Sleep apnea is treatable, and the right approach depends on how severe it is and what’s causing your airway to close during sleep. Options range from simple position changes and mouthpieces to pressurized air devices and surgery. Most people start with the least invasive option that matches their severity, then adjust from there.
Severity is measured by how many times per hour your breathing partially or fully stops during sleep, a number called the Apnea-Hypopnea Index (AHI). An AHI of 5 to 14.9 is mild, 15 to 29.9 is moderate, and 30 or higher is severe. Your treatment path hinges on where you fall in that range.
CPAP: The Standard First-Line Treatment
Continuous positive airway pressure (CPAP) remains the most widely prescribed treatment for moderate to severe sleep apnea. The machine pushes a steady stream of air through a mask you wear while sleeping. That pressurized air acts like a splint, supporting your airway walls from the inside so they can’t collapse and block your breathing. It works immediately on the first night you use it, and the effect lasts as long as you keep the mask on.
The challenge with CPAP is sticking with it. The mask can feel claustrophobic, the air pressure takes getting used to, and side effects like nasal dryness and skin irritation push many people to abandon treatment. If you’re struggling, there are practical fixes worth trying before giving up entirely.
Fixing Common CPAP Problems
Dry nose, dry mouth, sore throat, nosebleeds, and a runny nose are all signs your humidity setting is too low. Most CPAP machines have a built-in heated humidifier you can adjust. Increase it gradually, testing each setting over a few nights and noting how your symptoms respond. Always fill the water reservoir with distilled water rather than tap water to avoid mineral buildup.
If you sleep in a cold bedroom with heated humidification turned up, warm air can cool inside the tubing and create condensation (sometimes called “rainout”). Heated tubing, available from most CPAP suppliers, prevents this.
Mask leak is another common frustration. Air escaping around the edges dries out your nose and eyes, and it reduces the pressure reaching your airway. A poorly fitting mask is usually the culprit, so trying a different size or style often solves the problem. If you breathe through your mouth and use a nasal mask, air escapes through your mouth instead. Switching to a full-face mask or adding a chin strap can help. Bumping up the humidity setting also counteracts some of the drying caused by small leaks.
Oral Appliances for Mild to Moderate Cases
If your sleep apnea is mild or moderate, or if you simply can’t tolerate CPAP, a custom-fitted mouthpiece is a solid alternative. These devices work by pushing your lower jaw slightly forward, which pulls the tongue and surrounding tissue away from the back of your throat and opens the airway. A dentist trained in sleep medicine molds the device to your teeth and adjusts the jaw position over several visits.
Oral appliances improve daytime sleepiness just as effectively as CPAP. In a large head-to-head trial published in the Journal of the American College of Cardiology, both treatments reduced sleepiness equally. The mouthpiece group actually saw a greater drop in blood pressure: a 2.5 mmHg reduction in 24-hour mean arterial pressure at six months, compared to no significant change in the CPAP group. About 75% of mouthpiece users wore the device for at least four hours per night, with a median use of 5.5 hours, and overall adherence tends to be higher than with CPAP because the device is smaller, quieter, and easier to travel with.
The tradeoff is that oral appliances don’t reduce AHI as dramatically as CPAP in severe cases. They’re best suited for people with mild to moderate severity, or for those with severe apnea who have tried and failed CPAP.
Positional Therapy for Back Sleepers
Many people have “positional” sleep apnea, meaning their breathing problems are significantly worse when they sleep on their back. Gravity pulls the tongue and soft tissue backward in that position, narrowing the airway. If your sleep study shows your AHI is much higher on your back than on your side, positional therapy can make a real difference.
The simplest version is the old tennis-ball-in-a-pocket trick sewn onto the back of a shirt, but wearable vibrating devices are more effective and less disruptive. These small gadgets, worn on the chest, neck, or forehead, detect when you roll onto your back and deliver a gentle vibration that prompts you to turn over without fully waking you up. A meta-analysis in Thorax found that vibrotactile devices reduced AHI by about 43% and cut the time spent sleeping on the back by 70%. Neck-worn devices performed slightly better than chest-worn ones, lowering AHI by roughly 11 events per hour compared to about 8 for chest devices.
Positional therapy works best for mild to moderate positional sleep apnea. It won’t replace CPAP for someone with severe apnea that persists regardless of sleeping position, but it can be a useful add-on or standalone treatment for the right candidate.
Weight Loss and Lifestyle Changes
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 even 10% of body weight can meaningfully reduce AHI, and in some mild cases, weight loss alone resolves the condition entirely.
Alcohol and sedatives relax the muscles that keep your airway open, so avoiding them in the hours before bed reduces the frequency and severity of breathing pauses. Smoking increases inflammation and fluid retention in the upper airway, making obstruction worse. These changes won’t cure moderate or severe sleep apnea on their own, but they improve how well other treatments work.
Hypoglossal Nerve Stimulation
For people with moderate to severe sleep apnea who can’t use CPAP, an implanted nerve stimulator is an increasingly popular option. A small device, similar to a pacemaker, is surgically placed under the skin of the chest. It monitors your breathing pattern and, with each inhale, sends a mild electrical signal to the nerve that controls your tongue. This keeps the tongue from falling back and blocking the airway.
The largest registry tracking outcomes for this device, with over 500 patients, reports a surgical success rate of 81%. Success is defined as getting the AHI below 15 events per hour with at least a 50% drop from the pre-surgery baseline. Overall effectiveness ranges from 61% to 96% depending on patient selection. Not everyone qualifies: screening involves a procedure to examine your airway anatomy, and the device works best for people whose obstruction is primarily caused by the tongue rather than other structures.
The device is turned on with a remote control at bedtime and turned off in the morning. Most people adapt to the sensation of the tongue gently moving forward with each breath within a few weeks.
Surgical Options
When CPAP, oral appliances, and nerve stimulation aren’t viable, surgery to physically restructure the airway is an option. The most effective procedure for moderate to severe cases is maxillomandibular advancement, which moves both the upper and lower jaw forward to permanently enlarge the space behind the tongue and soft palate. Systematic reviews put the success rate at 86%, with a full cure rate (AHI below 5) of about 43%. Recovery takes several weeks, the jaw is typically wired or banded shut initially, and the facial changes from moving the jaw forward are permanent.
Other procedures target specific trouble spots. Surgery to remove or reduce the soft palate and uvula is common for snoring but has more modest results for apnea. Tonsil and adenoid removal is highly effective in children, who are the group most likely to be cured by surgery alone. A small subset of patients who initially improve after jaw surgery experience relapse over time, so long-term follow-up matters.
Combining Treatments
Sleep apnea management isn’t always one device or one surgery. Many people use a combination: CPAP at home with an oral appliance for travel, positional therapy layered on top of a mouthpiece, or weight loss alongside any device to gradually reduce the pressure or jaw advancement needed. If one approach isn’t getting your AHI into a healthy range or you’re not sleeping well despite treatment, the next step is usually adding or switching rather than giving up. The goal is finding the combination you’ll actually use consistently, because the best treatment for sleep apnea is the one you use every night.