CPAP Alternatives

There are several treatment options and CPAP alternatives for obstructive sleep apnea (OSA). Although CPAP (continuous positive airway pressure) is the most popular treatment for sleep apnea, there are other therapies available. In this section we will discuss some of the most popular CPAP alternatives.

Before we begin, let’s review CPAP.


CPAP is the most popular treatment for sleep apnea. It simply works by pushing air into the back of the throat acting as a splint to keep the airway open. The CPAP machine is very safe. It generally works from the first night of treatment. One of the most common problems with CPAP is discomfort or difficulty tolerating the mask and the air pressure. Although many of the new PAP machines incorporate technologies with the goal of improving therapy compliance,  many OSA patients continue to have difficulty with this treatment option

CPAP Alternatives F&P CPAP Mask


BiPAP, or BiLevel PAP therapy works in a similar manner as CPAP. However, instead of one single pressure, BiLevel uses two pressures – an inhale pressure and a lower exhale pressure. BiPAP/BiLevel PAP is often used for those that have sleep apnea and lung issues, like COPD. Historically, it was also used for sleep apnea patients that had difficulty tolerating CPAP.

Weight Loss as a treatment option for sleep apnea

Weight loss can be a very effective treatment option for overweight and obese patients. There is a strong correlation between weight and sleep apnea. Diet and exercise work for many. However, weight loss with traditional methods takes a long time and has a high failure rate. Bariatric surgery is an option for obese patients who are unable to lose weight through traditional approaches. Bariatric surgery, like all surgeries, has a risk for complications, is associated with post-operative pain, and is not guaranteed to yield weight loss.

Sleep apnea oral appliance 

CPAP Alternatives - Variety or sleep apnea oral mouth guards devices
Variety or sleep apnea oral mouth guards devices

also called mandibular advancing devices, these resemble sports mouth guards. They are specially adjusted by sleep apnea dentists. These dental devices work by moving the lower jaw forward which opens the airway wider during sleep. Many of these devices are adjustable. They are often made of plastic or silicone. Many are hinged, meaning that you can open your mouth with the device still in place. Sleep apnea oral appliances (OA’s) can cause tooth shifting and temporal manidibular joint (TMJ) pain. They work in the same manner as other snoring devices and stop snoring mouthpieces.

Oral surgery for sleep apnea

For adults, there are multiple surgical procedures that can be performed, and the choice among them can be based on the structures that are causing sleep apnea by blocking breathing during sleep.  Procedures can be grouped into those directed at the soft palate or other parts of the breathing passages, such as the tongue. Soft Palate procedures for sleep apnea are more common and include uvulopalatopharyngoplasty (UPPP) as well as newer procedures such as expansion sphincter pharyngoplasty or lateral pharyngoplasty that have proven better than traditional UPPP in some studies.

Hypopharyngeal procedures, including tongue radiofrequency, genioglossus advancement, hyoid suspension and partial glossectomy, can be performed alone or in combination with soft palate procedures. Jaw advancement surgery (called maxillomandibular advancement or bimaxillary advancement) is another option. In children, surgery (usually tonsillectomy and/or adenoidectomy) is a first-line option for obstructive sleep apnea, whereas surgery is typically a second-line therapy in adults.

Hypoglossal Nerve Stimulation 

CPAP Alternatives - Snoring Mouth Picture
Snoring Mouth Picture

This is a newer therapy that involves stimulation of the nerve that controls tongue movement (hypoglossal nerve).  A system is placed inside the body during a surgical procedure.  When the system is turned on during sleep, stimulation of the hypoglossal nerve moves the tongue forward to open the space for breathing in the throat.

Pillar Procedure 

This outpatient surgical procedure uses inserted coffee-straw-like pieces inserted into the roof of the mouth. The result is a stiffening of this area which reduces collapse of the airway.

Positional therapy

Sleep apnea is often worse when sleeping in the supine, or back, position. There are a few simple, as well as complex, devices that aim to prevent these people from sleeping on their back.

Other Alternatives to CPAP

EPAP Valve- Expiratory Positive Airway Pressure devices work by creating resistance on exhale of breath. Current devices are adhesive and stick to the nostrils like a bandage.

Oral Pressure Therapy (OPT) is a treatment for obstructive sleep apnea that uses vacuum pressure to suction the soft palate towards the middle of the mouth with the objective of widening the nasal airway reducing or eliminating airway obstruction.

Continuous Negative External Pressure (cNEP) is a new technology utilizes a sucking pressure outside of the neck area in order to keep the airway open during sleep.

Choosing an alternative to CPAP should be done in conjunction with your physician. Sleep apnea can be a potentially deadly sleep disorder. It is imperative that the treatment that you and your physician choose is ideal for you.  Every person has unique issues. The severity of sleep apnea must be evaluated in the context of the individual’s comfort desires and personal needs.

Above are several alternatives to CPAP for the treatment of obstructive sleep apnea. Not every option is suitable for every patient. Talk to your doctor about these CPAP alternatives for the treatment of sleep apnea.

41 Replies to “CPAP Alternatives”

  1. Randall

    I am exhausted at night. I have an extremely tough job. I am fully self employed. I own a gutter cleaning service. I am so tired of waking up on the couch. My wife gets upset with me because of how loud I snore. I am tired of the sore throat and headaches. Please tell me which mouth piece you recommend.

  2. jaredh4

    Some of those options mentioned at the end of the article are still in ‘experimental’ phase. They are not common and most clinicians are not familiar with some of them.

  3. Mark

    Hello. I’m a sleep tech in Ohio. The mouth pieces pull your jaw forward, much like they teach in CPR classes, to pull the tissue away from the back of your throat. They only cure low levels of sleep apnea.

    Some dentists do fit them, but most do not. Also, the problem with going to a dentist is that most bill though your dental insurance, and treatment for sleep apnea may not be covered under that. You would have to pay for it yourself and submit the information to your insurance for reimbursement.

    Probably the best thing for you to do is to have your family doctor order a home sleep test. There are certain criteria (CHF, neurological disorders, and the use of certain medications, among others) that would mean a home sleep test would not work, and you might have to have an in-lab study. Then, if the home sleep test does show you have sleep apnea, assuming you are otherwise healthy, your family doctor might be able to order an “autopap” device that automatically adjusts to whatever pressures are needed to clear your airway. Again, there are certain conditions that would not allow that to work for you. If those things are possible, that could be the least expensive way to get treated.

    By far, the best way to get treatment is to go to see an actual sleep specialist and see what they recommend. That may involve in-lab sleep studies. If it does, SHOP AROUND FOR THE PRICE!!! I used to work for three labs. The independent lab charged $1900. One hospital charged $3000. The other charged $6,200- all for the same test.

    The consequences of sleep apnea are severe and possibly fatal, and what you described makes it sound very much like you have it. Start with your doctor- they can get you started in the right place.

  4. Robin

    I just finished a sleep study night and the tech told me I stopped breathing so many times in one hour I was not breathing for more minutes than I was breathing. I cannot tolerate a mask strapped to my face due to my trauma history. What other options are going to help me?

  5. Barry

    It seems there are no answers offered here but I’ll put in my bit anyway. I went through the tests in hospitals twice. The first was with faulty equipment. They kept waking me to fix it. So much for the results. The next was good and showed I needed help. I bought a good CPAP device then found I needed a full face mask as my mouth opens and air rushes out making lots of noise. The full face kept my mouth closed but a sinus inflammation problem blocks my nose deep inside so I can’t breath anyway. I had a sinus operation but it came back. I only need the minimum pressure anyway. I’m a “lazy” breather and often relax so much I stop breathing for a short time, even when I’m awake. I don’t snore all night or even every night. I have a gag problem so I can’t use the mouth guard style device. Any suggestions?

    • Sylvia Robinson

      I have used cpap since 1987 and believe me i have tried most of them. I cannot do full face or nose mask does not seal or causes claustrophobia.the Pillows are better does not cover your face at all. And if your mouth tends to fall open get a chin strap. There is one I liked a lot the ‘tap pap’ my insurance didn’t cover it. One other things shop for headgear,some are very restrictive and you feel like that silence of the lamb guy. Look online at different cpap vendors see whats out there. your DME is probably only going to carry a fraction of whats out there.

  6. Lori

    There was a lot of talk a couple of years ago on a cpap message board about 2 ways to keep your lips from opening. One was using white medical paper tape. You can find at any discount store or drug store. I use the 2″high tape, I tear it off at about 2.5 – 3 inches, and tape my mouth closed. My doctors nurse was aghast, and asked me what if I had to throw up? Well, I’ve yet to wake up with an urgent need to be sick, so not too worried about that. The other way was to use a small amount of denture cream on your lips, when its on lightly lick your lips, then press them together and hold a minute for it to set up. This works as well; if you wake up with a leak, lick the spot where air is leaking through and press your lips together again. Should hold up well for at least 8-9 hours.

  7. Lori

    I wanted to finish off, this allows me to use a nasal pillow mask, where virtually nothing but the 2 nasal pillows touches my face, so all the inability to sleep with a mask should be alleviated.

  8. Deb

    I too have been evaluated a sleep lab and told I have severe obstructive sleep apnea. The Dr. told me my only option is CPAP. I am claustrophobic and cannot tolerate the machine, even with the simple nasal pillows. I would like to look into surgery but have not found anyone with experience. For now I wear a snoring mouthpiece which stops my snoring considerably and my husband is happy.

  9. Veronica Gore

    I have had my CPAP machine for over 10 years, is there any other cures for sleep apnea instead of a machine? The straps have left wrinkles on my forehead and strap intentions. Tricare no longer covers CPAP accessories I have been ordering online and that cleaning machine is 300 dollars. I seriously think we all need proper cleaning for the mask and hoses.

  10. Oventus

    Australia’s Oventus Medical has been working on a streamlined, compact solution in the form of their customizable titanium mouth device called the O2Vent. We’ve reported previously on Oventus and their collaboration with Australia’s Commonwealth Scientific and Industrial Research Organisation in bringing this innovative, customized breathing device to market in Australia this year.

  11. David

    I have given my full mask CPAP a chance and used it for the obligatory three months. I hate using it! I have not had a full nights sleep in three months. I hate using it ! All I hear is Darth Vader breathing all night. I hate using it! All I feel is Capt. Hook’s crocodile biting my head and face! I hate using it! In the morning my mouth is dry as Lawrence of Arabia! I hate using it!

    I really want to find an alternative. Other than a dentist making one for me, is there a mouthpiece out there that works?

    Oh……did I tell you that I hate using it?

    • Tamara Lichtenstein

      Yes! (Hearing that you hate using it). Mine was prescribed a few years ago. Tried many masks, none fit well, all leaked. I really gave it a good effort, but eventually couldn’t take it anymore–which was worse: disrupted sleep from apnea, most of which I wasn’t aware of (very high apnea score though) or disrupted sleep from the medieval contraption? Yeah… Got surgery for deviated septum (the doc said this would not replace need for CPAP but would help it work better). Not better. Pulled the machine out of the closet a couple nights ago after a terrible apnea night, the kind that reminds you this can kill you. Did okay the first night but second night, last night, woke with a horribly bloody-looking eye. So I’m online discovering that eye problems go with CPAP, not just dry eye but potentially from mask pressure. What the hell…Now I have to make up fun story (instead of boring CPAP crap) to explain at work for however long I look this way. Tired and scared to sleep, not a good combination.

      • BJ

        CANNOT TOLERATE MY MASK, I am allergic to the plastic and nose and lip gets blisters, then cannot wear it until the sores heal up.

      • Laura

        the cpap machine has to be adjusted when you have nasal or face surgery..or lose or gain some wieght..tamara get your machine mother had blood filled eyes that really could cause you to go blind to much pressure?just a guess..but your surgeon should have told you go back do a study get it adjusted do not even bother wearing it until then …more harm than good.

  12. Pamela Gay Conley

    I am allergic to the silicone in my full face mask. Do you or anyone else know of a full face mask made without silicone? I cannot use the Remzzz’s as they slip off at night and the fibers get into my eyes. Please email me if you have any information about an alternative mask. The Sleepweaver cloth mask is useless. I cannot seal it. Thanks

  13. Andrew

    Have a look at a product called air ring, just google air ring. It’s not available yet as it hasn’t been approved by the regulators but it looks like it will be easier to use this compared to a CPAP Machine

  14. Jim

    I have to confess that I’m mildly astonished at all the negativity surrounding the CPAP machines. For people who are reading these notes before having tried any of the alternatives, let me add a more positive experience. I have been using one for about three years, and my only real complaint is the annoyance of having to carry it around when I travel.
    The machines themselves are quiet, and a little tinkering with the strap tension and mask positioning eliminates any escaping air noise. I have used both the full face mask and the pillow; the pillow is clearly preferable.

    • Ruth Wilson

      Thank you for your positive spin. I am just researching for the first time about sleep apnea. My husband is fairly convinced I have sleep apnea. Just starting a potential journey.

  15. Coan C

    Like all of the people above, I too had problems for the entire time I used my CPAP. I was diagnosed by a doctor who prescribes CPAPs as if he’s using a rubber stamp. Everyone who sees this guy gets a CPAP. I used a CPAP for 9 years, reluctantly. I hated the machine and I hated the noise and the wind and the hose disconnecting during the night, and the weight of carrying the machine while traveling. Not to mention, I hated HAVING to sleep on my back. I used it, because without it, I was worse off.
    When I heard about a study being conducted by Johns Hopkins, I immediately contacted them to find out about details.
    I was lucky enough to be selected to participate in ImThera’s trial of their Aura 6000 device. What a Godsend!
    Now, without a CPAP, I am getting the best sleep of my life.
    I’m still in the trial and I’m still being followed, but the results so far are extraordinary. I’ve gone from 38 Apneas per hour to 2 per night. I get better, more restful sleep. I don’t wake up my wife, and I don’t need to carry 10 Lbs of CPAP with me wherever I go, and now, I no longer have to sleep on my back.
    In my opinion, if you are examined and have the right physiology and are willing to try, Hypoglossal Nerve Stimulation is the single best solution for Sleep Apnea.
    It works for me and I would do it again.

  16. Don Lief

    At age 88, I’m about to start using a CPAP device for a trial period. The greatest disincentive for me are the strong recommendations to clean everything–everything–frequently. Some parts of the system even daily. This is not mentioned in the various comments above. How onerous is the cleaning task? It strikes me that it’s as disruptive to one’s daily life as using the CPAP at night.

  17. Sandie

    After a few years of waking up with a headache most mornings my neurologist suggested I have a sleep study done. Result was sleep apnea. Now no morning headaches. It did take a while to get used to the CPAP but it was worth it. After reading more on sleep apnea my current goal is to lose 20 pounds to see if that reduces the apnea. I would love to sleep without the headgear again but it beats waking with the headaches.

  18. Denise Jones

    I have been using the machine off and on for about 11 years now and I hate it, I am a light sleeper I can hear the air going through the hoses the face mask irritates my skin and the nose pieces cause my sinuses to dry up at night, I was told by my ductut yo use nose spray before I go to bed with the machine who wants to do that every night so I just don’t use it I sleep with my table fan running, I have thought of the mouth piece but with my health insurance I have a 700 copay so I am looking into just the nose piece I saw on the internet have anyone tried it and we’re successful

  19. Mike

    This is an interesting discussion. I’ve been using CPAP for about 20 years and found that a lot of adjustment is necessary to make it work well. I couldn’t use it more than two days at first then my sinuses plugged with what seemed like the worst sinus infection ever. Totally felt swollen and dry inside and my eyes were irritated.
    The nasal pillows were the worst for me. My DR. suggested Afrin but that made it worse. I finally found out about using heated water for humidity It wasn’t common then) and that solved most of the problems. They now have heated tubes as well as the humidifiers. I sleep on my side so there is a lot of strap adjustment before I finally get to a good seal. As a new mask breaks in it seals better. There are gauze-like doughnuts (Remzz) that go between mask and skin that help seal also. If needed I just use a gauze bandage, peel a layer, and make a hole for my nose. Works fine for me. I have to use CPAP or I’m miserable but I’ve learned to keep trying things until I get a solution and that with enough use I can get used to about anything. Good Luck!

  20. Jenny

    I have just been diagnosed with severe apnea (60 occurrences/hour) and was fitted yesterday for my machine. Tried three masks and within five minutes was experiencing vertigo (which i have a history of). Was so lightheaded, dizzy and nauseous that I left without a cpap machine and felt terrible for the rest of the evening. Anyone else have this problem and what did you do?

    • Mike

      My buddy had immediate vertigo after testing CPAP. Turns out he had continuois inflamation in his ear canal caused by food allergies. He stopped eating grains and other triggers, and his vertigo is gone.

  21. Deb

    Had sleep study bout two wks ago and told have sleep apnea. Supp’d get CPAP soon but didn’t like when they slapped in on me at 3am in hospital…don’t think going to like now any better! What are some other alternatives not as obtrusive?

  22. Tammi Lindskov

    I’m having major issues with thread machine. I’m more tired now that m using it then I’ve ever been!!! I feel Smothered and unable to breath out!! I wake in the middle of the night in a dead panic ripping it off my face!!!!

  23. Fri Z.

    Can snoring devices and sleep apnea oral appliances totally get rid of my sleep apnea? Or do you need another treatment as well?

  24. Annick

    I have always snored like a truck and was always so tired. While at the the hospital for something else, the nurse at night would hear the loud noise so I was told that I would get a lovely visit with a respiratory therapist for a test with a machine, who then later sent me to a sleep clinic, that had me do a 2 night home test with another machine, and with all that, surprise…they said that I needed the commomly beloved CPAP machine. Ahhh that machine… I said to myself there is my little sleep savior… my neighbor loves his, he wakes up rearing to go. So I’ll love mine… life’s looking up… look out people….I’m going to be ready to go! Well, tried out a heck of a lot of masks at home and in the clinic because of not fitting right and as one said it’s also because of the unusually high gauge of my prescription. O.K. Finally got the mask problem resolved. Got used to the machine after a little a while… used it religously every night for months, then a couple years….and wait for it….guess what…I’m still tired. I told the clinic about it a few times and they said, well it happens, there are exceptions…I told myself, great. That’s without saying about the lovely strap lines that I carry often on my face for a few hours during the day. It has been 6 years now that I use that darn thing (off and on during the week since 4 years (more tired in the morning when I use it then when I don’t, go figure)) my blood sugar went down and my high pressure went down. But I do wish that there would be something less expensive (medical, so of coarse it costs a lot & always spending for having to replace the parts) and less time consuming (relentless cleaning) and would make me finally not tired anymore.

  25. N kenyon

    I was diagnosed with mild sleep apnea, and they ordered a CPAP machine, I’m a mouth breather, and as much as I tried I cannot get used to this machine at all. Total fail . I have to find another method or just desl with the possible outcomes.

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