6 CPAP Alternatives For Sleep Apnea, According To Experts (2024)

Sleep apnea is a sleep disorder that leads to frequent pauses in breathing during sleep, potentially resulting in low oxygen levels, daytime tiredness and other health concerns, such as type 2 diabetes, heart attacksand strokes.

There are two types of sleep apnea: OSA and central sleep apnea (CSA). The most common form, OSA, occurs when the upper airway is blocked recurrently during sleep. This form of sleep apnea is treated with CPAP, as well as additional methods of reducing the frequency of the blockages. CSA occurs when the brain doesn’t send signals to the body to breathe during sleep. CSA can be caused by other health conditions, such as heart failure, stroke and amyotrophic lateral sclerosis (ALS), and is typically treated by addressing any underlying factors.

Sleep apnea can’t be cured, but treatments can help improve sleep by reducing the number of breathing interruptions.

A CPAP machine is a device that delivers constant air pressure into the airway through a motor that blows air into a tube-connected mask, allowing the airway to stay open during inhalation and exhalation. The CPAP mask is worn either in a user’s nostrils or over their nose and mouth during sleep.

CPAP machines may not immediately feel comfortable for all users. Individuals should work with their providers to increase comfort and compliance, try different mask types or sizes and use add-on features like a humidifier chamber or different pressure settings.

Immediate benefits of using a CPAP machine include reduced snoring, better sleep quality at night and less daytime sleepiness. In the long term, a CPAP machine can help prevent high blood pressure, risk of stroke, risk of heart attacks and reduce memory decline, all of which can be side effects of untreated sleep apnea.

CPAP therapy is considered the standard treatment for OSA, but the most effective treatment is one a person diagnosed with sleep apnea is willing to use. “Any alternative is better than not following through with CPAP, which is, unfortunately, a very common scenario for many [people] that have been diagnosed with OSA,” says Paul Schalch Lepe, M.D., a board-certified otolaryngologist and sleep medicine specialist with Silenso Clinic and UC San Diego Health in California.

Similar to CPAP, alternative treatments focus on maintaining an open airway and promoting regular breathing during sleep. Some include lifestyle changes, while others are more invasive.

Weight Loss

Weight loss is recommended for over 80% of people with OSA as a means of reducing the severity of the condition, according to a 2022 study in Breathe^[3]Verbraecken J, Dieltjens M, Op de Beeck S, et al. Non-CPAP therapy for obstructive sleep apnoea. Breathe (Sheff). 2022;18(3):220164. . When someone loses weight, even the tongue, which can block a person’s airway during sleep, can lose fat, according to Valerie Cacho, M.D., a sleep specialist who practices in California and Hawaii.

According to the Breathe study, a weight loss of 5% can improve symptoms, but a weight loss of over 10% is necessary to reduce symptoms and severity of OSA. Weight loss can be effective if it’s maintained, but research shows only 5% of overweight individuals with OSA who lose weight keep the weight off. OSA symptoms can also return even if weight loss is maintained.

Although both weight loss and CPAP treatment are considered effective ways of reducing OSA symptoms, research is conflicting. Some studies suggest that CPAP treatment can be associated with weight gain during initial therapy. Weight loss is mainly recommended as an additional treatment alongside other interventions.

Exercise

Regular aerobic exercise can benefit sleep apnea symptoms, whether weight loss is involved or not, says Dr. Cacho. Researchers aren’t exactly sure why exercise is helpful in reducing sleep apnea symptoms with or without weight loss, but one theory is that exercise may improve sleep quality.

Some evidence also suggests myofunctional therapy, which features exercises to strengthen the upper airway, can help with sleep apnea, Dr. Cacho adds. Myofunctional therapy is an exercise program used to correct abnormal movements of the face and mouth. It might be conducted by a speech and language pathologist or other health care provider who has a certification of orofacial myology. Exercises that strengthen throat muscles are also shown to help improve sleep apnea to some degree, according to David Rosen, M.D., a sleep medicine physician and CEO of Renuma, a digital health platform designed to deliver sleep apnea treatment through telehealth.

FEATURED PARTNER OFFER

We receive compensation from our partners for Featured Partner Offer placements. While this may influence where their products or services appear on our site, it in no way affects our ratings, which are based on thorough research, solid methodologies and expert advice. Our partners cannot pay us to guarantee favorable review of their products or services.

Sleep Doctor- Zzoma Positional Device

• A practical, affordable and comfortable CPAP alternative
• FDA-cleared therapy for mild to moderate positional sleep apnea
• Can be comfortably worn on the upper torso, encouraging side sleeping for improved and uninterrupted sleep
• Designed by board-certified sleep physicians is trusted widely for effective management of positional OSA

Shop Now

On Sleep Doctor's Website

Positional Therapy

Changing sleep positions can also help reduce OSA symptoms in some people. Alternative sleeping positions may include sleeping on one’s side instead of on their back or sleeping with one’s head slightly elevated, says Dr. Cacho, adding that positional therapy tends to work best for those with mild sleep apnea that occurs exclusively during back sleep. This therapy may also be helpful in more severe cases of OSA when combined with other therapeutic options.

If you’ve been diagnosed with OSA and would like to try positional therapy, talk to the medical provider who is treating your OSA, who can suggest sleep positions that might help improve one’s symptoms.

Oral Appliances

Oral appliances are devices made by a dentist and customized to an individual’s mouth shape and size. There are two types of devices: mandibular repositioning mouthpieces, which hold the lower jaw in position, and tongue-retaining devices, which hold the tongue in position. Some devices may work on the jaw and tongue at the same time. Oral appliances are considered a first-line treatment option for mild to moderate OSA and are recommended for people with severe OSA who have problems with higher pressure intolerance, are non-responders to a CPAP device (or prefer not to use a CPAP machine).

Oral appliances may prove to be a preferred alternative to CPAP for some users thanks to their small, convenient size, lack of noise and little need for maintenance, says Kevin Postol, D.D.S., a sleep medicine dentist in St. Louis. In fact, over 80% of people with OSA who are given oral appliances still use them five years later, which is important because it means they’re complying with treatment, he says.

If a person is eligible for an oral appliance, it’s important to consult a qualified sleep dentist for a professional fitting and to help source an appliance customized for one’s individual needs, adds Dr. Postol.

Meanwhile, eXcite OSA, a device approved by the U.S. Food and Drug Administration (FDA), features a mouthpiece that sends electrical impulses to stimulate the tongue and help make the airway less collapsible, adds Dr. Rosen. This device isn’t worn while the user sleeps, and only requires constant use for 20 minutes each day.

FEATURED PARTNER OFFER

We receive compensation from our partners for Featured Partner Offer placements. While this may influence where their products or services appear on our site, it in no way affects our ratings, which are based on thorough research, solid methodologies and expert advice. Our partners cannot pay us to guarantee favorable review of their products or services.

Sleep Doctor – ApneaRx Sleep Apnea Mouthpiece

• Clinically proven to treat mild-to-moderate obstructive sleep apnea
• Boil-and-bite design makes it easy to customize the fit at home
• Adjustable in 1mm increments to maintain comfort and reduce jaw pain
• Made from medical-grade thermoplastic, which is durable and biocompatible

Shop Now

On Sleep Doctor's Website

Surgery

There are several surgeries available to help keep airways open by removing tissue or repositioning jaw bones. These surgeries include:

• Adenotonsillectomy or tonsillectomy, which features removing the tonsils or the adenoids (tissue in the throat behind the nose) and tonsils.
• Tissue removal, which removes extra soft tissue in areas like the tongue, nose or uvula (soft tissue that looks like a ball and hangs in the back of the mouth)
• Jaw repositioning surgery moves the upper and lower jaw to make the airway bigger

Regarding the efficacy of surgical treatments for OSA, Dr. Cacho says the best results occur when tonsils that are too large are removed. Improvements may also occur in individuals with OSA who have a piece of their tongue removed to reduce its size, she adds.

Hypoglossal Nerve Stimulation

Hypoglossal nerve stimulation is a relatively new treatment that involves a surgeon implanting a thin, flexible tube in the muscles between the ribs and an electrical pulse generator in the chest (below the collarbone). The device monitors a user’s breathing and stimulates the hypoglossal nerve, which controls tongue movement, to move the tongue away from the airway when breathing stops.

This procedure is FDA-approved for people with moderate to severe OSA, according to Dr. Cacho.

Anyone who has been diagnosed with OSA and is unable to tolerate use a CPAP device, as well as individuals with mild OSA or snoring can benefit from lifestyle changes to reduce the risk of sleep apnea.

While lifestyle changes like exercise, weight loss and modified sleeping positions can be helpful, these modifications may not be enough to improve moderate to severe OSA on their own, and an alternative treatment like a custom oral appliance might be suggested to open the airway.

In the case of severe OSA,a health care provider or sleep specialist may suggest a person consider surgical options, should the obstruction blocking the airway require removal. Speak with a health care provider or sleep expert to help determine the best CPAP alternatives for your specific needs.