Sleep News

JUST BREATHE: What happens if I don’t want or like PAP therapy? You have options

It’s no secret that some people don’t like PAP therapy (nor is it a secret that some people swear by it). Therapies that require the use of devices can be challenging for some people and even with their best efforts, they may not  be able to use them effectively.


Below is a list of options for those who have tried and failed at PAP therapy for whatever reason. It is not the purpose of this website to favor one therapy or another, or to compare and contrast, but rather to illustrate the variety of options that patients with sleep-disordered breathing may have.As always, your diagnoses and treatments are best discussed with your sleep physician, as this website cannot diagnose your problem or prescribe or advise as to which options are best for you. Whether you qualify for any of these treatments is going to be a decision you make with your physician. 

  • Oral devices. Read here for a more detailed discussion about sleep dentistry and how it might help you. 
  • Expiratory positive airway pressure. This is a kind of nostril patch device that works by blowing against the patches during exhale, which may improve the “patency” or rigidity of the upper airway tissue and provide, for some, a kind of “tracheal traction” to create greater ease in inhalation. 
  • Oral pressure therapy. This works by using a small oral suction tube to draw the soft palate forward, which may stabilize the tongue and keep it from blocking the airway during sleep.
  • Pillar procedure. This is a minimally invasive surgical procedure in which tiny implants are inserted into the soft palate. Their presence may reduce tissue vibration which can lead to snoring, sleep apnea and upper airway resistance syndrome. 
  • Somnoplasty. This is a minimally invasive surgical procedure using radio frequency (RF) energy to sculpt upper airway tissue under local anesthesia; this may effectively open the airway.
  • Upper airway neurostimulation. The Inspire is a small device implanted into the chest to deliver to deliver carefully timed mild stimulation to the airway during sleep. This controlled neurostimulation may achieve “patency” or firmness of the tissues in order to prevent their collapse. 
  • Uvulopalatopharyngoplasty (UPPP). This surgical procedure removes excess tissue in the throat, soft palate, uvula, tongue, tonsils, and/or parts of the pharynx to create more space in the upper airway; this may prevent collapse airway collapse during sleep.
  • Adenoidectomy. Removal of the adenoids (tonsils) make help make space in an otherwise crowded airway.
  • Numerous other surgeries used to correct obstructive sleep apnea have been outlined clearly at this page hosted by the American Sleep Apnea Association.
Certain lifestyle changes or habits may not “cure” your sleep apnea, but they can certainly give you some relief. These include: 
  • Positional therapy. Read here for a more detailed discussion about how just changing your sleep position can help those who snore or have mild apnea.
  • Weight loss. Losing a few pounds, even just ten, can help shrink fat cells. Smaller fat cells retain less water and place less pressure on the tissues of the upper airway during sleep. This may reduce, if not completely eliminate, obstructive breathing patterns. Remember, even if you don’t have noticeable fat pads in your neck, you may carry extra water weight in your feet during the day; when you lie down, the fluid recirculates and plumps up fat throughout the body, including in the neck area. 
  • Gastric bypass or other surgical weight loss procedures. For those who are morbidly obese, these options may also help prevent obstructions secondarily, but these patients may need to have a sleep study prior to surgery to identify any preexisting sleep apnea so that the pre-surgical team can prepare proper anesthesia and respiratory therapies prior to the operation. 
  • Smoking cessation. Smoking (of tobacco or any other substance) may inflame the upper airway and, in the case of tobacco, create a “rebound effect” in the upper away during the night because of short-term nicotine withdrawal. Smoking may also lead to Chronic Obstructive Pulmonary Disease, a chronic and irreversible respiratory disorder which can severely impact one’s ability to breathe, especially at night while asleep.
  • Daily aerobic exercise. Daily aerobic exercise may help to improve the tone of the tissues in the upper airway and may lead to weight loss and the shrinkage of fat cells which are partly to blame for obstructions of breathing at night.
  • Change pillows or reduce the number of pillows used. If your pillow seems to be pushing your chin forward, it may be contributing to the mechanical obstruction of the airway. Find a pillow that allows your head to lie flat while still supporting your neck. Also, propping one’s head up with multiple pillows may do the same thing. If you struggle to sleep with your head flat, it could be that you have a severe obstructive respiratory condition, and you should discuss this with your physician. 
  • Play the didgeridoo. Seriously. There’s some evidence that playing some form of wind instrument may help improve airway tone and build a skill called “circular breathing” which allows for better gas exchange. 

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