CPAP Machines and Other Sleep Apnea Treatments: Which Is Right for You?

If you’ve been diagnosed with sleep apnea, you and your doctor will likely discuss a number of treatment options to help you manage the common sleep disorder.

Sleep apnea can be a potentially serious condition with harmful effects on health, especially when it is not diagnosed or treated correctly. But the good news is that there are a lot of solutions and therapies that can help you manage sleep apnea symptoms and avoid complications, explains Neeraj Kaplish, MD, an associate professor of neurology and the medical director of the Sleep Lab at Michigan Medicine’s Sleep Disorders Center at the University of Michigan in Ann Arbor. With the right treatment, he says, “most patients have resolution of symptoms.”

Here’s a primer on what types of treatments your doctor might suggest, as well as some new and promising therapies that are being investigated.

If you have mild sleep apnea, making some simple lifestyle changes may alleviate your symptoms, says Ronald Chervin, MD, a past president of the American Academy of Sleep Medicine, a professor of sleep medicine and neurology, and the director of the Sleep Disorders Centers at the University of Michigan. And even if you do require further treatment (like a breathing machine or surgery), your doctor will likely recommend taking some or all of these steps, too. The lifestyle modifications may include:

• Losing Weight Research has shown that weight loss can improve sleep apnea in people who are obese, and losing weight is actually one of the recommendations in the 2013 sleep apnea treatment guidelines from the American College of Physicians (ACP).

  

  Getting rid of excess weight can help reduce the amount of excess fat in your neck and relieve the constriction in your airway, Dr. Chervin explains.
• Sleeping on Your Side When you sleep on your back, your tongue and soft palate naturally fall back into your throat and can block the airway, causing obstructive apnea. Sleeping on your side (either with or without a special pillow to prevent you from rolling over) or, in some cases, on your stomach, can help reduce sleep apnea, notes Mayo Clinic.

  

• Avoiding Alcohol Late in the Day and Certain Drugs Alcohol and some medications — like sleeping pills, tranquilizers, opioids, or benzodiazepines — make you stay asleep and prevent you from waking up easily when you experience sleep apnea, says Chervin. Not only that, they can relax the muscles in the back of your throat, which can cause your airway to collapse and increase snoring and sleep apnea.
• Quitting Smoking Evidence suggests that smoking may make obstructive sleep apnea worse by increasing upper airway inflammation and reducing function. Though a review published in the journal Chest notes that there is limited evidence that quitting smoking can alleviate sleep apnea symptoms yet, experts suspect this is the case.

  

• Exercise Research published in the November-December 2016 issue of Jornal Brasileiro de Pneumologia has shown that regular physical activity can reduce the severity of sleep apnea and daytime sleepiness, improve sleep, decrease the body’s inflammatory response, and help reduce body weight.

  

  Even if you’re overweight or obese, research published in 2021 in the European Respiratory Journal suggested regular exercise can reduce sleep apnea risk.

  

  Regular moderate physical activity — such as 30 minutes of brisk walking at least five days a week — can help some people with sleep apnea even before any weight is lost. Exercise improves muscle tone in the throat and airways, which can ease symptoms in some cases. It’s not only an important part of treating mild cases of sleep apnea but also in treating moderate to severe sleep apnea in individuals who may not be able to tolerate using a breathing machine. Also, exercise helps thwart cardiovascular problems, such as hypertension and stroke.

The most common treatment for sleep apnea is the use of a continuous positive airway pressure (CPAP) machine. This device gently forces pressurized air into your airway (to keep it open) via a tube that’s attached to a face mask, which you wear over your nose and mouth (or in some cases just your nostrils) while you sleep. Your doctor will likely also recommend that you continue to make healthy lifestyle changes in tandem with using the CPAP machine.

Although CPAP machines are the most common treatments, some people dislike them, find them cumbersome or uncomfortable, or are unable to sleep well while using the apparatus.

“About one-third love it, one-third think it’s so-so, and one-third hate it and think it’s the devil,” says Robson Capasso, MD, the chief of sleep surgery and an associate professor of otolaryngology and head and neck surgery at Stanford University School of Medicine in California.

Common complaints that Chervin has heard from patients include those on this list:

• “The mask hurts the bridge of my nose.”
• “It makes my mouth dry.”
• “It leaks on the sides.”
• “It makes me feel claustrophobic.”

If your doctor has prescribed a CPAP to help you manage sleep apnea and you are having problems with it, let your doctor know. A different type of face mask may solve the problem. In other cases, using a humidifier along with a CPAP machine can help with mouth dryness.

If used correctly and well tolerated, a CPAP can effectively manage sleep apnea and is one of the most effective solutions currently available, according to the ACP guidelines. But there are other types of breathing machines that can be more effective depending on the type of sleep apnea you have, as well as how well you tolerate a CPAP. Alternatives include the following:

• Auto-CPAP Machines These devices automatically adjust the pressure while you sleep.
• Bilevel Positive Airway Pressure Machines These units deliver more pressure when you inhale and less pressure when you exhale. These devices, which can be particularly helpful in strengthening the weak breathing pattern in individuals with central sleep apnea, can be set to automatically deliver air if the machine detects that you haven’t taken a breath after a set number of seconds.
• Expiratory Positive Airway Pressure Devices Research has shown that these small single-use devices, which are placed over each nostril before you go to sleep, may be an effective treatment for sleep apnea for individuals who cannot tolerate CPAP machines.

  

  These small adhesives (which fit securely over each nostril) allow air to go in freely but are designed with small valves that close when you breathe out, increasing the pressure in the airway so it stays open.
• Adaptive Servo-Ventilation This breathing machine is similar to a CPAP in that it delivers positive air pressure to your airways, but it’s a smart machine, so it learns your normal breathing pattern during sleep and stores that info so that the device can then use air pressure to normalize your breathing and prevent pauses in airflow while you sleep, per the American Association of Sleep Technologists (AAST).

  

Mouthpieces or oral appliances are devices worn while you sleep that are typically custom fit and designed to help keep your airways open. They tend to be simpler, much more portable, and easier to use than a CPAP, so in some cases, your doctor may see if a mouthpiece alleviates your sleep apnea symptoms before trying a breathing machine. The appliances can be particularly helpful for individuals who have obstructive sleep apnea that occurs when you habitually sleep on your back. The device can help keep your airway open by bringing your jaw forward and preventing the tongue from falling back.

If other sleep apnea treatments don’t work and your symptoms are severe, your doctor may advise you to consider surgery. Surgery is typically performed to either make more room in the throat or to adjust your jaw to open up the airway. “Sometimes it’s making a small house larger, and sometimes it’s taking furniture out of the house,” Dr. Capasso explains. Some possible types of surgery that may be done to treat sleep apnea include these procedures:

• Removal of Extra Tissue from the Back of your Mouth and Top of Your Throat Called uvulopalatopharyngoplasty, the surgery involves the removal of part or all of your tonsils, adenoids, uvula, and other tissue from this area.
• Repositioning the Jaw or Correcting the Facial Structure to Open the Airway Doctors may move your jaw forward to enlarge the space behind the tongue and soft palate and help prevent airway obstruction.
• Tracheostomy This procedure is usually considered for people with severe, life-threatening sleep apnea who haven’t had success with a CPAP or other treatments. For the procedure, surgeons create an opening in the neck and insert a breathing tube directly into the trachea. The tube is kept closed during the day but is uncovered at night to allow unobstructed breathing during sleep.
• Implantation of a Neurostimulation Device One of the newest additions to the roster of sleep apnea treatment options is a pulse generator device. Similar to a pacemaker, it is surgically implanted underneath the skin of the neck and chest, according to the American Sleep Apnea Association.

  

  The device continuously monitors your breathing patterns while you sleep and delivers mild stimulation to key respiratory tract muscles in the upper airways to help keep the airway open as needed while you sleep, according to research published in The New England Journal of Medicine.

  

   Such devices have only been available in the last few years.
• Other Types of Surgery In some cases, weight-loss surgery, such as gastric bypass, or nasal surgery to remove polyps or straighten a deviated septum may be useful in treating sleep apnea.

Treating the causes of conditions that are related to sleep apnea such as cardiovascular disease or neuromuscular disorders can also help sleep apnea symptoms.