Sleep Apnea Treatment

Continuous positive airway pressure holds the airway open with a steady stream of pressurised air through a mask. It remains the first-line treatment for moderate to severe obstructive sleep apnea in every major guideline, including the 2024 joint clinical practice guideline from the American Academy of Sleep Medicine and the American Academy of Dental Sleep Medicine.

Three variants exist, and the one you are given changes how it feels:

• CPAP: delivers one constant pressure all night.
• APAP: adjusts pressure automatically, which suits people whose obstruction varies by position or sleep stage.
• BPAP: delivers a higher pressure when you breathe in and a lower one when you breathe out, which helps if a single high pressure makes exhaling feel like work.

CPAP's reputation for being abandoned is dated. Recent studies put adherence at roughly 75% at both 90 days and one year, helped by lighter masks and quieter machines. A common clinical benchmark is at least four hours a night on 70% of nights.

If you are struggling in the first month, the problem is almost always the mask or the humidification, not the therapy. Ask to try a different mask style before you conclude that CPAP is not for you, because nothing else matches it for reducing events per hour.

A mandibular advancement device is a custom-fitted appliance that holds your lower jaw forward while you sleep, which draws the tongue base away from the back of the throat. Tongue-retaining devices do a similar job by holding the tongue itself forward. This is the sleep apnea treatment most often fitted by a dentist rather than a sleep physician.

The evidence puts them behind CPAP on raw effectiveness and ahead of it on tolerability. In one two-year follow-up, 68% of 172 patients reached at least a 50% reduction in AHI. Guidelines recommend them for people who are intolerant of CPAP or who prefer an alternative, and for mild to moderate cases they are often a sensible starting point.

Fit quality decides the outcome. A fully customised device made from impressions of your teeth performs better and lasts longer than a semi-customised one, and boil-and-bite devices are not recommended by NICE.

Side effects are real but usually manageable: jaw discomfort, excess saliva, and over time small changes to your bite. That last one is why the dental review schedule matters, and why the cheapest device is rarely the cheapest decision.

If your apnea is much worse on your back, keeping you off your back is a legitimate treatment rather than a workaround. Devices range from wearable straps and vibrating position trainers to inserts sewn into sleepwear.

A Cochrane analysis found positional therapy reduced apnea events by 7.4 per hour. CPAP beat it by a further 6.4 events per hour, but people wore the positional device about 2.5 hours longer per night. For mild positional apnea that trade is often worth taking, and it combines well with an oral appliance. Expect one to two weeks before side-sleeping stops waking you.

Fat around the neck and tongue narrows the airway, so weight loss changes the mechanics rather than just the symptoms. The dose-response is clearer than most people expect: a 10% reduction in body weight predicts a 26% decrease in AHI. Over ten years, intensive lifestyle intervention produced remission of obstructive sleep apnea in 34.4% of participants, against 22.2% for education alone.

In December 2024 the FDA approved tirzepatide for moderate to severe obstructive sleep apnea in adults with obesity, used alongside a reduced-calorie diet and increased physical activity. It is the first drug approved for the condition. The SURMOUNT-OSA programme randomised 469 participants across 52 weeks in two arms, one for people not using positive airway pressure and one for people already on it, and it reduced the apnea-hypopnea index, hypoxic burden and body weight against placebo in both. It is licensed for people with obesity, not for sleep apnea in general, and approval outside the US differs by country, so ask your doctor what applies here.

Bariatric surgery works on the same mechanism at a larger scale, with a limit worth knowing in advance. Moderate or severe obstructive sleep apnea persisted in 20% of patients afterwards, and post-surgical CPAP use fell to 49% of nights. Losing the weight does not automatically retire the machine, and a repeat sleep study is how you find out.

Targeted exercises for the tongue, soft palate and facial muscles improve muscle tone in the airway. The effect is modest and slow, and it will not replace CPAP in severe cases, but it costs almost nothing, carries no side effects, and works alongside every other treatment here. Removable tongue muscle stimulators, used once daily while awake, are a device-based version of the same idea.

An implanted device senses your breathing and stimulates the nerve controlling tongue movement, keeping the airway open as you inhale. It is designed for people who cannot tolerate CPAP and who meet narrow criteria: age 22 or older, an unsuccessful trial of CPAP, an AHI between 15 and 100 events per hour with no more than 25% central or mixed apneas, and a body mass index of 40 kg/m² or less.

Early results showed a 68% reduction in AHI and a 66% success rate, and refined surgical technique has since pushed success to between 75% and 80%. If your BMI is above 40 this is not open to you yet, which makes weight loss a gateway to the option rather than a competing choice.