CPAP Alternatives: Other Ways to Treat Sleep Apnea

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Obstructive sleep apnea (OSA) is a sleep disorder that affects up to 30% of adults. OSA occurs when a person’s upper airway collapses or becomes blocked during sleep, causing them to breathe shallowly or stop breathing. People with OSA often wake up many times at night, feel tired during the day, and have an increased risk of health complications.

While obstructive sleep apnea usually cannot be cured, treatment can improve sleep, relieve symptoms, and reduce the risk of health complications. Positive airway pressure (PAP) therapy is the preferred and most effective treatment for most adults with OSA. Continuous positive airway pressure (CPAP) machines are a common way of delivering PAP therapy.

While CPAP is helpful for many people with obstructive sleep apnea, some people don’t respond to this type of treatment. Others have difficulties using CPAP consistently or prefer not to use it all. Fortunately, there are numerous CPAP alternatives for people who cannot or do not want to treat OSA with CPAP therapy.

CPAP machines are only one way of using pressurized air to keep the windpipe open and reduce blockages. Other PAP devices may be appropriate depending on a person’s individual needs and the type of breathing disruptions they experience.

BiPAP

Bilevel positive airway pressure (BiPAP or BPAP) offers two different levels of air pressure depending on whether the sleeper is inhaling or exhaling. Both pressure levels are preset by a doctor based on the results of a sleep study.

BiPAP may be an appropriate option for people who are unable to tolerate the continuous stream of pressure provided by CPAP machines. It may also be recommended for people with more complex breathing issues.

APAP

Auto-adjusting positive airway pressure (APAP) is another way of reducing obstructions using pressurized air. Also called auto-adjusting CPAP or auto-titrating BPAP, this technology can be added to CPAP or BiPAP devices to allow the machine to automatically adjust air pressure as needed during the night.

APAP machines deliver a lower average air pressure compared to a fixed-level CPAP. This makes APAP devices helpful for people who find the constant pressure from a fixed-rate CPAP machine uncomfortable. Because adjustments are made automatically, APAP technology doesn’t require a sleep study to determine the appropriate level of pressure.

Several new devices have been developed to treat obstructive sleep apnea without the need for CPAP. While these therapies are not recommended as first-line treatments, they offer promise to those who don’t find relief with standard approaches.

Nasal EPAP

Nasal EPAP is an emerging treatment for OSA that uses the individual’s own breath to keep their airway open. This therapy utilizes disposable valves that are secured into or over the nostrils. When the sleeper exhales, the valves block airflow and create enough pressure to keep the airway open.

Although additional research is needed to understand the risks and benefits of nasal EPAP, this treatment may be appropriate for people who have mild to moderate OSA and have trouble with a CPAP machine.

cNEP

Continuous negative external pressure (cNEP) is an investigational treatment for OSA. Unlike many PAP devices though, cNEP machines do not use a mask and do not cover the nose or mouth.

Instead, the cNEP system features a silicone collar that is worn around the front of the neck. The collar is attached to a vacuum pump by a flexible tube. The vacuum creates negative pressure inside the collar, which pulls the tissues of the throat to keep the airway open.

Doctors often recommend changes in behavior for people living with OSA. Rather than an alternative to CPAP, behavioral changes are often recommended in addition to CPAP and other treatments.

Weight Loss and Exercise

Experts estimate that obesity contributes to as many as 60% of cases of moderate to severe OSA. As a result, doctors recommend weight loss for people with OSA who have obesity or are overweight.

Physical activity has also been shown to improve symptoms of OSA, even among individuals who do not lose weight. If dietary changes and exercise are not effective in reducing symptoms, doctors may suggest bariatric surgery.

Switching Sleeping Position

Some people see a significant improvement in their OSA symptoms when they stop sleeping on their backs. Though getting used to a new sleep position can be a challenge, several wearable devices are available that alert the user when they move onto their back. 

Quit Smoking and Avoid Alcohol

Reducing alcohol and tobacco use may be helpful for lessening the symptoms of OSA. Drinking alcohol before bed can worsen OSA, promote snoring, and depress the central nervous system. Smokers are more likely to snore and are at an increased risk of sleep-related breathing disorders like OSA when compared to nonsmokers.

Oral appliances position the jaw or tongue to keep the upper airway open. Although these devices are an alternative to CPAP therapy in people who cannot tolerate continuous airway pressure, some people benefit from using an oral appliance alongside CPAP therapy.

Mandibular Advancement Devices

Mandibular advancement devices (MAD) are worn on the teeth at night. By shifting the jaw forward, these devices enlarge the airway and prevent it from collapsing. MADs come in one- and two-piece varieties and are often custom fitted.

Tongue Retaining Devices

Tongue retaining devices (TRD) use suction to draw the tongue partially out of the mouth, which helps prevent the base of the tongue from blocking the airway. Additional studies are needed to understand the potential benefits of TRDs, but these devices may be a reasonable alternative for people without teeth or who cannot use other oral devices.

Sleep apnea surgery can be used in several different circumstances. As a first-line treatment, surgery may be recommended prior to CPAP therapy in people who have a blockage in their airway that can be fixed with a surgical procedure.

Surgery can also be performed to help people better tolerate CPAP therapy or an oral appliance by addressing physical features that interfere with these other treatments for OSA. As an alternative therapy, surgery may be recommended for people who cannot tolerate CPAP or prefer a different treatment.

There are many surgical procedures used to treat OSA. The type of surgery a person undergoes depends on multiple factors, including their anatomy and both the site and underlying cause of their airway obstructions.

Uvulopalatopharyngoplasty

Uvulopalatopharyngoplasty (UPPP) involves reducing the chances of airway collapse by addressing features of the mouth and throat that contribute to sleep-induced blockages. Surgery often alters the shape and position of the soft palate, which is the rear portion of the roof of the mouth. UPPP is the most common type of surgery used to treat OSA.

Lower Airway Surgery

Surgeries to the lower airway resolve blockages or collapse caused by the tongue or epiglottis, which is the piece of tissue that prevents food from entering the lungs when a person swallows. More than one-third of people with OSA have obstructions in the lower airway, making these surgeries a potential alternative for many people.

Maxillomandibular Advancement Surgery

Maxillomandibular advancement is a surgery that pushes the jaw and other tissues forward. This procedure tightens the inner walls of the throat to reduce the risk of airway collapse. People who have maxillomandibular advancement surgery must wear orthodontic appliances before and after the procedure.

Hypoglossal Nerve Stimulation

Hypoglossal nerve stimulation is a treatment for obstructive sleep apnea that uses a surgical procedure to implant a device in the upper chest. This device stimulates the hypoglossal nerve that causes the tongue to move forward in the mouth and expand the airway. A remote control is used to turn on the device at bedtime.

Before considering an alternative to CPAP therapy, it’s important to discuss any concerns or challenges about this treatment with your doctor. Although adjusting to CPAP therapy can come with its challenges, many side effects of CPAP can be prevented or resolved by working with a health professional.

Your doctor can also discuss alternatives to CPAP if you are unable to use CPAP therapy, if it has not been effective for you, or if you simply want to explore your other options. Although CPAP remains the treatment of choice for many people with obstructive sleep apnea, several alternatives are available to help reduce breathing issues and resolve daytime symptoms.

About The Author

Rebecca Levi

Staff Writer, Sleep Health

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With a bachelor’s degree in anthropology from Indiana University Bloomington, Rebecca enjoys making accurate, up-to-date health information accessible to all readers. As a freelance writer and editor, she has covered everything from healthcare and experimental music to education. Rebecca lives in Tennessee, where she spends her free time reading, writing fiction, and making music.

• POSITION: Side Sleeper
• TEMPERATURE: Cold Sleeper
• CHRONOTYPE: Dolphin

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