Does CPAP Really Work for Sleep Apnea?

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A man uses a CPAP machine while sleeping.

Roughly 8 million people — including President Joe Biden — use a CPAP machine in the U.S.¹

CPAP, which stands for continuous positive airway pressure, is the “gold-standard” treatment for obstructive sleep apnea (OSA). OSA is a condition in which your breathing stops and restarts while you’re sleeping. OSA results from blocked airflow through your upper airway.^2,3,4

A CPAP machine continuously forces air into your mouth, nose, or both. The goal is to keep your airway open during sleep, allowing you to breathe normally.³

But how effective is CPAP for sleep apnea, really? That’s the question we’ll answer in this article as we cover the topics below:

How a CPAP machine works
Side effects of CPAP
CPAP adherence
Medical alternatives to CPAP

Let’s start by understanding how a CPAP machine works and why it’s the preferred medical treatment for sleep apnea.

How a CPAP machine works

A CPAP machine consists of an air filter, a motor, a tube, a mask, and straps. The tube connects the motor to the mask, which fits over your nose and/or mouth and is held in place by the straps.³

When the machine is activated, an air filter first absorbs and purifies room air. The motor then pressurizes the filtered air and blows it into the tube. The tube, in turn, delivers the air into the mask.^3,5

The steady, pressurized air flow is designed to create an “air splint” that prevents your throat from collapsing. The pressure also keeps your tongue, uvula (the tiny hanging ball in the back of your throat), and soft palate from moving backward and obscuring your airway. Without these obstructions, you should be able to breathe normally.⁶

Some CPAP devices have other features. For instance, they may have pressure settings that you can adjust. Some models also have heaters and humidifiers.³

A CPAP machine aims to decrease the number of breathing interruptions while you’re asleep. This means your sleep quality should improve. Reported benefits of CPAP include reduced snoring, less daytime sleepiness, and even enhanced mood in the short term.³

As for long-term benefits, CPAP machines may help lower blood pressure and reduce the risk of cardiovascular problems, such as heart disease and stroke. Over time and with consistent use, CPAP may improve memory and thinking as well.³

But for CPAP to work, you need to use the machine consistently — that is, every time you sleep (naps included) — at home or elsewhere. Unfortunately, about two-thirds of patients who’re prescribed CPAP never experience the benefits because they wind up discontinuing treatment, mostly as a result of side effects.^3,7

Side effects of CPAP

Most side effects of CPAP involve either the device’s mask, the pressurized air delivered by the machine, or microbial contamination.⁷

A poorly fitted CPAP mask can leave marks on the skin. Worse, it can cause rashes or ulcers, especially along the nose bridge. Ill-fitting masks can result in air leaks too. Such leaks have been associated with discomfort and poor sleep quality, not to mention noise that often bothers bed partners.⁷

Pressurized breathing with CPAP has been reported to cause nasal dryness, which can lead to nosebleeds. In addition, the pressurized air can dry out your mouth and throat. The upper airway dryness, in turn, can cause mild to moderate hoarseness of your voice.⁷

For some CPAP users, the pressurized air leads to a runny or congested nose. This happens because the air pressure can impair cilia (tiny hair-like structures in your nose), reducing clearance of mucus and trapped particles from your nose. Such dysfunction can eventually lead to diseases of the upper airway like sinusitis.⁷

If bacteria and viruses become trapped in CPAP machine parts, your risk of respiratory infections will be increased. Bacteria under the mask can make their way into the eyes too, possibly irritating or infecting them.⁷

Speaking of the eyes, CPAP can increase pressure inside of them at night. This higher pressure puts you at a greater risk of glaucoma (a disease that can make you blind by damaging your eye’s optic nerve).^7,8

Plus, the increased pressure induces mechanical stress on the nasal mucus membranes, promoting inflammation. Inflammation in the nose can obstruct breathing, which is an especially ironic side effect for a device that’s intended to treat obstructed breathing.⁷

The air coming from the CPAP machine can affect pressure in the middle ear too, resulting in ear pain and discomfort.⁷

Another possible side effect is aerophagy. This happens when the CPAP user swallows the pressurized air, which gets trapped in the gastrointestinal tract. The trapped air brings about abdominal discomfort, such as excessive burping and/or flatulence. Over time, aerophagy can contribute to gastroesophageal reflux disease (GERD).⁷

Some people experience claustrophobic feelings from the CPAP mask, the airflow from the CPAP machine, or both. This can happen even to people who don’t have any reaction to other confined situations, such as airplanes or elevators.⁷

Last but not least, long-term use of CPAP may damage your face and teeth. The force exerted by the mask has been found to hinder facial growth in young CPAP users who have had long-term CPAP therapy. What’s more, the forward movement of the tongue during CPAP use has been associated with shifting teeth. Meanwhile, tight chin straps in some machines can induce tooth chipping.⁷

Considering this long list of side effects, it’s no wonder that many CPAP users fail to use their machines as much as recommended. In fact, some patients stop using their devices for good.

CPAP adherence

Based on a review of 82 CPAP trials conducted over a 20-year period, the average patient used their CPAP machines for only 4.7 hours out of 7 hours of sleep time. The same review showed that patients also skipped using their devices for up to 3 nights a week.²

Overall, the review found a non-compliance rate of 34.1 percent. Plus, roughly 11 percent of the patients were unable to continue treatment over the trial period. It’s worth pointing out that these data were obtained from trials, which supposedly provide the best conditions for therapy success.²

Other studies have revealed that almost half of patients quit CPAP after a year’s treatment. Moreover, up to 15 percent of patients reject CPAP therapy after a single night of using the machine.⁹

Given that the effectiveness of CPAP is dependent on adherence, the low number of patients who consistently use their CPAP machines means that, for most people, the treatment isn’t working nearly as well as advertised.

Medical alternatives to CPAP

For OSA patients who can’t tolerate CPAP, there are other medical options. Of course, these alternatives each have their pros and cons too.

Oral appliances aim to prevent soft parts of your mouth from obstructing your airway. For instance, mandibular advancement devices (MADs), which cover your upper and lower teeth, pull your lower jaw and tongue forward. This way, MADs increase space for air flow in the back of your throat. These devices are cheap, silent, and simple to use compared to CPAP machines. But MADs are only effective for mild cases of OSA, and they also only work when the patient sleeps on their back.^10,11

Another type of oral appliance is the tongue retaining device (TRD). TRDs use suction to pull your tongue forward and keep it in place during sleep. These oral appliances may work better than MADs for people whose teeth aren’t very strong. However, studies suggest that TRDs can be uncomfortable to use.^10,11

Myofunctional therapy is another alternative to CPAP. This option involves exercises to strengthen weak muscles in your face, lips, tongue, and soft palate. By improving the tone and function of these muscles, myofunctional therapy can keep your airways open during sleep. It may also help correct the position of your tongue, preventing airway blockage. Myofunctional therapy is non-invasive and can be effective in the long run, but it can take many months of weekly hour-long sessions to see results.^10,12,13,14

The most invasive treatment option for OSA is surgery. Common surgical procedures involve moving certain parts of your face or mouth. For example, they can reposition your upper and lower jawbones, your tongue, or a bone in your neck.^10,15

Other procedures can remove a portion of the back of your tongue, some tissues in the back of your throat, or your tonsils. The size of certain bones in your nose could be reduced too.^10,15

In addition, surgery can involve inserting artificial parts into your mouth. Typically, the device inserted is a nerve stimulator for controlling tongue movement and thus, keeping your airway open.^10,15

Surgery for sleep apnea is the most expensive option. And like all surgeries, these come with risks, including excessive bleeding and various infections. More breathing problems could also result from surgery over time, defeating its original purpose.^15,16

Conclusion

CPAP therapy is the standard medical treatment for moderate to severe OSA. Multiple side effects, however, discourage patients from using their CPAP machines as often as they should. Almost 50 percent of patients stop CPA treatment altogether after a year. This is bad news, as you need to use the machine religiously for treatment to be effective.

Medical alternatives to CPAP include oral appliances, myofunctional therapy, and surgical procedures. But these options have their drawbacks too.

What about natural options? Most commonly recommended are losing weight, sleeping on your side, or avoiding alcohol. Unfortunately, like the medical options, these solutions work only sometimes or, for some people, not at all.

Addressing OSA for good without the side effects isn’t a lost cause, though. Discover a natural, painless, and long-lasting remedy for sleep apnea — sign up for the Snoring Diet Solution now.

References

Does CPAP Really Work for Sleep Apnea?

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