Sleep apnea has more treatment options today than ever before, ranging from devices and lifestyle changes to surgery and even a newly approved medication. The right approach depends on how severe your condition is and what’s causing your airway to collapse during sleep. Severity is measured by how many times per hour your breathing stops or becomes shallow: fewer than 15 events is mild, 15 to 30 is moderate, and 30 or more is severe.
Weight Loss Has the Biggest Impact
Excess weight is the single most modifiable risk factor for obstructive sleep apnea. Fat deposits around the neck and throat narrow the airway, and losing weight directly reverses that pressure. The relationship is remarkably consistent: every 1% of body weight you lose produces a measurable drop in the number of breathing interruptions per hour. A 20% reduction in BMI has been linked to a 57% decrease in those events, though improvements taper off beyond that point.
For people with obesity and moderate to severe sleep apnea, there’s now a pharmaceutical option. In late 2024, the FDA approved tirzepatide (sold as Zepbound) as the first medication specifically indicated for obstructive sleep apnea. It works by mimicking gut hormones that reduce appetite and food intake, and the sleep apnea benefit comes from the resulting weight loss. In two clinical trials involving 469 adults, participants who took the drug weekly for a year experienced significantly fewer breathing disruptions compared to placebo, and a greater proportion achieved remission or dropped to mild severity. The medication is approved only for adults with obesity who have moderate to severe sleep apnea, and it’s meant to be combined with diet and exercise.
CPAP Remains the Gold Standard
Continuous positive airway pressure therapy keeps your airway open by delivering a steady stream of air through a mask you wear during sleep. It’s the most effective treatment across all severity levels and reduces breathing interruptions more than any other single intervention. The challenge is that many people struggle to use it consistently. Mask discomfort, dry air, noise, and the feeling of pressure all contribute to poor adherence, and a device that sits in a drawer doesn’t help anyone.
If you’ve tried CPAP and found it difficult, there are things worth adjusting before giving up. Different mask styles (nasal pillows, nasal masks, full-face masks) fit differently, and switching often solves comfort issues. Most modern machines also have heated humidifiers and pressure ramp features that start low and gradually increase, making it easier to fall asleep.
Oral Appliances for Mild to Moderate Cases
Mandibular advancement devices are custom-fitted mouthpieces that push your lower jaw slightly forward during sleep, pulling the tongue and soft tissue away from the back of the throat. They’ve proven effective for mild to moderate sleep apnea, and more recent evidence suggests they can also help selected patients with severe disease. A dentist trained in sleep medicine fits and adjusts them over several visits.
You’ll need at least eight teeth on each jaw to anchor the device properly. If you don’t meet that threshold, a tongue-stabilizing device is an alternative that holds the tongue forward with gentle suction rather than relying on teeth. Jaw joint problems were once considered a dealbreaker for oral appliances, but that’s no longer always the case. The most common side effects are temporary jaw soreness and changes in bite alignment, which your dentist monitors over time.
Positional Therapy for Side-Sleeping
Some people have sleep apnea that’s dramatically worse when they sleep on their back. In the supine position, gravity pulls the tongue and soft palate backward, narrowing the airway more than it does when you’re on your side. If a sleep study shows this pattern, positional therapy can help. Options range from simple (a tennis ball sewn into the back of a sleep shirt) to more sophisticated vibrating devices worn on the chest or neck that gently prompt you to roll over without fully waking you.
Positional therapy significantly reduces breathing interruptions during back-sleeping and carries a lower risk of device-related side effects than either CPAP or oral appliances. That said, it’s less effective than CPAP at reducing overall severity and improving oxygen levels. It works best as a standalone treatment for mild positional sleep apnea or as a complement to other therapies.
Mouth and Throat Exercises
Oropharyngeal exercises, sometimes called myofunctional therapy, strengthen the muscles of the tongue, soft palate, and throat. The logic is straightforward: firmer airway muscles are less likely to collapse during sleep. In one randomized trial, patients with primary snoring or mild to moderate sleep apnea who performed daily tongue and throat exercises for three months saw meaningful improvements compared to a control group doing only breathing exercises. The exercises typically involve things like pressing the tongue against the roof of the mouth, practicing specific swallowing patterns, and repeating vowel sounds in targeted ways.
This approach won’t replace CPAP for someone with severe sleep apnea, but it can reduce snoring intensity and mildly improve breathing interruptions for people on the lower end of the severity scale. It’s also free, has no side effects, and can be combined with any other treatment.
Hypoglossal Nerve Stimulation
For people with moderate to severe sleep apnea who can’t tolerate CPAP, an implantable device offers a different approach. A small pulse generator, placed under the skin of the chest during outpatient surgery, stimulates the nerve that controls tongue movement. Each time you breathe in during sleep, the device gently pushes your tongue forward to keep the airway open. You turn it on with a remote before bed and off when you wake up.
In clinical trials, the device reduced breathing interruptions by 68%, bringing the average from about 29 events per hour down to 9. Two-thirds of patients achieved at least a 50% improvement that held up at three and five years of follow-up. Side effects were generally minor: temporary soreness at the incision sites and some tongue discomfort that improved over time as patients adjusted to the sensation or had the device reprogrammed.
Not everyone qualifies. You need to be 22 or older with a BMI under 33. A specialist performs a procedure called drug-induced sleep endoscopy to examine how your airway collapses while sedated. If the collapse forms a complete circle at the back of the palate, tongue stimulation won’t fix it, and you’d be steered toward other options.
Avoiding Alcohol and Sedatives
Alcohol relaxes the muscles that hold your airway open, making it floppier and more prone to collapse. Even a moderate amount in the evening can worsen snoring and increase the number of breathing interruptions during sleep. Sedative medications have a similar effect, and combining alcohol with sedatives is particularly dangerous because it can suppress your drive to breathe deeply enough overnight.
If you drink regularly in the evening, cutting back or shifting your last drink to earlier in the day is one of the simplest changes you can make. The same applies to sedating medications: talk with whoever prescribes them about alternatives that are less likely to relax airway muscles.
Combining Treatments
Sleep apnea rarely has a single cause, and the most effective plans often layer multiple approaches. Someone might use CPAP at a lower, more comfortable pressure setting while also losing weight, which gradually reduces the pressure needed. Another person might combine an oral appliance with positional therapy and throat exercises. As weight comes down or fitness improves, the severity of the condition can change enough to warrant a new sleep study and an updated treatment plan.