Alternatives to CPAP

Written by

Danielle Pacheco

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Medically Reviewed by:

Dr. Anis Rehman

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If you breathe irregularly as you sleep, wake up gasping for breath, or feel excessively sleepy during the day, you may be experiencing symptoms of sleep apnea.

There are three types of sleep apnea. The most common type of sleep apnea is obstructive sleep apnea (OSA). OSA affects between 2% and 9% of adults in the United States and about 2% of children. If you have this respiratory disorder, your breathing is interrupted as you sleep. You might snore, gasp, choke, or snort during your sleep. These body responses may wake you from sleep.

Central sleep apnea (CSA) is a much rarer type of sleep apnea. The breathing difficulty isn’t from the airway itself but rather from the part of the brain that controls your breathing. A major symptom of CSA is a repeating cycle where your breathing gradually slows until you stop breathing altogether for a brief period. Mixed sleep apnea is a combination of OSA and CSA symptoms, though it typically presents as OSA first.

If you are diagnosed with obstructive sleep apnea, your healthcare provider may recommend a continuous positive airway pressure (CPAP) machine for treatment. A CPAP machine gives you pressurized air as you sleep to ensure your airway stays open. Patients who use a CPAP machine consistently experience improved quality of life and reduced cognitive impairment. CPAP therapy may also reduce blood pressure.

However, CPAP machines are not the only treatment for OSA. Your doctor can help you determine what treatments might work best for you.

Why Use an Alternative to a CPAP Machine?

People with OSA seek out CPAP alternatives for a number of reasons:

  • Cost: The machine’s out-of-pocket cost starts near $250 and can be up to $1,000 or more. If you use insurance to get a CPAP machine, you often are required to enroll in a rent-to-own plan3 with strict compliance requirements.
  • Compliance Requirements: Insurers such as Medicare require CPAP machine users to adhere to a 30-day compliance period, using the machine at least 4 hours a night on 70% of nights. Patients may struggle to meet these requirements and feel it is an invasion of privacy.
  • Side Effects: Side effects vary among CPAP users. Some find the mask uncomfortable or experience dry mouth, red or itchy eyes, and a dry, stuffy, or runny nose. CPAP users and their sleeping partners may also be affected by noise caused by mask leaks. All of these side effects impact adherence.
  • Adherence: Adherence rates for CPAP machines may be as low as 50%.

A number of lifestyle choices, devices, and surgeries can serve as alternative sleep apnea treatments for people who choose to not use a CPAP machine.

Weight Loss and Exercise

Obesity is a risk factor for OSA. Research shows that significant weight loss reduces the severity of OSA. One study of weight loss intervention for OSA showed a change in diet in combination with a minimum of three hours of moderate exercise weekly is effective. Another study showed that bariatric surgery is also effective in reducing OSA severity. Patients should seek help from an obesity medicine specialist or an endocrinologist to help with medical treatment of obesity.

Patients who lose weight and change their sleeping positions see better results than those who only lose weight. However, weight loss alone cannot completely eliminate OSA.

Sleep Position

Sleeping in a supine position, on your back with your face up toward the ceiling, increases the number of apnea episodes you have in a night. When you have OSA and sleep on your back, your tongue and larynx can obstruct your breathing. One study found that nearly 62% of people with OSA have supine-predominant sleep apnea.

Instead of sleeping on your back, experts recommend sleeping on your side to reduce the impacts of OSA. Studies have shown that patients who wear devices that alert them when they are on their backs have fewer apnea events. However, adherence to use of these devices is an issue, and the technology itself needs improvement.

Avoiding Alcohol

Alcohol use can worsen OSA symptoms in many people. The American Academy of Sleep recommends avoiding alcohol as one of the first steps in treating OSA, along with weight loss and changing sleep position.

Nasal Expiratory Positive Airway Pressure

A nasal expiratory positive airway pressure (nEPAP) device is a one-time use product that is inserted into your nostrils before you go to sleep. These nEPAP devices, sold under the commercial name Provent, provide positive pressure when you exhale and prevent the collapse of your upper airway. Benefits of these devices include reduced apnea events, better quality of life, and reduced snoring.

While nEPAP devices cannot eliminate OSA, they are convenient, less expensive than CPAP, and easy to use when traveling. However, like other devices for OSA treatment, adherence is a concern.

    Mandibular Advancement Devices

    Mandibular advancement devices cover your upper and lower teeth and keep your jaw in a position that prevents it from blocking your upper airway. These devices are silent, easy to use, and less expensive than CPAP machines. However, mandibular advancement devices work best if you have mild OSA or if you experience OSA only when you sleep on your back.

    Tongue Retaining Devices

    Tongue retaining devices keep your tongue forward so that it does not block your airway. These devices also help reduce the number of apnea events you experience, although studies have shown issues with compliance. People tend to prefer mandibular advancement devices over tongue retaining devices.

    Orofacial Therapy

    Orofacial therapy, or therapy for facial and mouth muscles, may help reduce apnea events. In this therapy, you learn how to correct the position of your tongue so that it does not block your airway. You also learn how to control and strengthen muscles in your tongue, soft palate, lips, and face.

    Surgery

    Commonly, children who have OSA will have their tonsils and adenoids removed. A number of other surgeries can reduce apnea events in adults, though the evidence for their efficacy is limited to small studies. Potentially effective surgeries as a treatment for OSA include:

    • Maxillomandibular Advancement (MMA): The upper and lower jawbones are repositioned to help keep the upper airway open.
    • Uvulopalatopharyngoplasty: This surgery includes removal of tissue from around the upper airway.
    • Tracheostomy: This procedure creates a hole in the windpipe where a tube is inserted in order to improve breathing.

    Some treatments require surgery to implant devices. For hypoglossal nerve stimulation (HNS), the surgeon inserts a stimulator into the nerve that controls tongue movement. When this nerve is stimulated, the tongue is positioned to keep the airway open. Studies of HNS show the treatment improves sleep quality, mood, daytime sleepiness, and quality of life.

    Choosing CPAP Alternatives

    Talk to your healthcare provider about which CPAP alternative treatments are appropriate for your OSA. Take note of your symptoms and sleep habits to help your doctor have a clear picture of how OSA affects your life. Together, you can develop a treatment plan to help reduce your apnea events.

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