Why Patients Seek Alternatives
Continuous Positive Airway Pressure (CPAP) remains the standard for moderate–severe obstructive sleep apnea (OSA). It physically prevents airway collapse by pushing air into the throat.
But many people struggle with it:
- Mask leaks or claustrophobia
- Nasal congestion or dry mouth
- Mouth breathing that overwhelms pressure
- Noise, travel inconvenience, or bed-partner disruption
- Discomfort with straps or facial marks
For some, the challenge isn’t motivation—it’s anatomy and airway function. If the nasal passages are blocked, the tongue posture is weak, or the jaw sits posteriorly, therapy compliance is harder regardless of pressure settings.
Alternatives exist—and in the right patient, they can be as effective as CPAP.
Oral Appliances
These mandibular advancement devices (MADs) reposition the lower jaw forward and open the upper airway.
They are crafted by qualified dentists with sleep training and customized to your bite and jaw shape.
Who they help most
- Mild–moderate OSA
- Positional OSA
- Patients intolerant of CPAP
- Snoring with clear tongue-base collapse
Pros
- Quiet and portable
- No tubes or electricity
- Often easier for partners
- Better adherence in real-world use
Limitations
- Effectiveness depends on airway geometry
- May require “titration” (incremental jaw advancement)
- Possible jaw soreness, tooth shifting, or TMJ symptoms if not monitored
- Less predictable in severe obstructive sleep apnea unless combined with other interventions
Appliances control collapse—they do not strengthen the airway.
Pairing them with airway-focused therapy can increase durability and reduce symptom recurrence.
Myofunctional Therapy
Myofunctional therapy (or airway functional therapy) retrains how your tongue, lips, soft palate, and respiration muscles behave at rest and during sleep.
It is not passive—it is targeted rehabilitation.
Why it matters The airway is dynamic: if tongue posture is low, the mouth rests open, or the soft palate is weak, collapse occurs regardless of devices.
Therapy goals:
- Proper tongue resting posture on the palate
- Nasal breathing day and night
- Lip seal
- Coordinated diaphragm and posture
- Strengthening of oropharyngeal muscles
Outcomes seen clinically and in research
- Reduced snoring
- Lower apnea-hypopnea index (AHI)
- Better REM stability
- Improved tolerance of Continuous Positive Airway Pressure or devices
- Fewer nighttime awakenings
- Long-term stabilization of airway mechanics
Who benefits most
- Mouth breathers
- People with suboptimal tongue posture
- Post-surgical patients who want durability
- Appliance users wanting fewer titrations
- Children with airway dysfunction or enlarged tonsils/adenoids
Myo does not “mask” the problem—it targets the neuromuscular cause of collapse.
ENT / Maxillofacial Options
When airway obstruction is structural, surgery may be the most direct path.
Nasal surgeries
- Septoplasty and turbinate reduction
- Polyp removal or sinus interventions
These improve airflow and often make CPAP or oral appliances more tolerable. They are not usually curative on their own.
Soft tissue procedures
- UPPP (uvulopalatopharyngoplasty)
- Palatal stiffening or remodeling
These address the soft palate. Outcomes vary because they often do not correct tongue-base collapse.
Jaw surgeries
- Maxillomandibular advancement (MMA): Mobilizes both jaws forward, enlarging the entire airway space.
This is the most effective long-term structural option, frequently considered the closest thing to a cure in adults with jaw deficiency.
When surgery makes sense
- Severe OSA with poor tolerance of other therapies
- Known anatomical restriction (small jaws, collapsed palate, severe nasal obstruction)
- Desire for durable intervention rather than nightly devices
- Patients who have already optimized airway function with therapy
Surgery is not a shortcut—it is part of a staged plan that often includes pre- and post-therapy to ensure lasting results.
Insurance Basics
Coverage varies by state and plan, but a few patterns are consistent:
- Oral appliances: Often covered when OSA diagnosis is established and CPAP intolerance documented. Medical plans—not dental—usually handle claims.
- Myofunctional therapy: Covered in many markets when delivered by credentialed speech-language pathologists; coding depends on functional deficits (airway, orofacial myofunctional disorders, swallowing).
- Surgery: Typically covered with documented severity and failure of conservative options.
Every patient should verify individually—benefits, deductibles, and pre-auth rules vary widely.
FAQ
Are appliances as effective as CPAP?
For many with mild–moderate OSA, yes. Real-world adherence is often higher. Severe OSA may still require CPAP or combination therapy.
How long is myo?
Programs typically last 8–16+ weeks, depending on muscle tone, posture habits, nasal status, and adherence. Results build over time and can be durable.
Will insurance help?
Often. Appliances, therapy, and surgery can be covered with proper diagnosis and documentation. Plans differ—benefits verification is essential.
Where to Go Next
If you’re exploring CPAP alternatives, start with a full airway assessment. Determine why the airway collapses—structure, function, or both—and build from there.
- Oral appliance vs CPAP comparison:
/blog/oral-appliance-vs-cpap - Myofunctional therapy & airway rehabilitation:
/services/myofunctional-therapy - Insurance and coverage basics:
/insurance
