If you live with sleep apnea, continuous positive airway pressure (CPAP) therapy is probably on your radar. CPAP machines treat obstructive sleep apnea (OSA), the most common form of this sleep disorder.
Obstructive sleep apnea occurs when the throat muscles relax to the extent that it creates a blockage in the upper airway, causing gaps in breathing while the individual sleeps. Positive airway pressure treats this condition by delivering a steady stream of air through a tube and mask.
Although CPAP treatment can help relieve obstructive sleep apnea, not everyone is a fan of them. For those looking for CPAP alternatives, we will share the different options available.
Problems With CPAP Treatment
CPAP machines are costly, and not everyone has the budget to afford them. For example, the price range for continuous positive airway pressure therapy runs from 500 dollars to 3,000 dollars, with an average price tag of around 850 dollars.
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. Medicare can help cover this sleep apnea treatment, but the program has specific rules the patient must follow.
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 report waking up with a dry mouth.
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.
Finding a CPAP Alternative
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 index (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 obstructive 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 obstructive sleep apnea.
One risk factor for developing obstructive sleep apnea is excess weight. According to the Mayo Clinic, the majority of people with obstructive sleep apnea are overweight. 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. Achieving a healthy weight can also be good for your overall health and well-being. In addition to sleep apnea, obesity6 is linked to heart disease, stroke, type 2 diabetes, certain cancers, heartburn, gallbladder disease, liver problems, osteoarthritis, and more serious Covid-19 complications.
Read More: Obesity and Sleep
Additional lifestyle changes may also serve as a mild sleep apnea treatment. According to the Mayo Clinic, the following guidelines 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
Positional therapy could also improve cases of mild sleep apnea. Back sleeping is considered the worst position for sleep apnea. Instead, experts advise resting on your side or stomach.
Positional therapy is a treatment method to help train yourself to sleep in a more favorable position for keeping the upper airway open. If you have been sleeping on your back for years or even decades, you may need some help adjusting.
Some folks apply the tennis all technique, where a ball helps prevent you from rolling onto your back. A 2015 study found that this therapy was a successful short-term method for treating positional obstructive sleep apnea. However, the researchers add that most participants did not stick with this treatment long-term.
Nasal Expiratory Positive Airway Pressure
Nasal Expiratory Positive Airway Pressure (nasal EPAP) could be a viable CPAP alternative. EPAP therapy 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.
Mandibular Advancement Devices
Mandibular advancement devices9 are another popular CPAP alternative. They look similar to a mouthguard and open the airways by advancing the tongue and jaw forward, allowing more space to keep the airway open. The three types of mandibular advancement devices are boil and bite, semi-custom, and custom dental.
A boil and bite device can either be purchased online or in a pharmacy. You use hot water to soften it and then place the item in your mouth to get the right fit.
For a semi-custom MAD, you take a mold of your teeth and then send it to a company that makes these products. The maker will create a device according to your mold. However, if the fit isn’t right, you can have it adjusted.
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 mandibular advancement device.
The most expensive of the three is the custom-made device, which can cost around 2,000 dollars. On the other hand, boil and bite products typically have a price tag of around 40 dollars. However, a MAD made personally for you by a healthcare expert should provide the optimum results. Depending on your insurance plan, though, they may assist with the cost.
Possible side effects of Mandibular Advancement Devices include a sore or stiff jaw, toothaches, teeth placed out of alignment, joint wear, excess saliva, and dry mouth. 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 stimulator 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.
Treating the Underlying Medical Condition
The Mayo Clinic points to specific health conditions that can increase the risk of obstructive sleep apnea. Therefore, treating these underlying medical issues could result in sleep apnea symptom improvements.
One such condition linked to sleep apnea is high blood pressure – or hypertension. When someone has high blood pressure, the amount of blood pumped by the heart is comparatively higher than the width of the arteries, creating pressure against those artery walls.
There are several ways to treat hypertension at home, including a heart-healthy diet, cutting your salt intake, exercising regularly, keeping a healthy weight, and limiting your alcohol consumption. Additionally, your doctor may prescribe medications to treat high blood pressure.
The following groups are most at risk for high blood pressure.
- Individuals in their mid-60s and older
- African Americans
- People with a family history of it
- Those who are overweight or obese
- People who do not exercise
- Heavy drinkers
- People who consume too much salt or not enough potassium.
- Those who have high amounts of stress can also contribute
- People with chronic conditions like kidney disease and diabetes.
Bi-Level Positive Airway Pressure (BPAP)
Bi-level therapy provides pressurized air like a CPAP machine, but it is slightly different. Instead of a steady stream, this device uses a certain amount of pressure when you inhale, followed by less pressure as you exhale. According to Cleveland Clinic, patients who do not find success with a CPAP may switch to BPAP.
Supplemental oxygen is another form of sleep apnea treatment. However, opinions on how effective it is may vary. Research has found that while oxygen can improve hypoxemia (low oxygen in the blood), it could increase the duration of apnea episodes.
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.
Types of Surgeries for Sleep Apnea
According to Cleveland Clinic, the following surgeries are available for those with obstructive sleep apnea. In most cases, surgery may follow an unsuccessful round of treatment with a CPAP machine.
In a somnoplasty, 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.
A tonsillectomy 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.
Similar to a somnoplasty, a uvulopalatopharyngoplasty 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. When part of the tongue is also removed, it is called a uvulopalatopharyngoglossoplasty.
Even though the surgery should improve the airway, health experts say you may need CPAP treatment following the procedure. The success rate for uvulopalatopharyngoplasty is mixed. Furthermore, it may reduce snoring, but sleep apnea could persist.
Patients may experience complications during and after surgery. During surgery, there is the possibility of accidentally damaging nearby blood vessels and tissue. Post-surgery complications might include trouble swallowing, speech problems, a more nasal-prone voice, changes in food taste, swelling, pain, infection, bleeding, nasal and throat airway narrowing, and tiredness and apnea from medications.
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).
This surgery repositions the jaw to prevent blocking the airway. More specifically, the upper and lower jaws are placed in a more forward position.
The procedure is about six hours long, and patients will need four to six weeks of recovery time afterward. In some cases, patients may experience numbness in the lips and mouth for up to a year. Additionally, the surgery could make it difficult to eat for a while, with some patients losing 15 pounds or more.
Nasal surgery focuses on treating sleep apnea by addressing nasal obstructions. A deviated septum is an example of a nasal blockage that could trigger sleep apnea. Under the umbrella of nasal surgeries 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.
A septoplasty treats a deviated septum, which is when the bone and cartilage between the nostrils is crooked. The surgeon will go in and straighten this area.
Additionally, the surgeon may remove any other blockages that are impairing your breathing. Patients usually need about a week of recovery time following a septoplasty.
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. In many cases, this is done in conjunction with a septoplasty. Patients typically recover within a week.
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.
There are three specific nasal valve procedures. The first is to input spreader grafts to widen the nasal valves. Second, alar batten grafts can help prevent collapsing, and lastly, lateral nasal valve stabilization supports the upper and lower lateral cartilages.
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. The treatment process involves collaborating with an orthodontist and surgeon.
Frequently Asked Questions
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, not all is lost; 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.
The type of mask you wear can also make a difference. For example, some are full-face masks covering the nose and mouth, with straps around the forehead and cheeks. The extent of this mask design could make you feel claustrophobic.
However, nasal pillows are placed only underneath the nose, and the straps cover less facial space. Therefore, if your CPAP mask is triggering claustrophobia, a nasal pillow style may feel better.
Need help? Check out our guide for 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
Sometimes CPAP machines may leave patients with a dry or stuffed-up nose. For example, an ill-fitted mask could cause dryness, so adjust your device or order a better fit to help prevent this. Additionally, a machine with a humidifier or using a nasal spray before bed could help.
Full face masks that cover the nose and mouth may work better for those dealing with a dry mouth from CPAP. A humidifier feature or chin strap to keep the mouth closed may also improve this.
Skin irritations and marks may be due to a poor fit as well. In this case, finding the right size or opting for a nasal pillow instead may be the ideal choice.
We mentioned earlier that noisy CPAP machines are another complaint, impacting both the user and their partner. One thing that could help is ensuring the device’s air filter is clean.
In some cases, a louder CPAP may be caused by the machine not working properly, so try repairing it. Also, keeping the machine further away from the bed could reduce the noise level.
Get More Info: Best CPAP Machine
What are the warning signs of sleep apnea?
If you think you may be at risk of obstructive sleep apnea, certain symptoms are associated with this condition. Knowing these can help you pinpoint whether to make an appointment to see your doctor for a proper diagnosis.
- Excessive daytime sleepiness
- Loud snoring
- Frequent gaps of 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
According to the Mayo Clinic, you should make an appointment with your doctor if you experience snoring that disturbs you or your partner, waking up during the night and gasping or choking for air, pauses in breathing while asleep, and excessive daytime sleepiness. Of course, there’s a chance you may not have sleep apnea, but it is better to know for sure because the consequences of not treating it could be harmful to your health.
What happens if you don’t treat it?
As mentioned above, avoiding sleep apnea treatment could result in serious health consequences. For example, sleep apnea has been linked to diabetes, strokes, and heart attacks.
Sleep apnea can also lead to extreme tiredness during the day, bringing with it a slew of other dangers. 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.
If you are having trouble with sleep apnea, you can take a look at our list of best mattresses for sleep apnea.
Sources and References:
-  “CPAP Treatment”, American Sleep Association
-  “Continuous Positive Airway Pressure devices, accessories, & therapy”, Medicare
-  “I can’t tolerate CPAP, what can I do?”, Harvard Health, July 29, 2020.
-  “The Dangers of Uncontrolled Sleep Apnea”, Johns Hopkins Medicine
-  “Obstructive sleep apnea”, Mayo Clinic, July 27, 2021
-  “Obesity”, Mayo Clinic, September 2, 2021
-  Grietje E. de Vries MSc, Aarnoud Hoekema MD PhD, Michiel H.J. Doff DMD PhD, Huib A.M. Kerstjens MD PhD, Petra M. Meijer NP, Johannes H. van der Hoeven MD PhD, Peter J. Wijkstra MD PhD, “Usage of Positional Therapy in Adults with Obstructive Sleep Apnea”, Journal of Clinical Sleep Medicine, 2015
-  Geraldo Lorenzi-Filho, Fernanda R. Almeida, Patrick J. Strollo, “Treating OSA: Current and emerging therapies beyond CPAP”, National Library of Medicine, 2017
-  “FAQs: Mandibular Advancement Device”, American Sleep Association
-  “Sleep Apnea”, Cleveland Clinic, March 3, 2020
-  “High blood pressure (hypertension)”, Mayo Clinic, July 1, 2021
-  Vanita Mehta MD, Tajender S. Vasu MD M.S, Barbara Phillips MD FAASM, Frances Chung MBBS, “Obstructive Sleep Apnea and Oxygen Therapy: A Systematic Review of the Literature and Meta-Analysis”, National Library of Medicine, 2013
-  “Tonsillectomy”, Mayo Clinic, November 10, 2020
-  “Uvulopalatopharyngoplasty for Obstructive Sleep Apnea”, University of Michigan Health, October 26, 2020
-  “Maxillomandibular Advancement for Obstructive Sleep Apnea”, Penn Medicine
-  “Sleep Apnea Surgery for the Nasal Cavities”, Penn Medicine
-  “CPAP machines: Tips for avoiding 10 common problems”, Mayo Clinic, May 17, 2018.
Jill Zwarensteyn is the Editor for Sleep Advisor and a Certified Sleep Science Coach. She is enthusiastic about providing helpful and engaging information on all things sleep and wellness.