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- Price: $2,395
- Insurance coverage: Yes
- Standout feature: Custom-molded to your mouth
Learn more about at-home sleep apnea tests.
CPAP Alternatives: Sleep Apnea Treatment Without CPAP
Sep 20, 2024
Fact Checked
Find out what your options are for CPAP alternatives in our guide to alternative sleep apnea treatments.
Key Takeaways
- Our pick for the “Best CPAP Alternative” is the Daybreak device. It’s a custom oral device based on a mold of your teeth, which fits in your mouth like a retainer. The device holds your jaw forward during sleep to open the airway.
- The two CPAP alternatives in our roundup cost between $1,795 and $2,395 out of pocket, but our top pick accepts insurance.
- Oral devices may be helpful for mild to moderate sleep apnea, while other treatment options, such as surgery, may be recommended for people with more severe symptoms.
Best CPAP Alternative
Daybreak
•
FDA-approved CPAP alternative •
Custom-fitted oral device •
Accepts most insurance plans Continuous positive airway pressure (CPAP) machines are commonly prescribed for people with breathing conditions like obstructive sleep apnea (OSA). While CPAP machines can be effective for OSA, they may not be the right choice for everyone. Some people may find sleeping with a CPAP mask uncomfortable, and certain CPAP machines can be noisy,
Luckily, there are CPAP alternatives for people with mild to moderate sleep apnea, such as mandibular advancement devices (MADs). Here, our Reviews Team walks you through some of these CPAP alternatives for OSA. Plus, get expert insight on improving your sleep quality.
Best alternatives to CPAP for sleep apnea
Daybreak: Our Top Pick for CPAP Alternatives
Best CPAP Alternative
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We chose Daybreak as the “Best CPAP Alternative” overall for its Daybreak Device, a custom-made mouthpiece that is self-fitted at home with a mouth impression kit developed in cooperation with a team of dentists, doctors, and sleep specialists. Daybreak also offers an at-home Daybreak Sleep Test, which measures and diagnoses your sleep quality so you can determine whether you need further treatment. Our Top Pick
Our expert take on the Daybreak device
The Daybreak Device is an oral mouthpiece that’s worn during sleep to help control apnea, or snoring. It works by gently pressing your jaw forward to open your airway further. According to Daybreak, the devices work best for people living with mild to moderate sleep apnea, not severe or chronic sleep apnea.
When you order a Daybreak device, you’ll first receive a sleep test kit. It includes a NightOwl sensor and instructions on how to download the companion app and how to use the test. According to our tester, “I found it easy to use. You just put the tape around your finger and it held it in place and it was pretty straightforward.” Your results are analyzed by a team of doctors at Daybreak who will determine if you have sleep apnea and if the Daybreak device is appropriate for you. If it is recommended, you will then receive an impression kit that you can use to make a custom mold of your teeth. After sending your mold back to the company, you’ll receive your custom oral device in the mail around five to seven days later. Creation of the Daybreak device is overseen by a dentist, and every device is individually tested before shipping.
The Daybreak device is considered a medical device for treating sleep apnea, making it eligible for insurance coverage if you have a medical diagnosis of sleep apnea and a prescription from your doctor (check with your insurance provider to confirm coverage). If you don’t already have a sleep apnea diagnosis, you can use a Daybreak Sleep Test kit to measure your sleep quality. Sleep test kits cost $160. You don’t need a sleep apnea diagnosis or prescription to purchase a Daybreak Device. You can pay for it out of pocket or use CareCredit financing to pay in installments.
Who may love Daybreak for sleep apnea
- People who want a simpler alternative to a CPAP machine
- People who would prefer an at-home sleep apnea test as opposed to an in-person sleep study
Who may want to avoid Daybreak device for sleep apnea
- People with more severe or chronic forms of sleep apnea
Lofta: Best CPAP Alternative with Telehealth Support
Best CPAP Alternative with Telehealth Support
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We chose the Lofta oral sleep apnea device as the “Best CPAP Alternative for Telehealth Support” because the device includes follow-up consultations with a dentist who can help address concerns. Our expert take on the Lofta oral appliance
The Lofta oral sleep apnea device works by pushing the jaw and tongue slightly forward to keep the airways clear. Like other oral sleep apnea devices, you’ll start by taking a mold of your mouth with an impression kit provided by Lofta, and then mailing it back to the company. You’ll then receive your custom oral appliance in the mail. The Lofta appliance comes with a three-year warranty. If you have any questions or concerns, you can schedule a follow-up telehealth appointment with a Lofta dentist.
The company offers at-home sleep apnea test kits for $349, but you’ll still need a prescription from your doctor to purchase a Lofta oral appliance.
Who may love Lofta for sleep apnea
- People who want an oral sleep apnea device that includes telehealth follow-ups
Who may want to avoid Lofta for sleep apnea
- People who want to use insurance to pay for their CPAP alternative
How we test CPAP alternatives and sleep products
We spent over 250 hours researching CPAP machines, positive airway pressure (PAP) machines, and other sleep apnea alternatives. We interviewed medical experts, such as respiratory therapists, and consulted recent academic research on CPAP alternatives, like oral devices, to bring the most up-to-date information to our articles.
To learn more about our testing, review our CPAP review methodology.
Insurance coverage for sleep apnea treatments
To qualify for insurance coverage for your OSA treatment, CPAP machine, or other devices (like a portable oxygen concentrator for supplemental oxygen therapy during the day), you’ll need an official sleep apnea diagnosis and a prescription from your doctor. If treatment or therapy is deemed medically necessary, your health insurance should provide some amount of coverage. Private insurance varies by plan, and Medicaid coverage varies by state. Talk to a representative with your health insurance company to confirm coverage and to find out whether there are any limitations for coverage.
Medicare coverage depends on the treatment type. Medicare Part B covers durable medical equipment ⓘ Medical equipment expected to last at least three years, prescribed for in-home use for a medical reason (DME) if it’s prescribed by a healthcare provider. To learn more, read our guide to Medicare coverage for CPAP machines and supplies.
Table 1, Comparison of CPAP vs. other therapies
| Treatment type | Best for | Medicare coverage |
|---|---|---|
| CPAP | Moderate to severe OSA | Yes |
| Expiratory positive airway pressure (EPAP) | Mild to moderate OSA | Yes |
| Automatic positive airway pressure (APAP) | Moderate to severe OSA | Yes |
| Bilevel positive airway pressure (BiPAP) | OSA combined with other health issues like COPD | Yes |
| Oral appliance | Mild to moderate OSA | Yes No, for tongue-retaining devices. |
| Weight loss and exercise | Mild to moderate OSA | N/A |
| Surgery | Moderate to severe OSA | Yes, for some procedures. |
| Physical therapy | Moderate to severe OSA | Maybe |
| Positional therapy | Moderate to severe OSA | Yes |
Centers for Medicare & Medicaid Services. Billing and coding: Surgical treatment of obstructive sleep apnea (OSA). Aug. 27, 2023. Found on the internet at https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=56905
Types of CPAP alternatives
Multiple alternative ways exist to treat sleep apnea without a CPAP machine—such as using an oral device to help keep airways open, trying different sleeping positions like side or stomach sleeping, and using an adjustable bed to lift the head and relieve pressure on the breathing passages.
Some of the most popular treatment methods for sleep apnea include the following.
Lifestyle changes
Beyond modifying your diet and exercise routine for better sleep hygiene, the following lifestyle changes may help with sleep apnea:
- Weight loss: “Obesity is a significant risk factor for sleep apnea due to increased soft tissue around the neck that can obstruct the airway during sleep,” said Kubanych Takyrbashev, MD, health and wellness advisor at NAO. One research review found that weight loss could potentially ease sleep apnea symptoms by 50% in individuals who are overweight.
- Side sleeping: “I encourage my patients to sleep on their side (lateral position), which can prevent airway obstruction and improve symptoms,” Takyrbashev said. You can take measures to keep yourself on your side during the night by propping yourself with pillows or wearing devices that alert you when you roll onto your back.
- Drinking less alcohol: The more you drink, the higher your risk of sleep apnea. It’s a good idea to cut off alcohol consumption at least three hours before bed to lessen the effect of alcohol on the airways
- Diet, exercise, and sleep hygiene: Eating a healthy diet and exercising regularly can help improve sleep apnea symptoms. Good sleep hygiene practices, such as limiting screen time (TV, computer) before bed, can help as well.
Oral appliances
Oral sleep apnea appliances can come in a few different designs, including the following:
- Mandibular advancement devices (MADs): “MADs work by gently moving the lower jaw forward, which helps keep the airway open by preventing the collapse of soft tissues,” said Takyrbashev. One study found that custom-made MADs reduced sleep apnea events by at least 50%.
- Mandibular advancement splints (MAS): MAS devices hold the jaw and tongue forward to improve breathing. A recent study found that MAS devices reduced sleep apnea events in people with mild, moderate, and severe sleep apnea.
- Tongue-retaining devices (TRDs): “TRDs hold the tongue in place to prevent it from obstructing the throat during sleep,” Takyrbashev explained. One study found that suction-based TRDs reduced sleep apnea events by more than 50%.
Alternate pressurized sleep apnea treatments
CPAP machines aren’t the only pressurized air devices that can help ease sleep apnea symptoms. The following positive airway pressure (PAP) machines could also prove useful for some people.
- Automatic positive airway pressure (APAP): An APAP machine auto-adjusts the pressure of air in response to breathing patterns instead of providing a constant air pressure level. Research indicates that APAP machines can be just as effective as CPAP machines for certain people, with the advantage of using lower air pressure.
- Bilevel positive airway pressure (BiPAP): BiPAP machines push air into the upper airway and lungs to help people breathe more clearly. These machines allow the user to set different air pressure levels for inhaling and exhaling.
- Expiratory positive airway pressure (EPAP): EPAP devices provide air pressure when exhaling. Instead of a mask, the EPAP device uses two valves that cover the nostrils to limit airflow. The valves open when you breathe in and close when you breathe out to create enough pressure in the airway to prevent it from collapsing and obstructing airflow.
Surgery
“In very severe cases, surgery may be considered to alleviate symptoms,” said Kevin Huffman, DO, bariatric physician and CEO of On the Rocks Climbing Gym in Elyria, Ohio. Some of the surgeries used to treat sleep apnea can include the following:
- Transoral robotic surgery (TORS): This surgery trims away obstructive tissues behind the tongue, which can block the airways during sleep, such as the epiglottis, a flap of cartilage sitting at the back of the throat. Research indicates this procedure can reduce apnea events by 40%.
- Maxillomandibular advancement (MMA) surgery: This procedure moves the upper and lower jaw slightly forward to expand the airway. According to the University of Pennsylvania, success rates for MMA surgery are around 90%.
- Uvulopalatopharyngoplasty (UP3): This procedure removes excess tissue from the back of the throat to open the airway. One research review found that UP3 surgery may lead to a 50% reduction in sleep apnea events for some people.
Drawbacks of using a CPAP machine to treat sleep apnea
A CPAP machine may provide more restful sleep for many people, but for others, the cons may outweigh the pros. Some of the more common drawbacks to CPAP machines include the following.
Uncomfortable side effects
CPAP machines can lead to unpleasant side effects. According to our 2023 survey of 600 CPAP users, the following side effects were most commonly reported by respondents:
- Dry Mouth (37.33% of respondents)
- Dry nose (32% of respondents)
- Trouble sleeping (26.17% of respondents)
- Face redness (20.17% of respondents)
- Nasal congestion. (19.83% of respondents)
- Sore throat (17.33% of respondents)
CPAP machines can also be noisy, making it hard to sleep if you’re sensitive to sound. And some people may prefer a device worn in the mouth versus one that connects to tubing and hoses, which can make it difficult to get comfortable.
How to choose the best CPAP alternative
The best CPAP alternative for your needs can depend on several factors, such as the severity of your sleep apnea, your overall budget, and your personal preferences.
For example, while noninvasive options like oral devices are approved for mild to moderate sleep apnea, severe and chronic sleep apnea may require more intensive interventions, such as surgery.
Your personal comfort also plays a role in your decisions. You may dislike the noise from an alternative pressurized air machine and prefer a noiseless alternative, like an oral device. Consider how much money you’re prepared to spend, too. For instance, the Daybreak oral device and Lofta oral appliance are both expensive out-of-pocket purchases, although Daybreak accepts insurance when the device is medically prescribed by a doctor.
Consulting a sleep specialist
Sleep specialists can include medical professionals such as neurologists, pulmonologists, or psychiatrists who undergo sleep medicine training. They may ask about your sleep habits and symptoms or suggest an overnight sleep study to diagnose sleep apnea or other potential sleep disorders.
“It’s important to talk to a sleep specialist before starting any alternative treatment,” said Huffman.
Bottom line
While CPAP is an effective way to treat obstructive sleep apnea, some may find a CPAP machine too noisy, uncomfortable, or cumbersome for long-term treatment. Luckily, research indicates that certain CPAP alternatives, like oral devices, alternate pressurized airway machines, and lifestyle changes could improve sleep apnea symptoms.
Our top CPAP alternative is the Daybreak oral device since the company provides an at-home kit for creating a custom-molded device. The company also accepts insurance when the purchase is accompanied by a doctor’s prescription, making it potentially more affordable.
“Some of these alternative treatments can be helpful, at least to some extent,” said Huffman. “But remember, if you have severe sleep apnea and you stop using CPAP, your symptoms will almost certainly worsen.” Huffman suggests consulting a sleep specialist before you stop using CPAP therapy so they can help you find the alternative treatment that will work best for your needs.
Frequently asked questions
If you don’t want to use a CPAP machine, you can try an oral device to support a clear airway. ”These custom-fitted devices can significantly improve sleep quality and reduce sleep apnea symptoms,” Takyrbashev explained.
Some people with sleep apnea may benefit from practicing good sleep hygiene habits. “Having consistent sleep and wake times, a restful sleep environment, and avoidance of stimulants before bed can help,” said Huffman. Maintaining a healthy weight can also lead to fewer symptoms since obesity is a risk factor for sleep apnea.
By treating sleep apnea naturally, you can potentially save money on expensive treatment options like CPAP machines, and avoid the potential discomfort of wearing a CPAP mask.
Adopting healthier lifestyle choices, like an improved diet and exercising, may also improve your overall health in other ways, allowing you to support your body while improving your sleep.
Have questions about this review? Email us at reviewsteam@ncoa.org.
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