Sleep Apnea Treatment

Key Takeaways

• Positive airway pressure (PAP therapy), which includes CPAP, APAP, and BiPAP, is the most effective standard treatment for obstructive sleep apnea.
• Oral appliances (like mandibular advancement devices and tongue repositioning devices) offer a non-PAP alternative, especially for those who cannot tolerate PAP therapy.
• Lifestyle changes like losing weight, exercising regularly, avoiding alcohol and sedatives, and sleeping on your side can reduce the severity of sleep apnea and improve overall sleep quality.
• Surgery may be considered when other treatments aren’t effective and can involve removing or repositioning tissue, advancing the jaw, or stimulating airway muscles to keep the throat open during sleep.

Positive Airway Pressure (PAP) Devices

Positive airway pressure therapy uses a machine to pump pressurized air into the upper airway during sleep. There are several types of PAP devices, which are a common and highly effective way of preventing the airway from collapsing during sleep and reducing symptoms of OSA. PAP therapy is also used to treat certain types of central sleep apnea (CSA).

Continuous Positive Airway Pressure (CPAP)

CPAP machines provide a continuous stream of pressurized air during sleep to keep the airway open. The fixed rate of airflow that an individual needs from their CPAP machine can be determined during a sleep study. By preventing airway collapse during sleep, CPAP therapy can reduce breathing disruptions and alleviate daytime symptoms linked to sleep apnea.

Auto-Adjusting Positive Airway Pressure (APAP)

APAP machines, also called auto-CPAP machines, automatically adjust the level of pressure used to prevent airway collapse. Rather than operating at a fixed rate of airflow determined during a sleep study, APAP machines use sensors to detect breathing changes and increase or decrease the air pressure as needed.

Bilevel Positive Airway Pressure (BiPAP or BPAP)

BiPAP machines deliver different rates of air pressure that are higher when a person is inhaling and lower when they are exhaling. BiPAP machines are programmed by a doctor based on the results of a sleep study. A BiPAP machine may be recommended in people with OSA who have difficulty using CPAP or in people with certain types of CSA.

Adaptive Servo-Ventilation (ASV)

ASV machines can sense changes in breathing and adjust airflow based on a proprietary algorithm, while also using rates that are programmed after a sleep study. ASV may be recommended for people with CSA that is caused by sedatives or certain health conditions, as well as in those who cannot use more common types of positive airway pressure therapy.

Expiratory Positive Airway Pressure (EPAP)

EPAP therapy does not require a bedside machine. Instead, EPAP therapy keeps the airway open during sleep using a nasal device. The device has valves that create resistance upon exhalation, using a person’s own breath to keep their airway open. Although more research is needed, EPAP therapy may be recommended for people with mild OSA who have already tried CPAP therapy.

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Oral Appliances

Oral appliances help adjust the position of the jaw or tongue to keep the airway open during sleep. The use of oral appliances to treat OSA may be most appropriate for people whose sleep apnea is not severe or who cannot tolerate positive airway pressure therapy. Several types of oral appliances are available.

Mandibular Advancement Devices

Mandibular advancement devices, also called splints, are the most common type of oral appliance for OSA. These devices are held in place by the teeth and cause the jaw to move forward, which opens the airway and reduces nighttime obstructions.

Tongue-Retaining Devices

Tongue-retaining devices reposition the tongue using suction. Holding the tongue in place at the front of the mouth prevents it from falling back and blocking the airway during sleep. Although this method of treating sleep apnea has not been widely researched, these devices may be a good choice for people who have dental problems or have not responded to other treatments.

Rapid Maxillary Expansion

Rapid maxillary expansion widens the upper jaw and nasal passages to create more space in the airway. The treatment involves a metal device that is attached to several teeth which uses screws to slowly exert the pressure needed to widen the upper jaw. This device can help to reduce OSA in certain children, including those who still have sleep apnea after surgery.

Medication

In December 2024, the U.S. Food and Drug Administration (FDA) approved prescription weight-loss drug Zepbound to treat moderate to severe obstructive sleep apnea in adults with obesity. It works by activating hormone receptors to reduce appetite and body weight, leading to weight loss and lessening the excess fat tissue and pressure around the airway that contribute to OSA.

Two clinical trials funded by the drug’s manufacturer found that patients given tirzepatide (the active ingredient in Zepbound and Mounjaro) experienced 20 to 23.8 fewer respiratory events (breathing disruptions) per hour after 52 weeks versus patients given a placebo.

However, it's not a standalone solution for everyone with OSA, especially those whose airway obstruction results from anatomical issues or non-weight factors. And PAP therapy remains the gold standard of OSA treatment.

Surgery

Sleep apnea surgery involves removing or repositioning bone and tissues in the upper airway. While surgery isn't a first-line treatment for most adults with OSA, it's an option for some adults who cannot tolerate or haven't improved with other treatments. Surgery can be used alone or in combination with other treatments.

For children, though, surgery is commonly used as a first-line treatment. Children with sleep apnea often have enlarged tissues in the throat that, when removed, can reduce the risk of breathing disruptions during sleep.

A number of surgical procedures can increase the space within the airway or stabilize it and prevent collapsing during sleep.

• Uvulopalatopharyngoplasty (UPPP): Removes excess tissue from the soft palate, uvula, and throat to widen the airway and reduce blockage.
• Genioglossus Advancement (GA): Repositions the main tongue muscle forward to prevent the tongue from collapsing into the airway during sleep.
• Maxillomandibular Advancement (MMA): Moves the upper and lower jaws forward, enlarging the space behind the tongue and soft palate for improved airflow.
• Tonsillectomy and Adenoidectomy: Removes enlarged tonsils or adenoids that contribute to airway obstruction, particularly in children.
• Nasal Surgeries (Septoplasty, Turbinate Reduction): Straightens or clears nasal passages to make breathing easier during sleep.

Nerve Stimulation Treatment

Nerve stimulation treatments are newer approaches to treating sleep apnea. Their use is increasing among people who want to treat sleep apnea without CPAP or for whom CPAP is ineffective.

• Hypoglossal nerve stimulation: Inspire uses a device that's implanted into the chest to stimulate a nerve that affects muscles in the tongue. This stimulation helps to move the tongue forward, which opens up the airway. The device is activated using a remote control so it can be turned on before a person sleeps.
• Phrenic nerve stimulation: Phrenic nerve stimulation is used to treat CSA. This therapy also involves the implantation of a nerve-stimulating device in the upper part of the chest. Phrenic nerve stimulation is programmed to stimulate nerves that control the diaphragm, which is a muscle that contracts rhythmically during breathing, and restarts breathing if it stops during sleep.

Lifestyle Changes

Many people with OSA have one or more risk factors that increase their chances of developing breathing issues during sleep. Lifestyle changes can be helpful for people hoping to alleviate breathing disruptions and improve their overall health. In most cases, these approaches are recommended in addition to medical treatment.

• Lose weight: Obesity can cause or worsen the symptoms of OSA. Although losing excess weight is unlikely to eliminate sleep apnea altogether, it can help diminish symptoms.
• Avoid alcohol and sedatives: Alcohol, along with medications like opioid pain medicines and benzodiazepines, may aggravate both central and obstructive sleep apnea symptoms. People should speak with their doctor about whether changes in medication could improve nighttime breathing issues.
• Quit smoking: Smoking irritates and inflames the airway, making it more prone to swelling and blockage. Quitting smoking not only improves breathing during sleep but also enhances cardiovascular and lung health overall.
• Change sleep position: In some people with OSA, airway collapse is worse when they sleep lying on their back, so sleeping on their side is preferable. There are positioning devices that can help people remain in an optimal position during sleep.
• Get enough sleep: People with sleep apnea should aim toward getting at least seven to eight hours of sleep per night, going to bed and waking up at the same time each day.
  

Let Sleep Doctor Help You Find the Right Sleep Apnea Treatment

Finding the right treatment for sleep apnea can dramatically improve your sleep, reduce daytime symptoms, and lower your risk of long-term health complications. When you complete a home sleep test through Sleep Doctor, you’re paired with a dedicated Sleep Care Advocate who helps you understand your results and walks you through your treatment options.

CPAP is the most effective treatment for most people with sleep apnea. But adjusting to nightly CPAP use can be challenging. If your mask feels uncomfortable, the pressure seems too strong, or you’re having trouble using your device consistently, your Sleep Care Advocate can help you troubleshoot issues, explore different mask styles, or adjust comfort features like ramp settings or humidification.

If CPAP therapy isn’t the right fit, Sleep Doctor can also help you explore other PAP therapy options, oral appliances, and lifestyle changes. Your Sleep Care Advocate stays with you throughout the process, checking in, answering questions, and helping make sure your treatment remains comfortable, effective, and tailored to your needs.