 users who were subjected to a study which involved the Good Morning Snore Solution and a control device. The study duration lasted two weeks. On average, Respiratory Disturbance Index was reduced by at least 50% in over one-third of subjects, Snoring Index was reduced by nearly 40%, and 70% users wanted to continue using the device.
An Online Analysis of TRD Ratings and Un-Biased Reviews
7 out of 10 online websites that rate snoring devices had a TRD as one of their top 3 devices as of March 2018. Sites analyzed include SnoreWhisperer, AmericanSleepAssociation, TopSnoringMouthpieces, Snore.net, SnoringDevicesThatWork, Apnea Treatment Center, SnoringHQ, Znoring, TopComparisons, and SnoringAids.
A study of reviews in March 2018 for TRD’s sold on Amazon shows a total weighted average of 2.9/5 stars by 335 buyers. No TRD had more then 3.5 star reviews – which shows that TRD buyers were not completely satisfied with their TRD experience.
However, common complaints on Amazon are the ease of use, discomfort, drooling, and not being able to keep the TRD on during sleep. Users do not complain about the effectiveness of the device in reducing snoring after consistently using the device.
Also, because there are no TRD’s approved by the FDA for over-the-counter use for snoring, the TRD’s sold on Amazon are not compliant with Amazon’s seller policy. Thus, review counts and success rates are low, possibly due to the quality of the knock-off, unapproved, and uncompliant listings.
The reputation management firm, Birdeye, published a 4.7-star rating on 1177 reviews of the Good Morning Snore Solution product as March 2018.
TRD’s and Ease of Use
Like most mouthpieces, a TRD requires an adjustment period. It’s not uncommon to feel the tongue bruised in the beginning. Dry mouth and drooling are also common side effects and can be disconcerting but manageable if it means a peaceful night of sleep for the snorer and the sleep partner.
Conclusion
Tongue Retaining Devices offer one of many possible solutions for snoring. Their effectiveness depends upon many factors including the severity of the snoring condition as well as the persistence of the wearer.
TRD manufacturers claim very high success rates for their devices.
Clinical Studies show lower success rates than manufactured advertised rates. Yet, taking a weighted average of all six clinical studies, the success weighted average is 67% of a large reduction in symptoms/snoring in 203 people.
While TRD’s are not necessarily the proper solution for every snorer, the clinical test results are high enough to warrant TRD’s as a valid option to decrease snoring. Further testing would be beneficial.
Our conclusion is that Tongue Retaining Devices are successful in decreasing snoring, especially while sleeping on the back. However, TRD’s are hard to acclimate to and require several nights or even weeks to feel comfortable sleeping in.
About the Author Robert J. Hudson
Chief editor here at Snore Nation and a proud father of two cool boys. I am a reformed snorer, a reformed smoker, a reformed overeater, a reformed city dweller and a reformed workaholic stress monster on the mission to share my insider tips to restore that quality sleep for you and your partner!
