For many of the UK’s 8 million sleep apnoea sufferers (and their partners) the CPAP machine is a noisy and uncomfortable nightly horror. But many don’t know about these simple, life-changing alternatives. And you can get them on the NHS

It causes snoring at night and leaves people exhausted by day, but could a new generation of treatments – from a daily pill to a stick-on patch worn under the chin – finally transform how obstructive sleep apnoea (OSA) is treated?

Affecting about eight million people in the UK, obstructive sleep apnoea (OSA) occurs when throat muscles relax too much during sleep, cutting off breathing for seconds at a time and temporarily starving the brain of oxygen.

This disrupts sleep and is also linked to a greater risk of heart disease and stroke over time, as repeated drops in oxygen can cause surges in blood pressure.

For decades, the gold-standard treatment has been a continuous positive airway pressure (CPAP) machine, which pumps air through a mask worn over the nose and mouth to hold the airway open.

It’s highly effective, but more than half of patients stop using CPAP within a year because they find the mask uncomfortable, claustrophobic or it keeps their partner awake. However, there are now some realistic alternatives.

One popular option is a custom-made mouthguard fitted by a dentist. Called a mandibular advancement splint, it holds the lower jaw slightly forward during sleep to keep the airway open.

‘A mandibular splint produces a 50 per cent or greater reduction in breathing pauses in around 50 to 60 per cent of patients,’ says Dr Amanda Sathyapala, an associate professor at the National Heart and Lung Institute at Imperial College London. ‘For people with mild sleep apnoea, that often means their readings go back to normal, and they feel less sleepy during the day.’

If you’re not eligible for this on the NHS, custom-made devices from a private dentist cost £700 to £1,500. Here are five other promising treatments if you’ve failed with CPAP.

The stick-on plaster

A small patch worn under the chin is a new, non-invasive way to keep the airways open.

Developed by King’s College London, the Zeus device delivers electrical pulses to the hypoglossal nerve (which controls the muscles of the tongue), helping to stop the airway collapsing.

Patients wear a new adhesive patch each night – the chip that generates the pulses clips on to the patch (and needs to be recharged daily).

A study in eClinicalMedicine in 2023 found that in around half of the 56 patients who wore the patch, breathing interruptions fell back to within the normal range – fewer than five an hour.

There is now a major sleep apnoea trial under way to test the device in NHS patients. If successful, it could be prescribed across the UK by 2027.

A consumer version of Zeus for snoring is available privately, costing around £220. However, it is not approved or marketed as a treatment for OSA.

Nerve implants

For severe sleep apnoea (when people stop breathing more than 30 times an hour), another option is a small battery-operated device inserted under the skin in the upper chest.

It sends electrical signals to stimulate the tongue and throat muscles.

Fitted with the patient under general anaesthetic, two thin wires are tunnelled from the battery and generator in the chest: one wire is passed up through the neck and connected to an electrode via an incision in the jaw and then wrapped around the hypoglossal nerve.

The other wire is attached to a breathing sensor implanted between the ribs which detects pressure changes as the patient tries to breathe in.

The device then times the electrical pulse that moves the tongue forward with each breath.

The Inspire device reduced breathing interruptions by 50 per cent in about two-thirds of patients, reported The New England Journal of Medicine in 2014.

While it’s been available to NHS patients since 2023, it’s restricted to those with moderate to severe OSA who have a BMI of under 32, says Dr Sathyapala.

Patients also need the right sort of airway collapse: the size and position of the soft palate and tongue can vary individually.

For instance, in some people, the throat collapses from side to side during sleep, while in others it shuts from front to back. The implant works only for the second group. ‘The only way to tell which kind a patient has is to sedate them and send a tiny camera down the throat to see what happens,’ says Dr Sathyapala.

So far, fewer than 100 NHS patients have been fitted with Inspire since the rollout began in 2023. Privately, it costs around £40,000 for the surgery.

A newer alternative, called Genio and roughly the size of a 50p coin, is inserted through a single 6cm-sized incision under the chin. It stimulates two nerves that control the tongue.

It doesn’t use a battery – instead the patient sticks a small adhesive patch under their chin at bedtime; an activation chip (a little bigger than a £1 coin, weighing 12g) clips on to the patch and wirelessly transmits power through the skin to the implant. The chip is removed and recharged each morning.

Aimed at adults with moderate to severe obstructive sleep apnoea, Genio was fitted to the first two NHS patients in December 2024.

In a study, published in the Journal of Clinical Sleep Medicine in 2025, around 60 per cent of patients had their breathing interruptions cut by at least half after a year.

It’s approved for NHS use but currently only available at a few specialist centres. Privately, it costs around the same as the Inspire device.

Weight-loss jabs

For some patients, the answer may be losing weight. Extra fat around the neck and throat can press on the airway, making it more likely to close during sleep.

The weight-loss jab tirzepatide (brand name Mounjaro) was found to cut breathing interruptions by about half in obese adults with moderate to severe OSA, reported The New England Journal of Medicine in 2024.

US regulators have now approved tirzepatide for OSA in adults with obesity – the first weight-loss drug approved for it anywhere in the world.

But in many patients, sleep apnoea is linked to the shape of the jaw or throat, or the muscles that relax at night, so weight loss alone may not be enough.

A daily pill

A pill taken daily, called AD109, may be another option – it works by keeping the tongue and throat muscles more active during sleep.

The pill combines atomoxetine (already used for ADHD) and aroxybutynin (a newer drug related to one used for bladder problems) – the combination is thought to boost the nerves that keep the tongue and throat muscles toned during sleep.

The pill cut breathing interruptions by 45 per cent after four weeks in adults with mild to severe OSA, in a small study published in the American Journal of Respiratory and Critical Care Medicine in 2023. Larger trials are ongoing.

The manufacturer, Apnimed, plans to seek US approval this year; it’s thought it will become available in the UK in 2027.

Smartphone app

One of the most immediate changes may not be a new gadget, but better support for people prescribed CPAP to help them stick with the treatment.

Researchers at Imperial College London are developing a smartphone app, CPAP Buddy, to help people get through the difficult first weeks with tips on dealing with common problems – from air leaks to dry mouth caused by mouth breathing and lapses in motivation.

Dr Sathyapala, who is leading the project, says that CPAP remains the only treatment that can prevent all breathing pauses, as it’s the only one to counteract the disrupted airflow directly.

‘The sleep field has spent 30 years trying to develop interventions to improve CPAP use,’ she says.

‘If they work, and patients engage with them, the benefit is likely to be larger than that of any one new non-CPAP therapy.’