Alternatives to CPAP for Sleep Apnea

CPAP is the usual first treatment for moderate to severe obstructive sleep apnea (OSA), but it is not the only one. Other options include oral appliances, positional therapy, nerve stimulation implants, surgery and weight loss, including a weight-loss medicine approved for sleep apnea. Each works for some people and not others, so the choice is best made with a sleep doctor.

First, see if a different PAP setup helps

Many people who struggle with CPAP do well after a few changes. Before switching treatments, ask your sleep doctor about:

• Auto-adjusting CPAP (APAP) — changes the pressure through the night, so it is only as high as you need at the moment.
• BiPAP (bilevel) — uses a lower pressure when you breathe out. It can help if breathing out against CPAP feels hard or you need high pressures.
• Comfort fixes — a different mask, heated humidity or the ramp setting can solve leaks, dryness and feeling closed-in.

Oral appliance therapy

An oral appliance is a custom mouthpiece worn at night. It holds the lower jaw slightly forward, which helps keep the airway open.

• Who it suits — adults with OSA who cannot use CPAP or prefer another option, and adults who snore without sleep apnea.^[1]
• How it is made — the guideline suggests a custom, adjustable device made by a qualified dentist rather than a store-bought one.^[1]
• How well it works — it lowers breathing pauses for many people, though CPAP usually lowers them more. A follow-up sleep test checks how well it works.^[1]

Learn more in oral appliance therapy for sleep apnea.

Positional therapy

Some people have sleep apnea mainly when they sleep on their back. Positional therapy helps them stay on their side, using a wearable device that buzzes when you roll onto your back, a special pillow or a backpack-style belt.

In a review of studies, positional therapy lowered breathing pauses and daytime sleepiness compared with no treatment, but CPAP lowered breathing pauses more.^[2] It works best when a sleep study shows the apnea is clearly worse on your back.

Nerve stimulation implants and airway surgery

• Inspire and other nerve implants — a small device placed under the skin stimulates the nerve that moves the tongue, so the airway stays open during sleep. They are for some adults with moderate to severe OSA who cannot use CPAP, and there are rules about weight and how the airway collapses. Two newer implants, Genio and aura6000, have joined Inspire. See what is Inspire therapy.
• Nose and throat surgery — fixes a blocked nose or removes extra tissue in the throat, such as in UPPP. It often lowers breathing pauses rather than stopping them completely.
• Jaw surgery — moving the upper and lower jaw forward makes more room for the airway. It is a bigger operation with a longer recovery.
• Children — in children with large tonsils and adenoids, removing them is usually the first treatment.

The AASM guideline advises doctors to discuss a referral to a sleep surgeon with adults who cannot use or do not accept PAP, when their body mass index (BMI) is under 40.^[3] Our page on sleep apnea surgery explains each option.

Weight loss and weight-loss medicine

Extra weight around the neck and belly makes the airway easier to collapse. Weight loss can make sleep apnea milder, and some people improve enough that they no longer have it. Many still need some treatment.

• Modest loss helps — in a long-term study, losing 10% of body weight was linked to about a 25% drop in breathing pauses per hour.^[4]
• Zepbound (tirzepatide) — in trials, adults with obesity and OSA who took it had fewer breathing pauses than those on placebo.^[5] In December 2024, the FDA approved it for moderate to severe OSA in adults with obesity, used with diet and exercise.^[6]
• Weight-loss surgery — the AASM guideline advises discussing it with adults with a BMI of 35 or more who cannot use or do not accept PAP.^[3]

Keep using CPAP while you lose weight. Read more in weight loss and sleep apnea, and see new sleep apnea treatments for what is still being tested, such as the pill AD109.

What doesn't treat sleep apnea

Some products are sold for snoring but do not treat the breathing pauses of sleep apnea:

• Store-bought mouthguards — may quiet snoring while the apnea continues underneath.
• Nasal strips and sprays alone — may ease a stuffy nose or snoring, but do not keep the throat open.
• Mouth taping — there is little good evidence it treats sleep apnea, and it may not be safe if your nose is blocked.
• Snoring apps and smartwatches — can hint at a problem, but they do not diagnose or treat it.
• Sleeping pills and alcohol — relax the throat and can make apnea worse.

Mouth and throat exercises may help some people a little, but they are usually added to another treatment, not used alone. Feeling better or snoring less does not prove your apnea is gone. Only a sleep study can show that.

When to see a sleep specialist

• You have stopped using CPAP — or use it only part of the night.
• Snoring or daytime sleepiness came back — even with treatment.
• You want to try an alternative — most options need a sleep study first and a follow-up test afterward.
• Your weight has changed a lot — your treatment may need to change too.

Sleep apnea care in Cedar Park

Dr. Minal Patel is board-certified in pediatrics and sleep medicine. Our practice offers in-lab and home sleep studies, CPAP and BiPAP titration and therapy, and Inspire evaluation, and can help you talk through other options. We are accepting new patients. Office hours are Monday through Friday, 8:30 to 5:00. We accept Medicaid and CHIP for sleep patients. We do not take walk-ins.