Treating Obstructive Sleep Apnoea (OSA)
(Last updated on 22 July 2026)
There are several ways of treating obstructive sleep apnoea (OSA), and the most appropriate treatment depends on the severity of the condition, your symptoms, overall health, and personal preferences. Your doctor will discuss the most appropriate options for you.
In addition to treatment you should always consider the lifestyle adjustments as follows:
LIFESTYLE ADJUSTMENT
- Losing weight if you are overweight.
- Stopping smoking.
- Reducing or avoiding alcohol, especially in the evening, as alcohol relaxes the muscles in the throat and can make OSA worse.
- Keeping your nose as clear as possible if you have nasal congestion.
- Sleeping on your side or with your head slightly raised, rather than flat on your back.
WEIGHT LOSS
Being overweight or obese increases the risk of developing OSA because excess tissue around the neck can narrow the airway during sleep. However, not everyone with OSA is overweight.
Losing weight can improve OSA and, in some people, may reduce the need for treatment.
The best way to lose weight is to:
- Eat a healthy, balanced diet.
- Reduce your calorie intake.
- Be physically active on a regular basis.
BEING ACTIVE
Simple ways to become more active include:
- Taking the stairs instead of the lift.
- Walking instead of driving for short journeys.
- Enjoying activities such as walking, swimming, cycling, dancing, or gardening.
If you are finding it difficult to lose weight, speak to your GP or sleep clinic. They may be able to offer:
- Referral to a weight management programme.
- Weight-loss medications, if appropriate.
- Bariatric (weight-loss) surgery for people with severe obesity who meet NHS criteria.
Newer weight-loss medications, such as GLP-1 or GIP agonists, may also help some people lose weight and can improve obstructive sleep apnoea when combined with healthy eating and regular physical activity.
If you would like more information, please ask your sleep clinic about weight management and obstructive sleep apnoea.
1. CONTINOUS POSITIVE AIRWAY PRESSURE (CPAP)
The gold standard treatment for moderate to severe obstructive sleep apnoea (OSA) is Continuous Positive Airway Pressure (CPAP) therapy.
CPAP consists of a small machine connected to a mask worn over the nose only or nose and mouth during sleep. The machine delivers a gentle flow of pressurised air, which keeps the upper airway open and prevents it from collapsing during sleep. This reduces or eliminates episodes of apnoea and hypopnoea, helping you breathe normally throughout the night.
Modern CPAP masks are much lighter, quieter, and more comfortable than those used in the past. Although it can take a little time to adjust to wearing a mask, most people find that the benefits of treatment far outweigh any initial discomfort and choose to continue using their CPAP every night.
How long should I use my CPAP each night?
For CPAP to provide the greatest benefit, it should ideally be used every night for the entire time you are asleep, including naps whenever possible.
Everyone’s sleep needs are different, but the more consistently you use your CPAP, the more effective it is at treating your obstructive sleep apnoea. Regular use helps keep your airway open throughout the night, improving your sleep quality and reducing symptoms.
While you are asleep, CPAP should help prevent:
- Breathing pauses (apnoeas).
- Gasping, choking, or snorting during sleep.
- Frequent awakenings.
- Loud snoring.
When you wake up, you should notice improvements such as:
- Feeling more refreshed.
- No waking headaches.
- Reduced daytime sleepiness.
- Better concentration and memory.
- Improved mood and energy levels.
If you continue to experience any of these symptoms despite using your CPAP regularly, or if you are finding it difficult to use your equipment, please contact your Sleep Clinic. The team is there to support you, optimise your treatment, and help you get the most from your CPAP therapy.
You may want to read attached paper as it may help: How Much CPAP is Enough by Professor John Stradling, (published by SATA in December 2016), as well as this BBC article with video (published 24 January 2026): I snore – but didn’t know I stop breathing 10 times an hour in my sleep .
2. MANDIBULAR ADVANCEMENT DEVICES (MADS) (OFTEN PRIVATELY FUNDED)
Mandibular Advancement Devices (MADs) are custom-made oral appliances, similar in appearance to a gum shield, that are worn during sleep. They work by gently holding the lower jaw (mandible) in a forward position, helping to keep the upper airway open and reducing airway collapse.
MADs are most commonly recommended for people with mild to moderate obstructive sleep apnoea (OSA) or for those whose main symptom is snoring. They may also be suitable for some patients who are unable to tolerate CPAP therapy. (NICE Guidelines (NG202) )
A range of devices is available, from over-the-counter “boil-and-bite” appliances to custom-made devices fitted by a dentist or orthodontist with expertise in dental sleep medicine. Custom-made devices generally provide a better fit, greater comfort, and improved effectiveness compared with over-the-counter options.
According to NICE guidance, customised or semi-customised mandibular advancement devices (MADs) should be considered for adults aged 18 years and over who have good dental and periodontal (gum) health.
A MAD may not be appropriate for some people, particularly those with ongoing dental problems such as tooth decay or you are missing many teeth (though you may still be able to wear a custom-made device). Dental work may be needed before a MAD can be fitted. People who suffer from generalised (tonic-clonic) seizures should only use a customised (better fitting) MAD.
What else do I need to know about Mandibular Advancement Devices (MADs)?
NICE guidance reviewed evidence from research studies on mandibular advancement devices (MADs) and found that they can improve symptoms of obstructive sleep apnoea (OSA) and improve quality of life for many patients.
MADs are generally considered a safe treatment option, with no significant health risks associated with their use. However, some people may experience side effects, particularly when first starting treatment. These side effects often improve as you become used to wearing the device.
Possible side effects include:
- Increased saliva production.
- Jaw discomfort or aching in the jaw and facial muscles.
- Tooth discomfort.
- Dry mouth.
- An unpleasant taste sensation.
- Changes to your bite or tooth position over time.
Regular follow-up with your dentist or orthodontist is important to monitor the fit of the device, your dental health, and any changes to your bite. If you experience ongoing discomfort or concerns, you should seek advice from your dental or sleep team.
How to get a MAD
It was hoped that with the NICE recommendations of 2021 MAD would become available via the NHS. This is not yet the case in all areas, but this is being worked on. If you want to purchase a device, these are the options:
There are many different types of mandibular advancement devices (MADs) available. Broadly, they can be divided into three main categories:
- Fully-customised / Bespoke MAD
These are fitted by a suitably trained sleep dentist or orthodontist and are considered by NICE to be more effective than the alternatives, as they can be adjusted to bring the mandible forward more over time. They may also lead to fewer side effects, although the evidence for this is less conclusive. They tend to be the most expensive option but are more durable and longer lasting, making them cost-effective long-term options. They may also be suitable for people with multiple missing teeth who may otherwise not be able to use a MAD.
- Semi-customised / semi-bespoke MAD
With the semi-customised option, you are sent a kit to make a dental impression, which is then returned to the manufacturer who will make you a customised mouthpiece. It is less expensive (£90-2000) than the bespoke option. Studies show it gives increased comfort and effect compared to the boil-and-bite device.
- Ready made (“Boil and bite”) devices
These can be directly purchased for immediate wear: online and in certain retailers. They are the cheapest option (£20-50), although they are less effective and less well tolerated than the customised options. They are made of a thermoplastic material which allows them to be moulded to the shape of your teeth after heating. NICE did not recommend these.
3. POSITIONAL THERAPY
Positional therapy is a non-invasive treatment option for people with positional obstructive sleep apnoea. It can be used as an alternative to, or alongside, MADs or CPAP therapy depending on the severity of the condition and individual circumstances.
Positional therapy devices work by encouraging side-sleeping, which can help reduce airway collapse, improve breathing during sleep, and enhance overall sleep quality.
Choosing the most suitable device depends on several factors, including the severity of your sleep apnoea, comfort, lifestyle, treatment goals, and personal preference. Consistent use is important to achieve the best results.
This is one type of positional device:
What is positional obstructive sleep apnoea?
Positional obstructive sleep apnoea occurs when breathing interruptions are significantly worse when sleeping on your back (supine position) compared with sleeping on your side.
When lying on your back, gravity can cause the tongue and soft tissues in the throat to move backwards, narrowing or blocking the airway and leading to episodes of snoring, reduced airflow, or pauses in breathing.
How do positional therapy devices work?
Positional therapy devices are designed to prevent back-sleeping and encourage side-sleeping. Different types of devices include:
- Wearable devices – straps, belts, or vests that use gentle vibration alerts or inflatable supports to encourage you to change position when you roll onto your back.
- Pillows and wedges – specially designed pillows or foam supports that improve comfort while sleeping on your side and make back-sleeping less likely.
- Clothing-based solutions – specially designed sleepwear with pockets containing inserts that discourage sleeping on your back.
- Smart positional devices – advanced devices that detect changes in sleep position or snoring and provide gentle feedback to encourage repositioning without fully waking you.
Positional therapy can be an effective treatment for selected patients, particularly those whose sleep apnoea is mainly related to sleeping on their back. Your sleep team can advise whether this approach is suitable based on your sleep study results.
Effectiveness and Usage
- Positional therapy can be for patients who have mild to moderate POSA patients who primarily experience apnoea while supine.
- It may take 1–2 weeksto get used to any device/product, and consistent use is key.
- Devices can be used alone or alongside oral appliances or CPAP for residual apnoea events.
- Some devices provide data tracking for sleep quality, snoring, and supine attempts, whichmight help monitor therapy effectiveness.
4. TONSILLECTOMY FOR OBSTRUCTIVE SLEEP APNOEA
Tonsillectomy may be considered for a small number of patients with obstructive sleep apnoea (OSA), particularly those who are obese and have large, enlarged tonsils causing narrowing of the airway. Other surgical procedures may also be considered in selected cases, although the evidence for their effectiveness varies.
What is tonsillectomy?
Tonsillectomy is a surgical procedure to remove the tonsils. In children, it is often performed together with removal of the adenoids (adenotonsillectomy), as enlarged tonsils and adenoids are common causes of airway obstruction during sleep.
In adults, tonsillectomy alone may improve OSA symptoms when enlarged tonsils are a major contributor to airway blockage.
How does tonsillectomy help with OSA?
Large tonsils can reduce the space available in the throat, making it easier for the airway to become blocked during sleep. Removing the tonsils can increase the size of the airway, helping to reduce snoring and episodes of breathing interruption.
Who may benefit?
Tonsillectomy is most likely to benefit patients where:
- Enlarged tonsils are the main cause of airway obstruction.
- OSA is related to anatomical narrowing of the throat.
- A specialist assessment confirms surgery is appropriate.
- Your sleep and ENT (Ear, Nose and Throat) teams will discuss whether surgery is suitable based on your symptoms, sleep study results, airway examination, and overall health.
5. OTHER EMERGING TREATMENTS
HYPOGLOSSAL NERVE STIMULATION (HGNS)
Hypoglossal nerve stimulation (HGNS) is an advanced treatment option for obstructive sleep apnoea (OSA), designed mainly for people who are unable to tolerate or benefit from continuous positive airway pressure (CPAP) therapy.
HGNS works by stimulating the hypoglossal nerve, which controls the muscles of the tongue. During sleep, gentle electrical impulses are delivered to this nerve, helping to move the tongue forward and maintain an open airway. This reduces airway collapse and helps prevent the pauses in breathing that occur in OSA.
Some HGNS systems involve an implanted device placed under the skin, while other technologies, including some currently under investigation, are being developed with alternative placement methods.
Research studies have shown that HGNS can reduce the severity of OSA in carefully selected patients but may not fully treat OSA. Benefits may include:
- A reduction in the Apnoea–Hypopnoea Index (AHI), which measures the number of breathing interruptions during sleep.
- Improved sleep quality.
- Reduced daytime sleepiness.
- Improved quality of life.
Who may be suitable for HGNS?
HGNS is not suitable for everyone. Patients require a detailed assessment to determine whether this treatment is appropriate. This usually includes reviewing:
- Severity of OSA.
- Previous CPAP experience and tolerance.
- Airway anatomy.
- Overall health (including weight) and suitability for surgery.
As with any surgical procedure, there are potential risks and complications, which should be discussed fully with your sleep and surgical teams before making a decision.
HGNS represents an important development in the treatment of OSA and provides an alternative option for selected patients who are unable to use traditional treatments such as CPAP.
At the time of writing (July 2026), HGNS remains a specialist treatment available in a limited number of NHS centres in England. Access is dependent on referral pathways, eligibility criteria, and specialist assessment.
Written by Jennifer Troath with input from Claire Allen and Dr Swapna Mandal.
Jennifer Troath is an Advanced Clinical Physiologist in Respiratory and Sleep Medicine, AHCS Registration No. 69167 and a Volunteer Clinical Adviser for the Sleep Apnoea Trust