Sleep apnea is most commonly treated with a device that delivers pressurized air through a mask during sleep, keeping your airway open. But that’s just one option in a range of treatments that now includes oral appliances, nerve stimulators, surgery, weight loss strategies, and even a recently approved medication. The right approach depends on the type and severity of your sleep apnea, your body weight, and what you can realistically stick with long term.
Positive Airway Pressure Devices
Positive airway pressure (PAP) therapy is the first-line treatment for obstructive sleep apnea. These devices push a steady stream of air through a mask you wear over your nose, mouth, or both while sleeping. The air pressure acts like a splint, preventing the soft tissue in your throat from collapsing and blocking your airway.
There are three main types. CPAP delivers one fixed pressure all night. APAP (auto-adjusting) monitors your breathing in real time and raises or lowers the pressure based on what’s happening, moment to moment. BiPAP uses two different pressures: one when you breathe in and a lower one when you breathe out. About half of all prescribed PAP devices are now APAP models, with CPAP making up roughly 41% and BiPAP about 9%.
Many sleep specialists start patients on APAP to determine the right pressure range, then sometimes switch to a fixed CPAP setting once the ideal pressure is established. APAP can feel more comfortable because it doesn’t push maximum pressure when you don’t need it, but some patients do better on a consistent fixed pressure.
The biggest challenge with PAP therapy is using it consistently. The standard threshold for “regular use” is at least four hours per night on at least five nights per week. Studies tracking long-term use have found compliance rates around 83% in motivated patients, but many people struggle with mask discomfort, dry mouth, or feeling claustrophobic. If you’re having trouble, talk to your sleep provider about trying a different mask style or switching between CPAP and APAP. Small adjustments often make a significant difference.
Oral Appliances
If you can’t tolerate a PAP device, or if your sleep apnea is mild to moderate, a mandibular advancement device is the main alternative. This is a custom-fitted mouthpiece, similar to an orthodontic retainer, that holds your lower jaw slightly forward while you sleep. Shifting the jaw forward pulls the base of the tongue away from the back of the throat, widening the airway.
These devices reduce the number of breathing interruptions per hour by about 50% on average. That’s enough to bring many people with mild or moderate sleep apnea into a normal range, though results vary depending on the anatomy of your airway. A dentist trained in sleep medicine takes impressions of your teeth and adjusts the device over several visits to find the right jaw position. The appliances are quieter and more portable than a PAP machine, which makes them easier to use consistently, especially for travel.
Weight Loss
Excess weight is the single biggest modifiable risk factor for obstructive sleep apnea. Fat deposits around the neck and throat narrow the airway, and abdominal fat pushes the diaphragm upward, reducing lung volume. Losing weight directly reduces the severity of sleep apnea, and the relationship is well documented.
A large meta-analysis found that a 10% reduction in BMI corresponded to roughly a 36% drop in breathing interruptions per hour. A 20% BMI reduction was associated with a 57% improvement. Beyond that, the returns diminish: going from a 20% to a 30% BMI reduction only added about 12 more percentage points of improvement. This means the first significant chunk of weight you lose has the biggest impact on your breathing.
In 2024, the FDA approved tirzepatide (Zepbound) as the first medication specifically indicated for obstructive sleep apnea. It works by mimicking gut hormones that reduce appetite and food intake, leading to substantial weight loss. The improvement in sleep apnea appears to come directly from the reduction in body weight rather than any direct effect on the airway. The drug is approved for adults with moderate to severe sleep apnea who also have obesity, and it’s meant to be used alongside dietary changes and physical activity, not as a standalone fix.
Positional Therapy
Some people have sleep apnea primarily when lying on their back. In that position, gravity pulls the tongue and soft palate directly into the airway. If a sleep study shows that your breathing events happen mostly while supine, positional therapy can be effective. The idea is simple: keep yourself off your back.
Newer electronic devices worn on the chest or neck vibrate gently when you roll onto your back, training you to stay on your side. Studies of these devices show a 54% reduction in breathing interruptions per hour and an 84% reduction in the time spent sleeping on your back. The old approach of sewing a tennis ball into the back of a pajama shirt works on the same principle but is far less comfortable. Discomfort is the main reason positional therapy fails long term. Compliance with older methods drops to around 10% over time, while the newer vibrating trainers are better tolerated and provide data your doctor can review.
Hypoglossal Nerve Stimulation
For people who cannot use or tolerate PAP therapy, an implanted nerve stimulator is an increasingly popular option. The most well-known system, Inspire, works like a pacemaker for your tongue. A small device implanted in the chest sends mild electrical signals to the nerve that controls tongue movement. Each time you breathe in, it gently pushes your tongue forward to keep the airway clear. You turn it on with a remote before bed and off in the morning.
The FDA has approved this therapy for adults 22 and older with moderate to severe obstructive sleep apnea (15 to 100 breathing events per hour) who haven’t been able to use PAP. The BMI limit was recently expanded to 40, up from the original cutoff of 32, making it available to more patients. Teenagers aged 18 to 21 with moderate to severe sleep apnea, and adolescents aged 13 to 18 with Down syndrome, can also qualify under specific conditions.
One important requirement: a drug-induced sleep endoscopy must confirm that your airway doesn’t collapse in a complete circular pattern at the soft palate. If it does, the tongue stimulation won’t solve the problem. The implant procedure is done under general anesthesia and typically takes a few hours, with most people returning to normal activities within a couple of weeks.
Jaw and Airway Surgery
When other treatments fail, surgery can physically restructure the airway. The most effective surgical option is maxillomandibular advancement, which moves both the upper and lower jaw forward to permanently enlarge the airway space behind the tongue and soft palate. This is a major procedure with a significant recovery period, typically involving jaw wiring and a liquid diet for several weeks.
The overall success rate for this surgery, defined as at least a 50% reduction in breathing events with the total dropping below 20 per hour, is about 64%. A complete cure (fewer than 5 events per hour) occurs in roughly 23% of patients. Surgeon experience matters considerably: outcomes are significantly better when the procedure is performed by a surgeon with a high case volume. Average breathing events per hour dropped from about 57 before surgery to around 15 after surgery in the hands of experienced surgeons.
Less invasive surgical options include removal of excess tissue from the soft palate and throat, or procedures to stiffen the soft palate so it’s less likely to vibrate and collapse. These tend to work best for mild sleep apnea or as a complement to other treatments.
Treating Central Sleep Apnea
Central sleep apnea is a different condition from obstructive sleep apnea. Instead of a physical blockage, the brain intermittently fails to send the right signals to the breathing muscles. Treatment is more complex and depends heavily on the underlying cause.
Adaptive servo-ventilation (ASV) is a specialized breathing device that monitors your breathing pattern and fills in the gaps when your brain skips a breath. It’s effective at reducing breathing interruptions, bringing the average down to about 7 events per hour in clinical trials. However, ASV carries a serious warning: in patients with heart failure and reduced pumping function, the SERVE-HF trial found that ASV actually increased the risk of death from cardiovascular causes by 34%. For this group, ASV is now contraindicated.
CPAP can also be used for central sleep apnea, and some evidence suggests it may help when it successfully reduces breathing events below 15 per hour within the first few months. For central sleep apnea linked to heart failure, optimizing heart failure treatment itself is the most important step, since improving heart function often reduces the abnormal breathing patterns during sleep.