Devices and Oral Appliances to Treat Sleep Apnea

Reviewed by: HU Medical Review Board | Last reviewed: January 2022 | Last updated: February 2022

Sleep apnea is a sleep disorder in which a person stops breathing for several seconds or longer during sleep. These people tend to snore loudly or snort, gasp, or choke while asleep. Many devices can be used to treat sleep apnea. All are designed to get more air into the lungs and increase oxygen levels in the bloodstream.1

Positive airway pressure (PAP) machines are devices most often used. There are several types of PAP machines. Other treatment options include dental devices and hypoglossal nerve stimulation.

CPAP machines for sleep apnea

Continuous positive airway pressure (CPAP) machines work well to treat people with sleep apnea. That is why the American Academy of Sleep Medicine recommends that CPAP (or a similar machine) be prescribed for anyone with obstructive sleep apnea (OSA).2

A CPAP machine works by gently forcing pressurized air through a mask and into your airway. The air pressure keeps your airway from collapsing while you sleep. The mask may fit just over the nose, or over the nose and mouth.3

Figure 1. How a CPAP keeps the airway open

Person wearing CPAP mask, so air flow can keep airway open during sleep

It can take some time to get used to sleeping with a CPAP machine. One of every 3 people find it hard to sleep with a CPAP machine and eventually quit using it. About half of people quit using their CPAP machine over time or only use it for half the night.2,3

However, studies show that when used correctly and consistently, CPAP machines help improve health because your body gets enough oxygen during sleep. This increases sleep quality and daytime functioning. These machines also help reduce daytime sleepiness, blood pressure, number of vehicle accidents, and depression.2

A few studies suggest that CPAP therapy may improve symptoms of gastroesophageal reflux (GERD), heart failure, atrial fibrillation, and arrhythmias.2

There are other types of positive airway pressure machines, but CPAP is the one most often used.2,4

BPAP, APAP, and EPAP machines for sleep apnea

A CPAP machine delivers the same amount of air when you inhale and exhale. A BiPAP machine stands for bilevel positive airway pressure. BiPAP machines deliver higher pressure air on the inhale and lower pressure air on the exhale. BiPAP machines may be an option for people who have trouble exhaling when using a CPAP machine.3

APAP stands for auto-adjusting positive airway pressure. An APAP machine changes pressure throughout the night depending upon what is needed to keep your airway open. This pressure changes depending on your sleep position or the stage of sleep you are in.3

EPAP stands for expiratory positive airway pressure. These are small, disposable valves that are placed over each nostril. EPAP may be an option for people who cannot sleep with a CPAP machine or people who want to travel without their CPAP. Both require a prescription.3

Non-traditional PAP

Another positive airway pressure machine may work for people who do not like to use a CPAP or APAP machine. Known as non-traditional PAP, this device uses a valve to generate pressure, not airflow.

Non-traditional PAP does not need a humidifier and is generally smaller and quieter than a traditional CPAP or APAP machine. It comes with changeable settings for when you are falling asleep, in deep sleep, and when you exhale. This is a new technology, and doctors do not yet know if it works for all types of sleep apnea.5

Dental and tongue devices for sleep apnea

Dental, or oral, appliances may be prescribed for people with mild to moderate sleep apnea who do not want to sleep with a CPAP machine. These devices fit in the mouth and keep the airway open during sleep. They work by holding the chin forward or the tongue down. Some also trap air in the airway to help keep it open.4,6

eXciteOSA® is a device that improves how the muscles in the tongue work. The device works by stimulating the tongue muscles so the tongue does not fall backward during sleep. It is used while you are awake for 20 minutes a day for 6 weeks and then twice weekly. It requires a prescription and is available for people 18 and older who snore or who have mild sleep apnea.7

Oral appliances are not recommended for people with severe OSA.4,5,7

Hypoglossal nerve stimulation for sleep apnea

Inspire is a nerve stimulation device that may work for certain people with moderate to severe OSA. The device is implanted under the collarbone during surgery. It stimulates the hypoglossal nerve, which activates the genioglossus muscle and keeps the upper airway open.4

It is only recommended for people who cannot use a CPAP machine and who have a body mass index under 32.3

PAP and mission critical workers

CPAP or one of its variations is highly recommended for anyone working in what is called a mission-critical job. These jobs include airline pilots, airplane controllers, train engineers, bus drivers, truck drivers, and shipmates.4

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