10 CPAP Alternatives

Problems With CPAP Treatment

Expensive

CPAP machines are costly, and not everyone has the budget to afford them. For example, the average price of a CPAP machine is around $800¹.

Many health insurance companies may help cover this cost, but this health necessity can be a detrimental out-of-pocket expense for those without insurance. Additionally, Medicare can help cover this sleep apnea treatment, but the program has specific rules² the patient must follow.

Uncomfortable

Another complaint of CPAP devices is that they are uncomfortable to wear. Users may find the mask irritates their skin, leaves red marks and creases on their face, or makes them feel claustrophobic. Furthermore, the discomfort could cause them to remove the mask during the night inadvertently.

Even though the air is designed to help, patients may receive too much or too little of it. They may also have trouble inhaling and exhaling while using the machine, and some patients report³ waking up with a dry mouth.

Noisy

Some CPAP machines can also be noisy and disruptive for you and your partner, making it difficult to get restful sleep. Sometimes certain noises are due to a mechanical defect, while other models will emit a noise regardless. However, even softer sounds may bother those who are extremely sensitive to noise when trying to sleep.

CPAP Alternatives for Obstructive Sleep Apnea

If you want to swap out your CPAP machine for something else, the upside is that you have multiple options. However, some of these will depend on the extent of your sleep apnea disorder.

A sleep specialist will diagnose your sleep apnea symptoms as mild, moderate, or severe, which will affect the type of treatment you require. To determine the severity of your OSA, the specialist will look at the apnea-hypopnea index⁴ (AHI), which reflects how many times your breathing pauses every hour. Mild sleep apnea has an AHI of 5-15, and moderate sleep apnea has an AHI of 15-30. Lastly, the most serious form, severe sleep apnea, is classified by an AHI of 30 or higher.

We also want to emphasize that you should always consult your doctor before switching treatments, especially if you have severe sleep apnea. Having input from your physician can help ensure the alternative you choose will provide you with a safe and appropriate method for treating this disorder.

Other Types of PAP Therapy

As mentioned, CPAP therapy means the patient receives a continuous flow of air pressure from their CPAP machine. However, CPAP is also a specific form of positive airway pressure treatment, also known as PAP therapy. In some cases, a healthcare provider may recommend other types of PAP therapy instead of CPAP. 

• BiPAP – BiPAP⁵ stands for bilevel airway pressure. With BiPAP therapy, the patient receives a higher amount of air pressure when they breathe in and less air pressure when they exhale. Conversely, with CPAP therapy, the amount of air pressure remains the same the entire time.

• APAP – APAP⁶ means auto-adjusting positive airway pressure, and this machine is sometimes called an auto-CPAP. The difference between APAP and CPAP treatment is that an APAP device can automatically adjust the amount of positive airflow based on an individual’s needs, whereas CPAP machines are set to a fixed pressure amount.⁶   

• ASV – Adaptive servo-ventilation (ASV⁷) can be used to treat central sleep apnea⁸, a form of sleep apnea in which the gaps in breathing are the result of a miscommunication between the brain and breathing muscles during sleep. An ASV machine monitors a person’s breathing while they are asleep and adjusts the air pressure so that it can stabilize breathing. These machines have the ability to customize the pressure based on a user’s breathing patterns.⁷ 
  
• Nasal EPAP – Nasal expiratory positive airway pressure (nasal EPAP) could be a viable CPAP alternative. EPAP therapy⁹ involves using disposable valves that are placed inside the nostrils just before bed. EPAP is still an emerging sleep apnea treatment, but it has produced some good results. For example, research has found that nasal EPAP can minimize the severity of obstructive sleep apnea by up to 53 percent.

Weight Loss

One risk factor for developing obstructive sleep apnea is excess weight¹⁰ because the extra fat in the upper airway can cut off breathing during the night. Therefore, your doctor may suggest losing weight to treat your sleep apnea. In fact, researchers have seen AHI improvements¹¹ in people with OSA after weight loss.

Lifestyle Changes

Additional lifestyle changes may also serve as a mild sleep apnea treatment. According to the Mayo Clinic, the following guidelines¹² could help alleviate symptoms in obstructive sleep apnea patients.

• Regular exercise
• Moderate or no alcohol consumption. Avoid drinking before bed.
• Quitting smoking
• Use a nasal decongestant or allergy medications
• Do not take any sedative medications

Change Your Sleep Position

Adjusting your sleep position could also improve cases of mild sleep apnea. Back sleeping is considered the worst position for sleep apnea¹³, and instead, experts advise resting on your side or stomach.

However, if you have been sleeping on your back for years or even decades, you may need some help adjusting. Some people apply the tennis ball technique, in which a ball helps prevent you from rolling onto your back. A research study¹⁴ found that this was a successful short-term method for treating positional obstructive sleep apnea, but the researchers add that most participants did not stick with this treatment long-term.

Oral Devices

Oral devices are another popular CPAP alternative. They look similar to a mouthguard and help open the airways by either advancing the jaw forward or letting the tongue rest in a different position.¹²

To receive a custom dental oral appliance, you must first contact your doctor to obtain a referral to a dentist or sleep specialist. The dentist or specialist will then evaluate you, and if approved for this treatment, they will make a custom-fitted device. While custom-made devices are great to have, they’re usually more expensive, so many people may opt for a less-costly boil-and-bite guard that’s pre-made.

Possible side effects of oral appliance therapy for sleep apnea include bite changes¹⁵, pain and discomfort¹⁶, and the loosening of dental restorations¹⁷. Also, people may experience excess saliva or dry mouth from using one.¹⁶ However, oral appliance therapy doesn’t require electricity or batteries, making this a convenient option for frequent travelers.

See Our Guide: Best Snoring Mouthpiece

Hypoglossal Nerve Stimulator

Hypoglossal nerve stimulation involves placing a stimulator¹⁸ beneath the patient’s chest. The stimulator is connected to the hypoglossal nerve in the neck and the intercostal muscles in the chest.

The patient will turn on the stimulator when they go to bed using a remote control operator. The device stimulates the hypoglossal nerve as you breathe, causing the tongue to move out of the airway for a clearer breathing path.

Surgery

You may also consider surgery to avoid CPAP machine therapy. However, this would have to be approved by your physician. There are various surgeries to treat sleep apnea, some more complex than others.

Type of Surgeries for Sleep Apnea

• Uvulopalatopharyngoplasty (UPPP) – A uvulopalatopharyngoplasty²⁰ removes extra tissue in the back of the throat to make additional room for breathing. For example, the surgeon may remove sections such as the uvula, soft palate, tonsils, and adenoids. Even though the surgery should improve the airway and could reduce snoring, you may need CPAP treatment following the procedure. 

• Somnoplasty – In a somnoplasty²¹, radiofrequency energy is used to shrink tissue in the upper airway to provide more space for breathing. Somnoplasty is also minimally invasive compared to other surgeries.

• Tonsillectomy – A tonsillectomy²² removes the tonsils, which are located in the back of the throat. Tonsil tissue is often the cause of obstruction in children with sleep apnea. Tonsillectomies have also been used to treat tonsillitis – or inflammation of the tonsils. However, there are risks involved with this procedure, such as a bad reaction to anesthesia, swelling, bleeding, and infection.²²

• Mandibular/Maxillary Advancement – Mandibular/maxillary advancement surgery is a more invasive option for those with severe sleep apnea. The procedure may also be referred to as maxillomandibular advancement (MMA)²³. This surgery repositions the upper and lower jaw more forward to prevent blocking the airway.²³

• Nasal Surgery – Nasal surgery focuses on treating sleep apnea by addressing nasal obstructions. Under the umbrella of nasal surgeries²⁴ for obstructive sleep apnea, there are five procedures that a surgeon could perform.
  
  • Endoscopic Sinus Surgery: When the nasal cavities and sinuses become inflamed, this could trigger sleep apnea episodes. During this procedure, a surgeon will remove any obstructions and drain mucus for better airflow.²⁴
    
  • Septoplasty: A septoplasty treats a deviated septum, which is when the bone and cartilage between the nostrils are crooked.²⁴
    
  • Turbinate Reduction: The turbinates, bone structures in the nose, may become swollen from irritation due to allergies or dust mites. When this happens, it could make it difficult for the individual to breathe. A turbinate reduction uses cauterization, coblation, or radiofrequency ablation to open the airways.²⁴
    
  • Nasal Valve Surgery: Sometimes the walls of the nostrils can become weak and collapse, impacting airflow. If this happens, a surgeon can widen the nasal valves or create better support to prevent collapsing.²⁴
    
  • Distraction Osteogenesis Maxillary Expansion (DOME): A narrow jaw will also create a narrow nose floor, which can affect how well you breathe. The surgeon can expand the upper jaw through a distraction osteogenesis maxillary expansion procedure.²⁴

Frequently Asked Questions

Is there a pill to replace the CPAP machine?

There isn’t a pill alternative to CPAP yet. However, the Federal Drug Administration (FDA) has given “Fast Track” designation to AD109²⁵, a new medication from Apnimed, a pharmaceutical company that focuses on treating OSA. This drug aims to activate the upper airway dilator muscles during sleep to keep the airways open.25

Clinical research found that after a four-week trial, AD109 showed promising improvements in OSA symptoms²⁶.

What if I have to use a CPAP?

Even though you might prefer something other than CPAP therapy, your doctor may say that it is the best treatment for your case of sleep apnea. However, there are ways to help improve the CPAP experience.

One reason you may have trouble with CPAP is that your mask does not fit correctly. If this is the case, adjust the mask or order a different size that is more accommodating.

Need help? Check out our guide on the highest-rated CPAP masks here.

Wearing a CPAP machine is not a natural way of sleeping, and you might just need more time to get used to it. Try wearing your CPAP for a little while during the day to get more comfortable with how it feels. You should also use the CPAP every time you sleep, including naps.

If the air pressure is bothering you, a “ramp” adjustment feature could help. The feature allows you to start with lower air pressure, and as you doze off, it slowly increases.

Learn More: 9 Tips For Sleeping Better in a CPAP Mask

What are the warning signs of sleep apnea?

If you think you may be at risk of obstructive sleep apnea, the following symptoms are associated with this disorder10:

• Excessive daytime sleepiness
• Loud snoring
• Frequent gaps in breathing during sleep
• Suddenly waking up while gasping or choking
• Waking up with a dry mouth or sore throat
• Headaches in the morning
• Difficulty staying focused during the daytime
• Depression or irritability
• High blood pressure
• Decreased libido

What happens if you don’t treat sleep apnea?

Avoiding sleep apnea treatment could result in serious health consequences. For example, sleep apnea has been linked to cardiovascular issues like high blood pressure, heart attack, heart failure, and stroke.10

Sleep apnea can also lead to extreme tiredness during the day, bringing with it a slew of other dangers.10 For instance, if you are very tired and drive, this increases your risk of getting into a car accident. There is also the risk of workplace accidents or diminished work performance. In particular, for those who work in fields where work performance means life or death, quality rest is vital.

Read More: Can Sleep Apnea Kill You?

Can sleep apnea heal on its own?

Obstructive sleep apnea typically will not go away on its own without the help of treatment. However, depending on what causes your apnea and how serious it is, a combination of some lifestyle changes and the right treatment could cure your condition.