CPAP Alternative Treatments for Sleep Apnea

CPAP therapy is the most common and effective treatment for obstructive sleep apnea (OSA). But many people find it hard to use consistently. Masks can feel uncomfortable. Pressure can be difficult to tolerate. And compliance requirements from insurers can feel burdensome. Adherence rates for CPAP may be as low as 50 percent. That means half of people prescribed CPAP are not getting adequate treatment.

The good news is that CPAP is not the only option. Several alternatives have strong evidence behind them, and the right choice depends on the severity of your OSA and your personal preferences.

Alternative PAP Therapies

Some people do better with a variation of PAP therapy rather than standard CPAP. BiPAP machines use different pressure levels for inhaling and exhaling, which some people find more comfortable. APAP machines adjust pressure automatically throughout the night based on your breathing patterns. EPAP devices take a different approach entirely. Instead of a machine, they use small nasal valves that create pressure only when you exhale, keeping the airway from collapsing. EPAP is prescription-based, requires no power source, and is significantly less bulky than a CPAP machine.

Oral Appliances

Oral appliances are custom-fitted mouthpieces made by a sleep dentist. They work by repositioning the jaw or tongue to keep the airway open. Mandibular advancement devices hold the lower jaw forward and are the most commonly prescribed type. They work best for people with mild to moderate OSA. Tongue retaining devices hold the tongue forward and are another option, though studies show lower compliance compared to mandibular devices.

Lifestyle Changes

For people with mild OSA, lifestyle changes can meaningfully reduce symptoms. Sleeping on your side instead of your back reduces the number of apnea events for many people. Nearly 62 percent of people with OSA have position-dependent apnea, meaning symptoms are worse on their back. Losing excess weight can also reduce OSA severity. Research shows that combining weight loss with positional changes produces better results than either approach alone. Avoiding alcohol and quitting smoking are also recommended first steps by the American Academy of Sleep Medicine.

Myofunctional therapy involves exercises for the tongue, lips, and soft palate. Strengthening these muscles can help prevent the airway from collapsing during sleep and has been shown to reduce apnea events.

Newer Treatments

In January 2025, the FDA approved Zepbound, a GLP-1 medication, as the first drug approved to treat sleep apnea. Originally developed for weight loss, Zepbound showed reduced breathing disruptions and sleep apnea remission in clinical trials, particularly for patients with mild OSA.

Surgical options also exist for patients who do not respond to other treatments. These include hypoglossal nerve stimulation, which uses an implanted device to keep the airway open, and maxillomandibular advancement, which repositions the jawbones surgically.

Talking to Your Doctor

If you have been diagnosed with OSA but struggle with CPAP, or if you want to explore alternatives before starting CPAP, talk to your doctor or a sleep specialist. The right treatment depends on how severe your apnea is, your anatomy, and what you are most likely to use consistently. An untreated or undertreated airway is the real risk.