CPAP alternatives: your options if CPAP isn't working

What’s going on

This page is for adults already diagnosed with obstructive sleep apnea. If you haven’t had a sleep test, start with a physician. Only a physician can diagnose sleep apnea.

CPAP Strong is still the first choice for most people with sleep apnea. It pushes a gentle stream of air through a mask to hold your airway open. It only works when you wear it, though, and it can take time to get used to.

The good news is that there are real alternatives. The other news is that each one suits some people and not others. Every choice below goes through your sleep physician, who knows your test results.

Make CPAP work first

Most CPAP problems have a fix. The AASM lists these:

1. Try a different mask. There are three main types: nasal masks, full-face masks that cover the nose and mouth, and nasal pillows that sit in the nostrils. A mask that’s too big needs tight straps; one that’s too small leaks.
2. Turn up the humidity. A heated humidifier on the machine can ease a dry nose, mouth or throat. A saline nasal spray can help mild congestion.
3. Use the ramp setting. Ramp starts the air at a low pressure and raises it slowly, so you can fall asleep first.
4. Ask about your pressure or machine. Only your care team should change your settings. Some people do better on a machine that adjusts pressure automatically, or one with a lower pressure when you breathe out.
5. Practice while awake. Wear the mask while you read or watch TV, so it feels normal by bedtime.
6. Adjust for how you sleep. Refit straps, add soft strap covers, or try a pillow shaped for a mask and tubing.

If none of that helps, talk to your sleep center or equipment supplier. You may need a different mask, machine or pressure. CPAP machines and masks need a prescription; pillows, filters, tubing and cleaners don’t.

The alternatives

Custom oral appliance

A custom oral appliance Some holds your lower jaw forward while you sleep, which keeps the airway more open. The AASM and the American Academy of Dental Sleep Medicine recommend one for adults with sleep apnea who can’t tolerate CPAP or prefer another option.

Their guideline sets out how it works. A sleep physician prescribes it, and a qualified dentist makes a custom, adjustable device.

Both should check in with you over time. The guideline also suggests a follow-up sleep test to confirm it’s working.

The same guideline notes that CPAP lowers breathing pauses more than an oral appliance. People may wear an appliance more consistently, though.

An over-the-counter snoring mouthpiece is not a sleep apnea treatment. None is cleared by the FDA for apnea. See what a custom appliance costs.

Positional therapy

Some people have apnea mainly when they’re on their back. Your sleep test report can show this. For them, positional therapy Some keeps them on their side with a special pillow, a vest or a device that vibrates when they roll over.

A 2019 Cochrane review found it reduced breathing pauses and daytime sleepiness compared with no treatment. CPAP reduced pauses more, but people may stick with positional therapy longer.

The studies were short, so long-term effects aren’t known.

Weight loss

If you have overweight or obesity, weight loss Strong can make sleep apnea less severe. The American Thoracic Society strongly recommends a structured program of a lower-calorie diet, more activity and behavioral support.

Keep using your current treatment while you lose weight. Ask your physician whether and when to retest.

Zepbound (tirzepatide)

In December 2024, the FDA approved Zepbound Strong for moderate to severe sleep apnea in adults with obesity. It’s a weekly injection, used with a reduced-calorie diet and more physical activity.

In two year-long trials of 469 adults, people on Zepbound had significantly fewer breathing pauses than those on placebo. The FDA says the improvement is likely related to weight loss.

Side effects include nausea, diarrhea, vomiting and constipation, and it isn’t for everyone. It’s prescription only, so discuss it with your physician.

Inspire (hypoglossal nerve stimulation)

Inspire Strong is an FDA-approved implant. An ENT surgeon places a small device that stimulates the nerve controlling your tongue. During sleep, it stiffens and steadies the tongue so it doesn’t block your airway.

It’s for carefully selected people. In the main five-year study, patients had moderate to severe apnea, couldn’t use CPAP and had a body mass index under 32. They also had an airway exam under sedation to check how their airway collapses.

Among the 71 people who had a sleep test at five years, 75% met the study’s definition of success. Serious device-related problems, all needing adjustments, occurred in 6%. The study was industry-supported.

Surgery

The AAO-HNS describes several kinds of surgery, depending on where your airway narrows:

• Nose: fixing a deviated septum, shrinking swollen turbinates, or repairing a collapsing nasal valve. Nasal blockage can make CPAP and oral appliances harder to use.
• Throat and palate: reshaping the palate and throat, sometimes with removing the tonsils.
• Jaw: moving both jaws forward (maxillomandibular advancement) to enlarge the airway.
• Tongue base: reducing or advancing the back of the tongue.

The AAO-HNS advises seeing a surgeon with sleep surgery experience, who may examine your airway with a scope. Recovery varies by procedure; for throat and jaw surgery, most people return to work in about two to three weeks.

What a dentist or doctor can do

Your sleep physician is the one who decides. They’ll review your sleep test, your CPAP data and what you’ve tried. Tell them plainly what isn’t working; there’s almost always a next step.

A dentist trained in dental sleep medicine makes and adjusts custom oral appliances, on a physician’s prescription. As the guideline advises, the dentist also watches for side effects in your teeth and bite over time.

What not to do

• Don’t quit CPAP on your own. Stop only after talking with your physician and having a plan.
• Don’t switch to an over-the-counter mouthpiece. It isn’t a sleep apnea treatment.
• Don’t rely on mouth tape. See is mouth taping safe?
• Don’t count on a watch. Wearables can flag a possible problem, but they can’t tell you whether treatment works.