CPAP alternatives: 7 sleep apnea options

If you’ve been prescribed CPAP for obstructive sleep apnea (OSA) but the mask, hose, pressure, or travel hassle is a deal-breaker, you’re not alone. CPAP is still the gold-standard therapy for many people—but it only works if you can actually use it.

This guide walks through the most common CPAP alternatives, who they’re best for, what tradeoffs to expect, and how to choose a realistic next step with your clinician.

Educational only. Sleep apnea diagnosis and treatment should be guided by a licensed clinician.

Quick answer (TL;DR)

The best CPAP alternatives depend on your OSA severity, anatomy, and tolerance. Common options include:

• Oral appliance therapy (custom mandibular advancement device)
• Positional therapy (training/assisting side-sleeping)
• Different PAP modes (APAP, BiPAP, EPAP) that may be better tolerated than standard CPAP
• Lifestyle and behavioral changes (weight management, exercise, alcohol/sedative timing)
• Myofunctional therapy (mouth/throat exercises)
• Hypoglossal nerve stimulation (implantable “tongue pacing,” e.g., Inspire)
• Surgery (selected cases; anatomy-driven)

Guidelines also emphasize follow-up sleep testing to confirm that an alternative is actually controlling events—especially for oral appliances (see the 2015 AASM/AADSM clinical guideline).

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Why people look for CPAP alternatives

There are two big reasons:

1. Comfort and practicality: mask leaks, dryness/nasal irritation, claustrophobia, pressure discomfort, or disruption to a bed partner.
2. Adherence: If you can’t use CPAP consistently, benefits drop. CPAP adherence rates are estimated to be as low as 50% (Sleep Foundation), with other sources noting that up to 40% of users do not use it consistently (SleepApnea.org).

Important nuance: “CPAP alternatives” doesn’t always mean “no device.” Sometimes the best alternative is a different PAP mode or a different interface—because it preserves the effectiveness of pressurized air while addressing the specific sources of discomfort or intolerance.

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Determine your sleep apnea type and severity

Before switching therapy, make sure you know:

• Do you have obstructive sleep apnea (OSA) vs central sleep apnea (CSA)? Treatments can differ, and some therapies (like certain implants) are intended for OSA.
• How severe is it? OSA severity is commonly categorized by the apnea-hypopnea index (AHI) (events per hour).

A clinical review from Cleveland Clinic notes OSA is diagnosed using AHI, and an AHI ≥ 15, or ≥ 5 with symptoms/comorbidities, is consistent with OSA (Cleveland Clinic).

If you’re unsure of your AHI, ask your sleep clinic for your report. It’s the single most useful number for narrowing options.

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CPAP alternatives (with pros/cons and who they fit)

1) Oral appliance therapy (custom “sleep apnea mouth guard”)

What it is: A custom-fitted device worn during sleep that holds the lower jaw forward (mandibular advancement device) or, less commonly, holds the tongue forward.

Why it works: Moving the jaw forward can reduce airway collapse by increasing space behind the tongue.

Who it’s best for: Often mild to moderate OSA, or people with more severe OSA who can’t tolerate CPAP (Cleveland Clinic).

What guidelines say (high-impact points):

According to the 2015 AASM/AADSM clinical guideline:

• Sleep physicians should consider oral appliances for adults with OSA who are intolerant of CPAP or prefer an alternative.
• Custom, titratable appliances are preferred over non-custom devices.
• Dental follow-up matters to monitor bite/tooth changes.
• Follow-up sleep testing is recommended to confirm effectiveness.

Tradeoffs / side effects: Jaw soreness, tooth discomfort, dry mouth, and potential bite changes over time (monitoring is part of safe use) (SleepApnea.org).

Is an oral appliance as effective as CPAP? Oral appliances can significantly reduce AHI, but CPAP tends to be more effective at reaching target AHI in moderate-to-severe OSA; oral appliances are commonly used when CPAP isn’t tolerated or is not preferred (see the 2015 AASM/AADSM clinical guideline).

2) Positional therapy (stop back-sleeping)

What it is: A strategy/device that helps you sleep on your side if your OSA is worse when you’re on your back.

Why it works: Supine (back) sleeping can increase airway collapsibility for many people.

Who it’s best for: People with positional OSA—often those with lower levels of obesity—where AHI is meaningfully lower on the side than on the back (Cleveland Clinic; Sleep Foundation).

Tradeoffs: It’s simple, but adherence can drift over time (like any behavior-based therapy). It also may not be enough for moderate-to-severe OSA.

3) Alternative PAP modes for improved tolerability (APAP, BiPAP, EPAP)

If standard CPAP is hard to tolerate—often because of pressure settings or breathing comfort—your clinician may recommend another positive airway pressure (PAP) mode. These options are commonly described in patient education resources, including SleepApnea.org.

APAP (auto-adjusting PAP)

Adjusts pressure through the night based on breathing patterns.

BiPAP/BPAP (bilevel PAP)

Uses different pressures for inhalation vs exhalation, which can improve comfort for some people who struggle to exhale against fixed pressure.

EPAP (expiratory PAP)

Small valve-based devices that create resistance on exhale; may be an option for some mild-to-moderate cases (Cleveland Clinic).

Important note: These are still PAP therapies, but they can be more tolerable for some people—which can support more consistent use.

4) Lifestyle and behavioral changes

Lifestyle strategies are often recommended alongside devices and procedures, and in some cases can meaningfully reduce OSA severity.

Weight loss

What it is: Reducing body fat—especially around the neck and trunk—can lower airway collapse risk.

What the evidence says: A Cleveland Clinic review notes that 10% weight loss is associated with about a 26% decrease in AHI.

Tradeoffs: Weight loss can significantly reduce severity, but it doesn’t reliably “cure” OSA for everyone.

If you’re pursuing weight loss for OSA, consider prioritizing fat loss while preserving muscle (especially if you’re using medications or aggressive dieting).

BodySpec note: If you’re using weight loss as part of your sleep apnea plan, objective body-composition tracking helps you see whether you’re losing fat (and where) vs losing muscle. Our guide to Sleep apnea and weight loss explains this data-driven approach in more detail. You can also track abdominal fat more precisely with a DEXA scan for visceral fat.

Exercise

Exercise is often recommended because it supports cardiovascular health, and it may help OSA even when weight loss is modest (Cleveland Clinic; SleepApnea.org).

Alcohol and sedative timing

Alcohol can worsen OSA by relaxing airway muscles. A Cleveland Clinic review notes that alcohol consumption increases the prevalence and duration of apnea events.

A practical step: set a “last call” window (for many people, 3–4 hours before bed) and see if snoring/awakenings improve.

5) Myofunctional therapy (“mouth and throat exercises”)

What it is: Exercises targeting the tongue and upper airway muscles.

Why it can help: Strengthening and re-training these muscles may reduce collapse risk and improve airway tone.

A Cleveland Clinic review describes myofunctional therapy as promising for improving sleep parameters and potentially reducing AHI, though it is not considered a standard standalone treatment for OSA.

6) Hypoglossal nerve stimulation (HNS) / “tongue pacing” implants (e.g., Inspire)

What it is: An implanted device that stimulates the hypoglossal nerve to move the tongue forward during sleep, reducing airway blockage (Cleveland Clinic; Sleep Foundation).

Who it’s best for: Selected adults with moderate-to-severe OSA who have not succeeded with CPAP and meet specific anatomic and BMI/AHI criteria (SleepApnea.org; Cleveland Clinic).

What to know about Inspire specifically: Inspire markets a mask-free implant and reports outcomes such as a 79% reduction in sleep apnea events, and notes it is covered by most commercial insurers, Medicare, and the VA (Inspire Sleep). (Your eligibility and coverage depend on your plan and clinical criteria.)

Tradeoffs: It’s surgery + an implanted device. Like any implant, it has procedural risks and requires follow-up.

7) Surgery (anatomy-driven options)

Surgical treatments aim to remove or reposition tissue that contributes to obstruction.

Examples described in a Cleveland Clinic review include:

• Uvulopalatopharyngoplasty (UPPP): AHI reduction around 33%, with the note that effectiveness can diminish over time.
• Maxillomandibular advancement (MMA): A skeletal surgery that can be highly effective, with an 87% AHI reduction reported in that review.

Who it’s best for: People with specific anatomical contributors and those who have not succeeded with conservative approaches. Many clinicians use additional evaluation (like endoscopy-based assessment) to identify the obstruction site.

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A quick self-assessment: which CPAP alternative should you ask about?

Use this as a conversation starter with your clinician—not as a diagnosis tool.

1) Is your OSA mostly positional (worse on your back)?

• If yes: ask about positional therapy and how to verify effectiveness with repeat testing.

2) Is your OSA mild to moderate and your main issue is the mask?

• Ask about custom oral appliance therapy, and confirm you’ll have dental monitoring + follow-up sleep testing.

3) Is pressure the problem (breathing out feels hard)?

• Ask about BiPAP or pressure-relief features, and whether APAP could help.

4) Is travel or portability the problem?

• Discuss oral appliances (portable) and whether a different PAP setup could meet your needs.

5) Do you have moderate-to-severe OSA and you’ve failed CPAP?

• Ask whether you qualify for hypoglossal nerve stimulation or whether surgery evaluation is appropriate.

6) Is excess weight likely contributing?

• Consider a plan that combines treatment (device or not) with weight loss, since evidence suggests meaningful AHI reductions with weight loss.

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Comparison table: CPAP alternatives at a glance

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How to evaluate any CPAP alternative (don’t skip this)

Switching therapies without measuring outcomes is like changing a workout plan without tracking results.

1) Track symptoms that matter

• Daytime sleepiness
• Morning headaches
• Waking up gasping or choking
• Snoring (especially bed-partner report)

2) Confirm treatment efficacy with sleep testing when recommended

Oral appliance guidelines explicitly recommend follow-up sleep testing to confirm efficacy (see the 2015 AASM/AADSM clinical guideline). Clinicians may also recommend retesting after major weight changes or surgery.

3) Track risk factors you can influence

If weight loss is part of your plan, it helps to track more than scale weight.

• If you want a precise baseline for abdominal fat, a [DEXA scan[(/booking) can estimate visceral fat and track changes over time.
• If you’re working on weight as a strategy to reduce OSA severity, revisit your sleep study and ask your clinician about retesting after meaningful weight change.

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FAQs

What is the best alternative to CPAP?

The “best” alternative depends on your severity and why CPAP isn’t working. Common next steps include custom oral appliances for mild-to-moderate OSA, positional therapy for positional OSA, and hypoglossal nerve stimulation or targeted surgery for selected CPAP-intolerant moderate-to-severe OSA (see the 2015 AASM/AADSM clinical guideline; Cleveland Clinic).

Do mouth guards work for sleep apnea?

Custom oral appliances can reduce AHI and improve symptoms, particularly in mild-to-moderate OSA, and are recommended as an alternative when CPAP isn’t tolerated—especially when they’re custom, titratable, and paired with follow-up testing (see the 2015 AASM/AADSM clinical guideline).

Can weight loss replace CPAP?

Weight loss can significantly reduce OSA severity. One clinical review notes 10% weight loss is associated with a 26% decrease in AHI (Cleveland Clinic). But it may not fully resolve OSA for everyone—so don’t stop treatment without clinician guidance and objective retesting.

Is Inspire better than CPAP?

Inspire is a mask-free implant designed for selected patients who have not succeeded with CPAP. The Inspire site reports outcomes like a 79% reduction in sleep apnea events and broad insurance coverage, but it’s not for everyone and requires surgery (Inspire Sleep). CPAP remains the first-line gold standard for many patients because of its effectiveness when used consistently (Cleveland Clinic).

What if I can’t tolerate anything on my face?

Ask about oral appliances, positional therapy, and whether you’re a candidate for hypoglossal nerve stimulation. Also consider revisiting mask options and fit—sometimes a different interface changes everything.

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Next steps checklist (bring this to your appointment)

1. Get your AHI and your sleep study summary.
2. Write down what makes CPAP hard (mask? pressure? travel? dryness?).
3. Choose 1–2 topics to discuss first:
   • Oral appliances: “Is a custom oral appliance appropriate for my OSA severity and anatomy?”
   • Positional therapy: “Is my sleep apnea positional, and would positional therapy be enough?”
   • Alternative PAP modes: “Could APAP, BiPAP, or EPAP improve comfort and consistency for me?”
   • HNS implant evaluation: “Do I meet criteria for hypoglossal nerve stimulation?”
   • Surgery evaluation: “Should I be evaluated for anatomy-driven surgical options?”
4. Ask how you’ll verify success (repeat sleep test, device data, symptom tracking).
5. If weight is a factor, set a tracking plan (scale + body composition), and ask your clinician when retesting makes sense after weight change.

If you’re working on the lifestyle side too, see:

• How to fall asleep fast
• Magnesium for sleep: benefits and dosage

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Bottom line

There are real, evidence-backed CPAP alternatives —but the best choice depends on your OSA severity, anatomy, and what you can stick with night after night. Work with a sleep clinician, measure outcomes with follow-up testing when appropriate, and treat sleep apnea like a long-term health project: adjust, retest, and iterate.