What CPAP alternative is best for me?
CPAP Alternatives for Sleep Apnoea patients
CPAP therapy is a clinically effective therapy for Obstructive Sleep Apnoea and usually the first treatment option provided. However, if you are unable to use CPAP, alternative treatments are available.
For some CPAP is unsuitable; either for medical reasons or simply being unable to tolerate the therapy.
That said, none are as effective as CPAP. Therefore before looking for a CPAP alternative, we would recommend first reading our page about CPAP troubleshooting. This may help you become comfortable with the therapy.
However, if CPAP simply is not for you, then here are the alternative options available to help you sleep soundly.
Yes, we know you know - so let's get it out of the way! However, in a significant number of cases OSA can be reduced (or cured) by losing weight.
This is because OSA is often caused by excess soft tissue around the neck, combined with the additional weight pushing down on the airway.
Losing weight reduces the excess tissue, along with reducing this weight and therefore allowing the airway to remain clear.
Of course, for those who are no overweight (ie have a BMI below 25) then weight loss will not provide the CPAP alternative you are looking for.
Oral Appliance Therapy - the most common CPAP alternative
Oral Appliance Therapy uses a mouthpiece to position the lower jaw further forward. These devices, commonly called Mandibular Advance Devices, come in a variety of forms. However, all work in the same way. Positioning the lower jaw forward opens up the airway, making it more difficult for soft tissue to cause an obstruction.
A Mandibular Advancement Device is an excellent CPAP alternative for those with mild OSA. It can also help many moderate OSA patients. It also provides a convenient option for those times with using a CPAP machine may not possible - for example while camping or on a long-haul flight. Even for those with severe OSA, using such a device is a better option than going with CPAP altogether in such a situation.
If you have not used a Manidibular Advancement Device, then using a trial device will allow you to see if it works for you at minimal cost. For example, the Somnolis is a short-term device that is ideal for assessing whether or not this type of therapy works for you.
If you decide it is the right CPAP alternative for you, then you can consider a longer-term device, such as a Somnofit. These are more comfortable and more durable.
You can also get Mandibular Advancement Devices through some private dentists. Such custom-made devices typically cost around £1,000, but should last several years. You can contact the BDSDM to find an OSA-trained dentist local to you.
If you only experience OSA while on your back, then Positional Therapy is a viable CPAP alternative.
In most cases, the effect of gravity makes OSA worse when the patient sleep on their back. It pulls the soft tissue downwards, restricting the airway and making a full blockage more likely.
For most though, OSA will still be present while side-sleeping - just to a lesser extent. In those cases, side sleeping is not a true CPAP alternative as OSA will not be completely prevented.
Only if your AHI is normal when side sleeping would Positional Therapy be a suitable treatment option.
Most sleep studies do not provide this information. However any that monitor body position, such as an in-home Multi Channel sleep study, can provide the answers. If you have already done a sleep study and are consider Positional Therapy, then you can ask your consultant whether or not the study showed your OSA to be position-dependent.
If it did, the Positional Therapy may well be the suitable CPAP alternative that you are looking for.
Believe it or not, several Sleep Apnoea patients have reported that playing the didgeredoo has helped treat - or even prevent - their sleep problems. In fact, its effectiveness has even been proven in a clinical trial.
The conclusion of the trial stated that "regular didgeridoo playing is an effective treatment alternative well accepted by patients with moderate obstructive sleep apnoea syndrome", with the severity of OSA dropping and partner's sleep quality improving (presumably due to less snoring / noise).
OSA is often caused by loose tissue and weak muscles in the neck causing the airway to get blocked. Playing the didgeredoo help strengthen those muscles, as it requires a great deal of exhalation force to generate the sound.
However, your partner may need to be convinced that swapping snoring for a didgeredoo is a fair trade! Unfortunately, didgeredoos are not currently available to order from CPAP.co.uk - but you never know...
A clinical trial in China has shown acupuncture to be a potential CPAP alternative. Manual Acupuncture had the most positive effect.
It is not available as a recognised CPAP alternative through the NHS currently, so you would need to finance a course of treatment privately.
With a lack of extensive research into how effective acupuncture is for Obstrucitve Sleep Apnoea, we would not consider it a true CPAP alternative currently.
Surgery is very much a last resort for treating Obstructive Sleep Apnoea.
It is not normally advised as a CPAP alternative unless it is deemed unsuitable and you have tried all other treatment options. The success rate of surgery is between 50 to 60 percent, and often results in severe pain for several weeks while the wounds heal. Even with successfully surgery, symptoms return to normal within 6-12 months.
The most common surgical procedure used to treat OSA is Uvulopalatopharyngoplast (UPPP). The procedure involves attempting to increase the width of the airway and improve the movement and closure of the soft palate. Excess tissue is removed which may include the uvula, the soft palate, tonsils and adenoids. The removed tissue reinforces the area to keep it open and unobstructed.
UPPP is often a painful surgical procedure, with the possibility of complications during the surgery. Complications during surgery could involve accidental damage to the surrounding blood vessels or tissues. There is also a chance of complications after having surgery, such as swelling, pain, infection, bleeding, as well as having a sore throat and finding swallowing uncomfortable or impossible.
For these reasons, surgery is not often suggested as a CPAP alternative by the NHS. We would recommend considering carefully whether or not it would be the right option for you, and get a second opinion if possible before committing.
Other Lifestyle Changes
There are a variety of lifestyle changes that you can enforce in order to help reduce your sleep apnoea symptoms as listed below.