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



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 

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 

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.

View Comments (41)

  • 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.

  • 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.

  • 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

  • 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!

  • 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?

    • Jenny,
      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.

  • 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?

  • 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!!!!

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

  • 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.

  • 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.