Sleep apnea treatment ranges from nightly breathing devices to surgical implants, depending on how severe your condition is and what you can tolerate. Severity is measured by how many times your breathing pauses per hour of sleep, a number called the apnea-hypopnea index (AHI). Mild sleep apnea falls between 5 and 14 events per hour, moderate between 15 and 30, and severe above 30. The right treatment for you depends on where you fall on that scale, your body type, and what kind of apnea you have.
CPAP and Other Breathing Machines
Continuous positive airway pressure, or CPAP, is the most widely prescribed treatment. A CPAP machine delivers a steady stream of pressurized air through a mask while you sleep, keeping your airway from collapsing. Treatment is considered successful when it brings your AHI below 5, which essentially means your breathing interruptions drop to a negligible level.
The catch is that CPAP only works while you’re wearing it. For people with severe sleep apnea, the machine needs to be worn for roughly 85% of total sleep time, and ideally all night, to keep the overall AHI below 5. Even moderate cases require the mask for at least two-thirds of the night. The clinical definition of “good adherence” is using the device at least four hours per night on 70% or more of nights, but that’s really a minimum threshold. The more you wear it, the more benefit you get.
Many people struggle with CPAP. The mask can feel claustrophobic, cause nasal dryness, or leak air. Newer auto-adjusting machines (APAP) vary the pressure throughout the night based on what your airway needs, which some people find more comfortable than a fixed-pressure CPAP. BiPAP machines, which lower the pressure when you exhale, are another option for people who feel like they’re fighting the airflow.
Oral Appliances
If CPAP isn’t something you can stick with, a custom-fitted oral appliance is the next line of defense. The most common type is a mandibular advancement device, which looks like a sports mouthguard and works by pushing your lower jaw slightly forward to open the airway. A less common alternative, the tongue-retaining device, holds the tongue in a forward position instead.
For mild sleep apnea, mandibular advancement devices are clearly the better choice, with a success rate of about 58% compared to only 21% for tongue-retaining devices. In moderate and severe cases, the two types perform more similarly, with success rates in the 50% to 67% range. Oral appliances are fitted by a dentist trained in sleep medicine and typically require a few adjustment visits to get the jaw positioning right. Side effects can include jaw soreness, changes in bite alignment over time, and excess saliva.
Weight Loss
Excess weight is one of the strongest drivers of obstructive sleep apnea, and losing weight can dramatically reduce its severity. A meta-analysis of weight loss studies found that a 10% reduction in BMI corresponded to a 36% drop in AHI. A 20% BMI reduction cut AHI by 57%. Beyond that point, diminishing returns kick in: going from a 20% to a 30% BMI reduction only added another 12 percentage points of AHI improvement.
That first chunk of weight loss delivers the biggest payoff. For someone with a BMI of 35, a 10% reduction means losing roughly 30 to 35 pounds, which could be enough to shift moderate sleep apnea into the mild category or even resolve mild cases entirely. Weight loss doesn’t replace other treatments overnight, though. Most sleep specialists recommend using CPAP or an oral appliance while working toward a target weight, then retesting to see if the device is still necessary.
Positional Therapy
Some people only experience significant breathing pauses when sleeping on their back, a pattern called positional sleep apnea. For these patients, devices that encourage side-sleeping can help. Options range from simple foam wedges and bumper belts worn around the torso to small vibrating sensors that gently buzz when you roll onto your back.
Positional therapy carries a much lower risk of device-related complications than CPAP, with about one-third the complication rate in comparative studies. However, CPAP remains more effective at reducing overall AHI and improving blood oxygen levels, particularly in moderate to severe cases. Positional therapy works best as a primary treatment for mild positional apnea or as an add-on for people who use CPAP but still have more events when supine.
Nasal Expiratory Devices
A newer category of treatment uses small disposable valves placed inside the nostrils. These devices allow you to breathe in freely but create resistance when you exhale, building up enough back-pressure to keep the airway open. In a randomized controlled trial, nasal expiratory devices reduced AHI by a median of about 53% at one week and 43% at three months. Roughly half of patients met the criteria for treatment success at the three-month mark, compared to about 22% using a sham device.
These nasal valves are far less cumbersome than a CPAP mask, which makes them appealing for travel or for people who simply can’t tolerate a full machine. They tend to work best for mild to moderate cases and aren’t a substitute for CPAP in severe sleep apnea.
Hypoglossal Nerve Stimulation
For people who can’t use CPAP and have moderate to severe sleep apnea, an implanted nerve stimulator is an option worth discussing. The device, surgically placed under the skin of the chest, sends mild electrical pulses to the nerve that controls tongue movement. Each time you breathe in, the stimulator activates, pushing the tongue forward and opening the airway.
Eligibility criteria are specific. You generally need an AHI between 15 and 65, a BMI under 35, and an airway anatomy that doesn’t involve complete circular collapse at the back of the throat (determined by a brief scope exam done under light sedation). The FDA-approved device sets a slightly narrower AHI window of 20 to 65. The implant procedure itself takes a few hours, and most people need a couple of weeks to recover before the device is activated and calibrated during a follow-up visit.
Jaw Advancement Surgery
Maxillomandibular advancement is the most extensive surgical option. It involves repositioning both the upper and lower jaw forward, which permanently enlarges the airway behind the tongue and soft palate. The overall success rate, defined as cutting AHI by at least half and bringing it below 20, is about 64%. Complete resolution (AHI below 5) happens in roughly 23% of patients.
Recovery is significant. Patients typically spend time in intensive or medium care immediately after the procedure before transferring to a general ward. The jaw is wired or banded shut for a period, and a liquid or soft diet is required for weeks. Full recovery takes several months. Because of the intensity of the procedure, jaw advancement surgery is generally reserved for people with severe sleep apnea who haven’t responded to CPAP, oral appliances, or nerve stimulation.
Central Sleep Apnea: A Different Problem
Everything above applies to obstructive sleep apnea, where the airway physically closes. Central sleep apnea is a separate condition where the brain intermittently stops sending the signal to breathe. It often occurs alongside heart failure, and its treatment differs substantially.
The primary device-based treatment for central sleep apnea is adaptive servo-ventilation, a machine that monitors your breathing pattern and fills in the gaps when it detects a pause. This therapy can be used for patients with heart failure whose heart pumping function is only mildly reduced (ejection fraction above 45%) or whose central apnea is mild. In patients with more significantly weakened hearts (ejection fraction at or below 45%) and moderate to severe central apnea, adaptive servo-ventilation is contraindicated because clinical evidence showed it increased the risk of cardiac death in that group. This is one area where the distinction matters enormously, and the type of breathing machine prescribed depends on careful cardiac evaluation.