Sleep apnea treatment ranges from wearing a pressurized mask at night to surgery that repositions the jaw, depending on how severe your condition is and what you can tolerate long-term. Severity is measured by how many times your breathing pauses per hour of sleep: 5 to 14 events is mild, 15 to 29 is moderate, and 30 or more is severe. The right treatment plan usually combines a primary therapy like positive airway pressure with lifestyle changes that address the root causes.
Positive Airway Pressure: The First-Line Treatment
Positive airway pressure (PAP) therapy is the standard treatment for obstructive sleep apnea in adults. The American Academy of Sleep Medicine strongly recommends it for anyone with sleep apnea causing excessive daytime sleepiness, and conditionally recommends it for people with impaired sleep quality or coexisting high blood pressure.
A CPAP machine delivers a steady stream of pressurized air through a mask while you sleep, keeping your airway from collapsing. Most machines operate between 4 and 20 cm H₂O of pressure, with the average person landing around 8 to 10. You can start with either an auto-adjusting machine at home (which finds the right pressure on its own) or have a sleep lab calibrate your settings overnight. Both approaches are equally recommended. For ongoing use, standard CPAP and auto-adjusting PAP are preferred over bilevel machines for routine cases.
The biggest challenge with CPAP isn’t whether it works. It’s whether people keep using it. Common complaints include dry mouth, nasal congestion, mask leaks, and skin irritation, all of which have straightforward fixes.
Solving Common CPAP Problems
Dry mouth usually means air is escaping through your mouth while you sleep. A chin strap can help keep your mouth closed if you use a nasal mask, or you can switch to a full-face mask that covers both your nose and mouth. A heated humidifier attachment, which most modern CPAP machines include, also reduces dryness significantly. Special moisturizing mouth sprays and gels are available for persistent cases.
Nasal congestion often comes from a poorly fitting mask that leaks dry air around your nose. Check that the seal sits properly and isn’t riding too high on the bridge of your nose. Turning up the heated humidifier helps, as does a saline nasal spray before bed. If congestion persists, your doctor can prescribe a decongestant or nasal steroid.
Skin irritation and pressure sores develop when straps are too tight or the mask isn’t cleaned regularly. Wash both your face and your mask daily to prevent buildup. Petroleum-free moisturizers, mask liners, and specialized CPAP wipes can reduce friction. If you’re getting red marks or sores, you likely need a different mask size or style rather than a tighter fit.
Weight Loss and Its Direct Effect
Losing weight is one of the most effective non-device treatments for sleep apnea, particularly if you’re overweight or obese. A meta-analysis found that reducing your BMI by 20% was associated with a 57% reduction in breathing events per hour. That’s a meaningful drop, often enough to shift someone from severe to moderate or moderate to mild.
There’s a ceiling to this effect, though. Weight loss beyond that 20% BMI reduction produced progressively smaller improvements in sleep apnea severity. This means weight loss alone may not eliminate sleep apnea entirely, but it can reduce the pressure settings you need on CPAP or make other treatments more effective. For some people with mild sleep apnea, it can resolve the condition altogether.
Positional Therapy for Milder Cases
Many people’s sleep apnea is significantly worse when they sleep on their back, because gravity pulls the tongue and soft tissue into the airway. Positional therapy aims to keep you sleeping on your side. Options range from simple (a tennis ball sewn into the back of a shirt) to sophisticated, like smart pillows that gently reposition your head.
One study of an intelligent anti-snoring pillow found it increased side sleeping by nearly three times, reduced breathing events by 57%, and decreased snoring by 31%. Positional therapy works best for mild to moderate cases where your apnea is clearly position-dependent. Your sleep study results will show whether your events cluster during back sleeping, which tells you whether this approach is worth trying.
Nerve Stimulation Implants
For people who can’t tolerate CPAP, a surgically implanted device can stimulate the nerve that controls tongue movement. The device (sold under the brand name Inspire) senses your breathing pattern and delivers mild electrical pulses to keep your tongue from blocking the airway during sleep. It was approved by the FDA in 2014, and eligibility has expanded since then to include patients with BMIs up to 40.
Three out of four patients show significant improvement in the year after implantation. But body weight matters considerably. For patients with BMIs between 32 and 35, the likelihood of successful treatment drops by roughly 75% compared to leaner patients. For every single unit of BMI above 32, the odds of success decrease by about 17%. This makes nerve stimulation a strong option for people at lower body weights who have failed other treatments, but a less reliable choice for those with higher BMIs.
Jaw Advancement Surgery
Maxillomandibular advancement (MMA) surgery moves both the upper and lower jaw forward, permanently enlarging the airway behind the tongue and soft palate. It’s the most invasive option and is typically reserved for severe cases or people with specific jaw anatomy contributing to their apnea.
A meta-analysis of 455 patients found an overall surgical success rate of 85.5%, defined as at least a 50% reduction in breathing events. However, the results varied sharply by severity. Among patients who started with fewer than 30 events per hour, 77% achieved a very good outcome. For those starting between 30 and 60 events per hour, 73% did. But for the most severe cases (60 to 90 events per hour), the success rate dropped to 48%.
Recovery is significant. Temporary numbness in the face occurs in virtually all patients because the surgery stretches the nerve running through the lower jaw, though this resolves within 6 to 12 months for 85% to 90% of people. Other common effects include jaw stiffness, swelling, and changes in how your teeth fit together. Major complications like infection or hardware problems are rare, occurring in about 1% of cases, primarily in older patients or those with other health conditions.
Oral Appliances
Custom-fitted dental devices hold the lower jaw slightly forward during sleep, preventing the tongue from falling back into the airway. They look similar to a sports mouthguard and are made by a dentist with training in sleep medicine. Oral appliances work best for mild to moderate sleep apnea and for people who snore heavily but have fewer actual breathing pauses.
They’re easier to travel with than a CPAP and require no electricity, which makes them a practical alternative for people who find positive airway pressure unmanageable. The tradeoff is that they’re generally less effective than CPAP at reducing breathing events, particularly in severe cases. Jaw soreness and changes in bite alignment can occur with long-term use, so regular dental follow-up is important.
Combining Treatments
Most people get the best results by layering approaches. Using CPAP alongside weight loss, for example, can lower your required pressure settings over time and may eventually reduce your dependence on the device. Adding positional therapy to CPAP can further improve outcomes if back sleeping worsens your apnea. Avoiding alcohol within a few hours of bedtime also helps, since alcohol relaxes the muscles that keep your airway open.
Treatment isn’t one-and-done. Follow-up sleep testing after starting therapy confirms that your breathing events have actually decreased, and adjustments to mask fit, pressure settings, or treatment approach are common in the first few months. The goal is getting your hourly events as close to zero as possible while keeping the treatment tolerable enough that you actually use it every night.