This product is not available for purchase by the general public. It is delivered under the supervision of medical and dental practitioners.
PEEP Guard™ by iHeart Sleep
PEEP Guard combines mandibular advancement, an integrated air channel and oral EPAP — expiratory positive airway pressure generated by your own breathing — in one compact appliance worn while you sleep.
Takes about 60 seconds · Australia-wide · See your treatment options and next steps
From the clinician who developed it
Conventional oral appliances work by moving the lower jaw forward. They help many people — but for some, jaw advancement alone doesn't control the problem.
I'm Dr Chris Hart. I'm a dentist and researcher, and I've spent years asking whether oral appliance therapy could do more than reposition the jaw — whether it could also manage airflow and pressure through the airway. That question is what led to the integrated air channel and to oral EPAP.
PEEP Guard is the result.
video/why-i-built-it.mp4Dr Chris Hart on why he developed the technology
How it works
Most sleep apnoea mouthguards rely on a single mechanism. PEEP Guard combines three.
The lower jaw is gently held forward, helping to maintain space in the airway during sleep — the mechanism conventional oral appliances rely on.
A built-in airway provides a low-resistance path for airflow past potential sites of obstruction, so you don't have to draw air as hard.
On exhalation the valve restricts outward airflow, generating expiratory positive airway pressure inside the airway using your own breath.
Mandibular advancement + iACT + oral EPAP
Four chapters: the appliance in 3D, seating it in the mouth, airflow through the channel, and a cutaway of expiratory back-pressure. Open it full screen →
Two custom trays made from a digital scan or impressions of your own teeth, connected by advancement links, with the PEEP Shield valve sitting at the front.
video/device-in-hand.mp4Dr Chris Hart walks through the components
The honest explanation
CPAP and oral EPAP are not the same treatment. But they share one important principle.
CPAP
A bedside pump delivers continuous positive pressure through a mask, throughout the whole breathing cycle. Highly effective — when you can use it consistently.
PEEP Guard
The PEEP Shield restricts airflow as you breathe out, generating expiratory positive airway pressure inside your own airway. No pump. No hose. No mask.
Breathing out
As you exhale, the PEEP Shield closes and expiratory pressure builds through the oral cavity and pharynx — the same region where the airway is vulnerable to collapse.
Meanwhile the jaw stays advanced and the integrated air channel stays open, so all three mechanisms are working across the night.
The physiology
Think of drinking through a partly blocked straw. The harder you have to suck, the more the straw wants to collapse in on itself.
Your airway behaves in a similar way. When air has to be drawn past a narrowing, more negative pressure builds up inside the airway — and a vulnerable airway is more likely to collapse. Moving the jaw forward opens space, but it doesn't change how hard you have to work to pull air through.
The integrated air channel gives the air another path. Less effort to draw breath means less negative pressure inside the airway.
Upper-airway collapse is driven substantially by negative intraluminal pressure generated during inspiration against upstream resistance.
In a physiological study, adding the integrated air channel reduced negative pharyngeal pressure swings during sleep by approximately 52% — to levels similar to optimised CPAP.1 Reducing those pressure swings may help reduce the forces contributing to pharyngeal collapse.
Obstructive sleep apnoea is also pathophysiologically heterogeneous: anatomical compromise is only one endotype, which is part of why mandibular advancement alone produces an incomplete response in a substantial proportion of patients. Adding a second and third mechanism targets more than anatomy alone.
The PEEP Shield™ — the expiratory valve that generates oral EPAP. It clips to the front of the appliance and is the component doing the pressure work.
Clinical evidence
Published findings from studies of the oral appliance technologies underlying PEEP Guard. Every figure below is referenced — you can read the sources at the bottom of this page.
In a prospective study of people with severe OSA, EPAP-enhanced oral appliance therapy reduced sleep breathing events by an average of 76% — from 45.4 to 13.4 events per hour. 84% achieved at least a 50% reduction.
Adding oral EPAP to a device already incorporating an integrated air channel reduced the events still remaining by a further 53% — from 12.6 to 5.9 events per hour on average.
EPAP-enhanced mandibular advancement reduced sleep-apnoea-specific hypoxic burden — the oxygen stress caused across the night — by 76% after six months of treatment.
Opening the integrated air channel further reduced events remaining after standard mandibular advancement: ~50% in an initial physiological pilot, ~20% in MAD non-responders in a larger randomised airway-open/airway-closed study.
iACT reduced the negative pressure generated in the throat during breathing by approximately 52% — to levels similar to optimised CPAP.
In the first published clinical study of the airway-enhanced oral appliance, 24 of 29 patients reported no snoring after treatment. All five of the rest reported improvement in frequency and/or intensity.
Efficacy is only part of the story
CPAP reduces sleep apnoea events by approximately 86% while it is being used.7 But how consistently a treatment is worn also decides how much disease is actually treated across the night.
Nightly use in a prospective comparison of 94 patients with moderate-to-severe OSA — mandibular advancement device versus CPAP.8 Measured objectively with an embedded sensor rather than self-reported, oral appliance use averaged 6.6 hours a night.9
Mean Disease Alleviation was non-inferior for the mandibular advancement device compared with CPAP (p = 0.4), despite CPAP reducing breathing events more while worn. The authors note that MDA has not been validated against patient-important outcomes, so this does not establish clinical non-inferiority.8
Conventional oral appliances are worn for longer but generally reduce breathing events less than CPAP. PEEP Guard's technologies are designed to lift the efficacy side of that equation.
Already tried a mouthguard?
Conventional mandibular advancement addresses airway anatomy through jaw position. An incomplete response isn't unusual — sleep apnoea has more than one driver.
PEEP Guard adds two more mechanisms to the one your previous appliance relied on: an integrated air channel, and oral EPAP.
Could it work differently for me?Can't tolerate CPAP?
CPAP is an effective treatment for obstructive sleep apnoea when it's used consistently. We're not going to tell you otherwise.
But masks, hoses, pressure, noise, travel and simply sleeping comfortably make long-term use difficult for some people. If that's you, there may be another option worth discussing.
Check my suitability| CPAP | Conventional MAD | PEEP Guard | |
|---|---|---|---|
| Mandibular advancement | — | ✓ | ✓ |
| Integrated air channel | — | — | ✓ iACT™ |
| Positive airway pressure | ✓ Continuous | — | ✓ Oral EPAP |
| Mask | Required | — | — |
| Hose | Required | — | — |
| Bedside machine / power | Required | — | — |
| Worn in the mouth | — | ✓ | ✓ |
It isn't CPAP in a mouthguard. It's an oral appliance that combines mandibular advancement with an integrated airway and a form of positive airway pressure.
Go deeper
A longer explanation from Dr Chris Hart, for people who want to understand the whole picture before they commit to anything.
video/deeper-explainer.mp4
Dr Chris Hart, in his surgery
Suitability
PEEP Guard is a clinical treatment, not a product you buy off a shelf. Whether it's appropriate depends on your sleep study, your OSA severity, what you've already tried and your dental circumstances.
It may be particularly relevant if:
The advancement links are interchangeable, so the degree of jaw advancement can be adjusted during treatment.
The pathway
Come and see us in person on the Gold Coast or at Tweed Heads, or do the whole thing from home, anywhere in Australia. Either way it's about three weeks from your first assessment to wearing the appliance.
Option 1 — in person
Consultation and a digital intraoral scan — no impression putty. Your fitting and adjustment appointments happen in the chair, which makes optimising advancement faster.
Option 2 — online
Video consultation and a home impression kit with everything you need, plus support from our team while you take them. Fitting and reviews happen by video.
Your treatment journey
Complete the online assessment.
Review your OSA, sleep study and treatment history.
At home or with us, depending on your treatment pathway.
Your personalised oral EPAP-enhanced appliance is manufactured for you.
Your appliance is fitted and adjusted to your individual needs.
Ongoing clinical appointments and optimisation as required.
Only how we take your records, and where you're fitted, changes.
Whichever route you take, the treatment price, the appliance and the clinical care are identical.
Find us
Mermaid Dental Studio
Suite 5B, 2431 Gold Coast Highway
Mermaid Beach QLD 4218
iHeart Smiles at Tweed Dental
47 Kirkwood Road
Tweed Heads NSW 2485
Prefer to talk it through? Call 0458 914 390
Not near either clinic? The full treatment is available Australia-wide by video and post — the $49 consultation with Dr Hart is by telehealth.
Patient experience
We use published clinical research for treatment outcomes, and patient feedback for what the service itself is like.
“I was able to do the impressions with a doctor to fit my new device from the comfort of my own home. I love that it's virtual!”
Kiera J.Patient“The medical staff at iHeart were fantastic and it was a simple process to get started right away. Thanks to the iHeart team!”
Michael S.Patient“Very clear information given by Dr Hart, backed up by included research studies. I am a nurse and midwife, so I like deep diving into the science, and he could answer all my questions really well. Very impressed!”
Sandra F.Patient“Had my initial call and was comfortable with all the information given.”
Michelle W.Patient“Dr Chris Hart was very knowledgeable and answered all my questions.”
Andrew T.Patient“It was a brilliant experience talking to my doctor online.”
Nicholas G.PatientReviews describe patients' experience of our service. They are not statements about clinical outcomes, which vary between individuals.
Transparent pricing
Not a device you buy — a clinical treatment, from assessment through to ongoing care.
Complete PEEP Guard treatment
Everything below is included. No surprises later.
60-second assessment · No payment required to check your suitability
Prefer to talk first?
20-minute clinical consultation, online or in clinic
Go through your sleep study, your OSA severity, your CPAP or oral appliance history, and whether this approach may be appropriate for you.
Credited in full toward your treatment if you proceed.
Book a consultation — $49Dr Chris Hart is a registered dentist and dental sleep clinician.
Ask our clinical team about how treatment works, costs, payment options or the impression process.
Talk to our clinical team — free† Based on the total treatment price of $1,995 repaid over 36 months on SmileRight's interest-free payment plan — $55.42 per month, equivalent to approximately $1.82 per day. A deposit is required with the first payment. Payment plans are provided by SmileRight and are subject to their credit approval; plan length, repayments, fees and eligibility are determined by them, not by us, and are set out in the offer you receive. We also accept Afterpay, humm, PayPal and Square.
‡ Rebates depend on your insurer, level of cover, annual limits and applicable item numbers. Some patients receive no rebate.
Next step
A short set of questions about your diagnosis, your sleep study and what you've already tried. At the end you'll see your treatment options, the costs, and how to speak with our clinical team.
Takes about 60 seconds · Australia-wide · Your answers are used to assess clinical suitability
Questions
Obstructive sleep apnoea has several different drivers, and response to any oral appliance varies between individuals. What we can do is assess your sleep study, your severity, your anatomy and your treatment history, and give you an honest view on whether this approach is worth trying. That's exactly what the suitability assessment and the consultation are for.
CPAP uses a bedside pump to deliver continuous positive pressure through a hose and mask, across the whole breathing cycle. PEEP Guard is worn in the mouth and uses your own exhaled breath to generate expiratory positive airway pressure, alongside mandibular advancement and an integrated air channel. They are different treatments that share the principle of positive airway pressure.
EPAP stands for expiratory positive airway pressure. The PEEP Shield valve at the front of the appliance restricts airflow as you breathe out. That resistance generates positive pressure inside your airway during exhalation — pressure that has to be created by a machine in CPAP therapy, but is created by your own breathing here.
Most conventional mandibular advancement devices rely on a single mechanism: moving the lower jaw forward. If that mechanism alone didn't adequately control your sleep apnoea, PEEP Guard adds two more — an integrated air channel that lowers the resistance you breathe against, and oral EPAP. Published studies of these technologies have shown further reductions in events remaining after standard mandibular advancement.2,3
Severe OSA has historically been difficult territory for oral appliances. In a prospective study of 36 patients with severe OSA, EPAP-enhanced oral appliance therapy reduced sleep breathing events from an average of 45.4 to 13.4 per hour, with 84% achieving at least a 50% reduction.5 That said, severity is one of the most important factors in your individual assessment, and it's a conversation to have with a clinician rather than something to decide from a web page.
Yes — a diagnosis matters, and so does a reasonably recent one. If you have a sleep study, have it handy for your consultation. If you don't, or yours is quite old, we'll talk you through your options for getting one.
No. You can be treated entirely from home, anywhere in Australia — video consultation, a home impression kit posted to you with instructions and support from our team, then fitting and reviews by video.
If you can get to us, we have two clinics: Mermaid Beach on the Gold Coast, and Tweed Heads. In person we take a digital intraoral scan instead of impressions — no putty — and your fitting and adjustments happen in the chair, which usually makes optimising the advancement quicker. The price and the appliance are the same either way.
It's a custom appliance made from a digital scan or impressions of your own teeth, so it fits your mouth rather than being a generic shape. Like any mandibular advancement therapy, some people experience jaw or bite awareness in the early weeks. Your dental circumstances — existing dental work, gum health, jaw joint history — are part of the clinical assessment, which is why an appliance like this should be prescribed rather than bought.
About three weeks end to end, from your first assessment to wearing the appliance — consultation, then your digital scan or impressions, then manufacture, then fitting.
After that, advancement is adjusted over the following weeks based on how you're responding. Getting the appliance is the start of treatment, not the end of it.
That's the complete treatment price, covering the appliance and its five-year warranty, clinical assessment, treatment planning, your digital scan or impression kit, manufacture, fitting, optimisation appointments, follow-up and clinical support.
The $49 consultation with Dr Hart sits before treatment, and if you go ahead it's credited in full toward the $1,995 — so it costs you nothing to get a clinical opinion first.
Many patients with the right level of cover receive a rebate, but the amount varies enormously by insurer, policy, annual limits and item numbers — and some patients receive nothing. We'll give you the item numbers so you can check your specific entitlement with your fund before you commit.
Payment plans are provided by SmileRight. On their interest-free plan, the $1,995 treatment spread over 36 months is $55.42 a month — about $1.82 a day, with a deposit payable with the first payment. No interest is charged on that plan. SmileRight also offer longer interest-bearing personal loans if you'd prefer.
We also accept Afterpay, humm, PayPal and Square.
Applications are subject to SmileRight's credit approval. Their terms, fees and eligibility criteria are set by them, not by us, and are set out in the offer you receive when you apply.
Your PEEP Guard carries a five-year manufacturer's warranty covering fit and breakage. If the appliance doesn't fit as it should, or it breaks in normal use within five years, it's covered.
That's unusually long for an oral appliance, and it's worth knowing why we can offer it: the appliance is manufactured to your own scan or impressions rather than adapted from a stock size.