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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
Oct 29, 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 and fits in your mouth like a retainer. The device holds your jaw forward during sleep to open the airway.
- The oral device CPAP device in our review costs $2,395, but insurance may cover some of the cost.
- 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
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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.
Video: What is Obstructive Sleep Apnea?
Dr. Raj Dasgupta is an American Board of Internal Medicine quadruple board-certified physician specializing in internal medicine, pulmonology, critical care, and sleep medicine. In this video, he gives our readers an in-depth explanation of obstructive sleep apnea, or OSA, including its prevalence in the United States and the importance of diagnosis and treatment. Dr. Raj also explains the process of getting diagnosed and treatment options.
Daybreak: Our Top Pick for CPAP Alternatives
Best CPAP Alternative
✓
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 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 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 downloading the companion app and using 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 and include an interpretation of your results by a doctor and a diagnosis and prescription if necessary. 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
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 health care 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
There are multiple ways 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 people who are overweight.
- Side sleeping: “I encourage my patients to sleep on their side (lateral position), which can prevent airway obstruction and improve symptoms,” Dr. 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, smartphone, 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 Dr. 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,” Dr. 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 [help with] symptoms,” said Kevin Huffman, DO, bariatric doctor 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 how severe your sleep apnea is, 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 can be an expensive out-of-pocket purchase, although Daybreak accepts insurance when a doctor medically prescribes the device.
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,” Dr. 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 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 and lead to better sleep.
Have questions about this review? Email us at reviewsteam@ncoa.org.
Sources
- Akashiba T, et al. Respiratory Investigation. January 2022. Sleep Apnea Syndrome (SAS) Clinical Practice Guidelines 2020. Found on the internet at https://www.sciencedirect.com/science/article/pii/S2212534521001556?via%3Dihub
- Centers for Medicare & Medicaid Services. April 7, 2022. Positive Airway Pressure (PAP) Devices For the Treatment of Obstructive Sleep Apnea – Policy Article. Found on the internet at https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=52467
- Sleeper G, et al. Sleep Medicine. August 2022. Comparison of Expiratory Pressures Generated by Four Different EPAP Devices in a Laboratory Bench Setting. Found on the internet at https://www.sciencedirect.com/science/article/pii/S1389945722001824
- Centers for Medicare & Medicaid Services. Oral Appliances for Obstructive Sleep Apnea – Policy Article. Aug. 8, 2021. Found on the internet at https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=52512
- 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
- Francis C, et al. Pulmonary Therapy. June 2021. Mandibular Advancement Devices for OSA: An Alternative to CPAP? Found on the internet at https://link.springer.com/article/10.1007/s41030-020-00137-2
- Hudgel D, et al. American Journal of Respiratory and Critical Care Medicine. Sept. 15, 2018. The Role of Weight Management in the Treatment of Adult Obstructive Sleep Apnea. An Official American Thoracic Society Clinical Practice Guideline. Found on the internet at https://www.atsjournals.org/doi/10.1164/rccm.201807-1326ST
- Bailly S, et al. Journal of Clinical Medicine. Nov. 22, 2022. Impact of a Weight-Loss Rehabilitation Program on Sleep Apnea Risk and Subjective Sleepiness in Patients with Overweight/Obesity: The Diet Sleep Study. Found on the internet at https://www.mdpi.com/2077-0383/11/23/6890
- Kuna S, et al. American Journal of Respiratory and Critical Care Medicine. Jan. 15, 2021. Effects of Weight Loss on Obstructive Sleep Apnea Severity. Ten-Year Results of the Sleep AHEAD Study. Found on the internet at https://www.atsjournals.org/doi/10.1164/rccm.201912-2511OC
- Oweidat K, et al. Sleep and Breathing. May 5, 2023. Bariatric Surgery and Obstructive Sleep Apnea: A Systematic Review and Meta-analysis. Found on the internet at https://link.springer.com/article/10.1007/s11325-023-02840-1
- National Institutes of Health. Sleep apnea: Causes and Risk Factors. March 24, 2022. Found on the internet at https://www.nhlbi.nih.gov/health/sleep-apnea/causes
- American Academy of Dental Sleep Medicine. Oral Appliance Therapy. Found on the internet at https://www.aadsm.org/oral_appliance_therapy.php
- Ng J, et al. Sleep Medicine Clinics. March 2019. Oral Appliances in the Management of Obstructive Sleep Apnea. Found on the internet at https://www.sleep.theclinics.com/article/S1556-407X(18)30092-4/fulltext
- Chan A, et al. Thorax. August 2010. The Effect of Mandibular Advancement on Upper Airway Structure in Obstructive Sleep Apnoea. Found on the internet at https://thorax.bmj.com/content/65/8/726.long
- Chang E, et al. American Journal of Otolaryngology. May–June 2017. Tongue Retaining Devices for Obstructive Sleep Apnea: A Systematic Review and Meta-analysis. Found on the internet at https://www.sciencedirect.com/science/article/pii/S0196070916304197?via%3Dihub
- University of Michigan Health. Surgical Alternatives to CPAP. Found on the internet at https://www.uofmhealth.org/conditions-treatments/brain-neurological-conditions/surgical-alternatives-cpap
- Vicini C, et al. The World Journal of Otorhinolaryngology – Head & Neck Surgery. June 13, 2017. Transoral Robotic Surgery for Obstructive Sleep Apnea Syndrome: Principles and technique. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5683592/
- American Thoracic Society. Upper airway stimulation/hypoglossal nerve stimulator [PDF]. Found on the internet at https://www.thoracic.org/patients/patient-resources/resources/upper-airway-stimulation.pdf
- Costantino A, et al. Sleep and Breathing. June 2020. Hypoglossal Nerve Stimulation Long-term Clinical Outcomes: A Systematic Review and Meta-analysis. Found on the internet at https://link.springer.com/article/10.1007/s11325-019-01923-2
- Rosval B, et al. The Laryngoscope. May 12, 2017. Is Uvulopalatopharyngoplasty Effective in Obstructive Sleep Apnea? Found on the internet at https://onlinelibrary.wiley.com/doi/full/10.1002/lary.26631
- Oh H, et al. Scientific Reports. Feb. 7, 2020. The Clinical Efficacy of Relocation Pharyngoplasty to Improve Retropalatal Circumferential Narrowing in Obstructive Sleep Apnea Patients. Found on the internet at https://www.nature.com/articles/s41598-020-58920-9
- Sjöblom H, et al. European Archives of Oto-Rhino-Laryngology. March 2022. Treatment of Sleep Apnoea with Tonsillectomy: A Retrospective Analysis Using Long-term Follow-up Data. Found on the internet at https://link.springer.com/article/10.1007/s00405-022-07350-6
- Pavwoski P, et al. Neurology Clinical Practice. February 2017. Treatment Options for Obstructive Sleep Apnea. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5964869/
- Ghadiri M, Grunstein RR. Respirology. June 2020. Clinical Side Effects of Continuous Positive Airway Pressure in Patients With Obstructive Sleep Apnoea. Found on the internet at https://onlinelibrary.wiley.com/doi/full/10.1111/resp.13808
- Gambino F, et al. Internal and Emergency Medicine. June 2022. Treatment Options in Obstructive Sleep Apnea. Found on the internet at https://link.springer.com/article/10.1007/s11739-022-02983-1
- NCOA Adviser. CPAP Survey. 600 respondents. Conducted using Pollfish. Launched July 25, 2023.