Sleep Apnea Treatment Options Compared

Weight loss, sleeping on your side and less alcohol can be very effective. PAP often works best with them (NHLBI). The right choice depends on your severity, the cause and what you will use every night.

Last updated October 4, 2026

Sleep Apnea Treatments At A Glance

This table compares the options for obstructive sleep apnea (OSA) in adults. Severity comes from the AHI on your sleep study. Mild is 5 to 14 events per hour, moderate is 15 to 29 and severe is 30 or more (Sleep Foundation).

Option	How it works	Who it may suit	What the evidence says	Effort and trade-offs
CPAP or APAP	A machine sends air through a mask to splint the airway open; APAP adjusts the pressure through the night	Most people with OSA; first-line treatment	AASM strongly recommends PAP for OSA with excessive sleepiness, and CPAP or APAP for ongoing treatment	Nightly use, mask fitting, cleaning; dryness, congestion and strap marks are common but fixable
BPAP (bilevel)	Two pressures: higher when you breathe in, lower when you breathe out	People who struggle with CPAP or APAP, or have another breathing disorder too	AASM suggests CPAP or APAP over BPAP for routine OSA	As for CPAP; used for specific needs
Oral appliance	A custom mouthpiece that holds the lower jaw or tongue forward	Mild to moderate OSA in people who cannot tolerate CPAP or prefer an alternative	AASM and AADSM recommend considering it for CPAP-intolerant adults; custom, adjustable devices preferred	Dentist fitting and regular dental checks; a follow-up sleep test to confirm it works
Positional therapy	A belt, backpack-style device or vibrating neck device that keeps you off your back	People whose apnea happens mainly when sleeping on their back	Can reduce severity in some people; can be used alone or with other treatment	Simple to use; only helps position-dependent apnea
Weight loss and lifestyle	Less tissue around the airway; less alcohol and smoking-related airway irritation	Anyone with excess weight; helpful alongside any other treatment	Can be very effective as part of treatment, but weight loss does not guarantee apnea goes away	Slow and sustained effort; may need a repeat sleep study if weight changes a lot
Mouth and throat exercises	Exercises that strengthen and reposition the tongue, lips and throat muscles	Children and adults	May be effective; studies show improvement after about three months of regular practice	Regular practice for months
Airway surgery	Removes or reshapes tissue (for example tonsils) or moves the jaw forward	People with a specific anatomic cause, or who cannot use PAP	AASM recommends discussing referral to a sleep surgeon if you cannot tolerate or accept PAP and your BMI is under 40	Surgery; may not completely cure OSA and can have long-term side effects
Hypoglossal nerve stimulation	An implant in the chest stimulates the nerve that moves the tongue forward as you breathe	Moderate to severe OSA when PAP is not tolerated, if the tongue is the main blockage	A newer option; an airway exam during sedated sleep checks if you are a candidate	Outpatient surgery; you switch it on by remote each night
Bariatric surgery	Weight-loss surgery to reduce obesity-related airway narrowing	Adults with OSA and a BMI of 35 or more who cannot tolerate or accept PAP	AASM recommends discussing referral to a bariatric surgeon in this group	Major surgery, discussed with a bariatric surgeon
Medicine (tirzepatide)	An injected weight-loss medicine; apnea improves as weight falls	Adults with moderate to severe OSA and obesity	FDA-approved in December 2024 as the first drug treatment for OSA, used with diet and exercise	Prescription only, with possible serious side effects; not for everyone

Sources: NHLBI, AASM Sleep Education, AASM (CPAP), Patil and colleagues, 2019, Ramar and colleagues, 2015, Kent and colleagues, 2021, Sleep Foundation, FDA, MedlinePlus.

Positive Airway Pressure: CPAP, APAP And BPAP

A PAP machine is the most common treatment for sleep apnea (NHLBI). CPAP is the frontline treatment for most patients (AASM). It works well in most people with OSA (MedlinePlus). The air splints the airway open. That stops the breathing pauses and the snoring (AASM).

• CPAP gives one constant pressure set by your sleep doctor, sometimes after a titration study (AASM).
• APAP raises or lowers the pressure on its own through the night, as needed (AASM).
• BPAP uses a higher pressure when you breathe in and a lower one when you breathe out. Your doctor may advise it if CPAP or APAP causes problems. It may also help if you have another breathing disorder (AASM).

What The AASM PAP Guideline Says

The 2019 AASM guideline on PAP for adult OSA makes these key recommendations (Patil and colleagues, 2019):

• Use PAP rather than no therapy for adults with OSA and excessive sleepiness (strong). It is also suggested for impaired sleep-related quality of life or high blood pressure (conditional).
• In adults without significant other health problems, start PAP with APAP at home or with an in-lab titration study (strong).
• Use CPAP or APAP for ongoing treatment (strong). Choose them over BPAP for routine OSA (conditional).
• Give education when PAP is started (strong). Offer behavioral support, troubleshooting and remote monitoring in the early weeks (conditional).

Masks come in three common styles. A nasal mask is the most common. A full face mask also covers the mouth. Nasal pillows sit in the nostrils (AASM). Ask to try another style if the first one leaks or feels uncomfortable.

Oral Appliances

Oral appliances look like a sports mouth guard or orthodontic retainer. Mandibular repositioning devices hold the lower jaw forward so it cannot slide back and block the airway. Tongue-retaining devices hold the tongue forward (NHLBI). A dentist or orthodontist custom fits the device. Your provider may prescribe one if you do not want to use CPAP or cannot tolerate it (NHLBI).

An oral appliance is recommended for mild to moderate apnea in people who cannot tolerate CPAP or prefer to try an appliance (AASM).

The 2015 AASM and American Academy of Dental Sleep Medicine guideline backs this. Sleep physicians should consider one, rather than no treatment, for adults with OSA who cannot tolerate CPAP or prefer an alternative. It suggests a custom, titratable appliance fitted by a qualified dentist over off-the-shelf devices (Ramar and colleagues, 2015).

In practice you may see your dentist after 6 months and then every year (NHLBI).

Positional Therapy

Some people have apnea mainly when they sleep on their back. On their side, they breathe normally. Positional therapy keeps you on your side. It uses a device worn around the waist or back. Or it uses a small device on the back of the neck that vibrates gently when you roll onto your back (AASM).

Your sleep study can show whether your events cluster on your back. NHLBI also lists side sleeping as a lifestyle step that can help keep the airway open (NHLBI).

Weight Loss And Lifestyle Changes

Healthy lifestyle changes can be very effective for sleep apnea. They include regular activity, healthy sleep habits, a healthy weight, less alcohol and caffeine, and no smoking (NHLBI). Alcohol and sedating medicines before bed relax the throat and make symptoms worse (MedlinePlus).

Weight loss can improve or even eliminate apnea symptoms in people who are overweight. There is no guarantee it will make apnea go away (AASM). So most people keep using another treatment while they lose weight.

We explain how weight change affects apnea, and why poor sleep makes weight harder to lose, in the hidden link between sleep apnea and weight gain.

Exercises for the mouth and face muscles may also help children and adults. They are called orofacial or oropharyngeal therapy. They strengthen and reposition the tongue and throat muscles (NHLBI). In several studies, people improved after doing the exercises regularly for three months (Sleep Foundation).

Surgery And Hypoglossal Nerve Stimulation

Doctors usually consider surgery when CPAP or an oral appliance has not worked (AASM). Options include (NHLBI):

• Removing the tonsils, or removing tissue from the mouth and throat to widen the airway;
• Moving the upper and lower jaw forward;
• Hypoglossal nerve stimulation;
• Weight-loss (bariatric) surgery if obesity contributes and other treatments have not worked.

Hypoglossal nerve stimulation is also called upper airway stimulation. A small device goes in the chest wall, like a pacemaker. A wire runs to the nerve that moves the tongue forward as you breathe. You turn it on by remote control at night.

First, an ear, nose and throat doctor looks at your airway while you are sedated. You may be a good candidate if your tongue is what blocks the airway. You may not be if the airway collapses all the way around (AASM). It is a newer treatment. It is recommended for people with moderate to severe OSA who cannot tolerate PAP (Sleep Foundation).

The 2021 AASM surgical referral guideline sets two referral rules for adults who cannot tolerate or accept PAP. If your BMI is under 40, clinicians should discuss referral to a sleep surgeon. If your BMI is 35 or more, they should discuss referral to a bariatric surgeon.

With a major anatomic abnormality of the upper airway, the guideline suggests trying PAP first (Kent and colleagues, 2021). Surgery may not completely cure OSA and may have long-term side effects (MedlinePlus).

Is There A Medicine For Sleep Apnea?

In December 2024 the FDA approved tirzepatide (Zepbound) for moderate to severe obstructive sleep apnea in adults with obesity. It is used with a reduced-calorie diet and more physical activity. It was the first drug treatment option for OSA. It reduces appetite and body weight. The improvement in apnea is likely related to the weight loss (FDA).

It is injected under the skin. It can cause serious side effects in some people. Tell your provider if you or your family have had thyroid tumors, depression, kidney disease or diabetic eye disease (NHLBI). Your doctor decides whether it is suitable and how to use it.

Getting Used To CPAP

It can take time to get comfortable with CPAP. Good follow-up and support from a sleep center help (MedlinePlus). These steps come from AASM and NHLBI patient advice:

1. Practice awake. Wear the mask for short periods during the day while watching TV or reading (AASM).
2. Use it all night, every night, and for naps. Using CPAP less often reduces its benefits and makes it harder to adjust (AASM).
3. Get the fit right. Most CPAP problems come from a mask that does not fit. Too big and the straps must be pulled tight. Too small and air leaks into your eyes (AASM). Adjust the mask each night while lying down with the machine on (NHLBI).
4. Use the ramp setting if the pressure feels too high as you fall asleep. It starts low and builds up gradually (AASM).
5. Fix dryness and congestion. A heated humidifier helps a dry mouth, nose or throat. A saline spray can ease mild congestion (AASM).
6. Clean on a schedule. Clean the mask, tubing and headgear once a week (AASM). Reorder masks, tubes and filters on time (NHLBI).
7. Ask for help early. Do you feel claustrophobic? Does the noise bother you, or does the mask leak? Your provider can change the mask, machine or settings (NHLBI).

If you get stomach discomfort or bloating, stop using the machine and contact your provider (NHLBI). If you cannot stick with treatment, or cannot sleep even with it, a behavioral sleep specialist can help. They use cognitive behavioral therapy (AASM). Our insomnia guide covers how that therapy works.

Follow-Up: How To Know Treatment Is Working

• Regular checkups. You need checkups to make sure treatment is working. You may need a repeat sleep study, especially after a big weight change (NHLBI).
• Machine data. PAP machines record how often you use them and whether they work. Your provider, and possibly your insurer, may check this data (NHLBI).
• Oral appliance checks. Dental reviews watch for bite changes. A follow-up sleep test confirms the appliance controls your apnea (Ramar and colleagues, 2015).
• How you feel. Tell your provider if symptoms do not improve or new ones develop (MedlinePlus).

Sticking with treatment matters. Consistent CPAP use can lower the risk of heart problems and stroke. It can also improve daytime alertness, concentration and mood (AASM). We cover what untreated apnea does to the heart, metabolism and brain in sleep apnea health risks. The wider effects of poor sleep are in how sleep affects your health.

What About Central Sleep Apnea?

Central sleep apnea is treated differently because the airway is not blocked. PAP is the treatment most often used. It is often bilevel PAP or adaptive servo-ventilation (ASV), which adjusts pressure breath by breath to stabilize breathing.

Treating the underlying cause, such as heart or kidney failure, is essential. Apnea caused by opioids may need a change of medicine. Some people use low-flow oxygen or an implanted phrenic nerve stimulator (AASM).

ASV may be harmful for some people with both central apnea and certain types of advanced heart failure (Sleep Foundation). That is why central apnea needs a sleep specialist.

What If You Only Snore?

A sleep study may show simple snoring without sleep apnea. For adults who want treatment for snoring, the AASM guideline recommends oral appliances rather than no therapy (Ramar and colleagues, 2015). Our snoring causes and solutions guide covers the simpler fixes to try first.

Sleep Apnea Treatment FAQs

What Is The Most Effective Treatment For Sleep Apnea?

For most people with obstructive sleep apnea, it is CPAP or APAP used every night. It works best when used all night, every night, with healthy lifestyle changes.

Can Sleep Apnea Be Treated Without CPAP?

Yes. Options include oral appliances, positional therapy, weight loss, surgery and hypoglossal nerve stimulation. Some adults with obesity can also use an approved medicine.

Do Mouth Guards Work For Sleep Apnea?

Custom oral appliances fitted by a dentist are recommended for mild to moderate apnea in people who cannot tolerate CPAP. A follow-up sleep test confirms they work.

Who Is A Candidate For Hypoglossal Nerve Stimulation?

Generally adults with moderate to severe OSA who cannot tolerate PAP. Their tongue must be the main cause of the blockage, confirmed by an airway exam.

Can Losing Weight Cure Sleep Apnea?

It can improve apnea and sometimes eliminate symptoms, but there is no guarantee. Keep using treatment and ask about a repeat sleep study after big weight changes.

How Long Does It Take To Get Used To CPAP?

It varies from person to person. Daytime practice, a well-fitted mask, the ramp setting and a humidifier help. Your sleep center can adjust things if you struggle.

This article is general education, not medical advice. The right sleep apnea treatment depends on your sleep study, health and preferences, and only your doctor can recommend it. Do not start, stop or change any treatment or medicine without talking to your doctor.