A sleep apnea device is usually a CPAP, a small pump that blows air at mild positive pressure through a mask into your airway so it cannot collapse. But it is not the only option. A mandibular splint, positional therapy and in certain cases surgery are genuine alternatives, and which one suits you depends on the severity and on where the problem sits.
That last part decides everything and appears on almost no supplier page.
Whoever sells a device rarely compares it fairly with the option they do not stock. So below are the four forms side by side, including what they do for the complaints men usually arrive here with.
What does a CPAP machine actually do?
A CPAP holds your airway open with air pressure. The machine blows air continuously through a hose and a mask, and that mild positive pressure stops the wall of your throat collapsing during sleep. It is not oxygen, it is ordinary room air under pressure.
It works well. Used correctly, the breathing stops largely disappear, and for moderate to severe sleep apnea it is the treatment with the strongest evidence behind it.
The problem is not the effect but the use. A mask on your face takes getting used to, and a share of people give up in the first months. That is also exactly why the alternatives matter: a splint you put in every night does more than a machine sitting in a cupboard.
For a plain-language Dutch explanation of sleep apnea and its treatment, Thuisarts is the best starting point.
What alternatives to CPAP are there?
Three count seriously: a mandibular advancement device, or splint, positional therapy, and surgery. The table sets them alongside CPAP, with what each does and who it is meant for.
| Form | What it does | Hassle | Mainly for |
|---|---|---|---|
| CPAP | Holds the airway open with air pressure | Mask and hose, every night | Moderate to severe apnea |
| Mandibular splint | Moves your lower jaw forward and makes room behind the tongue | Splint in the mouth, jaw adaptation | Mild to moderate apnea |
| Positional therapy | Stops you sleeping on your back | Strap or small vibrating device | Apnea occurring mainly on the back |
| Surgery | Removes or repositions tissue narrowing the passage | Procedure and recovery | Clear anatomical narrowing |
What stands out in that table: the hassle column is not the least important one. With a treatment you have to apply again every night, sticking with it counts as heavily as the effect per night.
Take two men who both have an AHI of 20. One gets a CPAP that drops his breathing stops to 3 an hour but which, a month in, he only puts on 2 nights a week. The other gets a splint that stalls at 9 an hour, but which he wears every single night. Counted across a week, the second man sleeps better.
Weight loss is deliberately absent, because it is not a device. It is however the best-evidenced measure that sits in your own hands, and it works alongside all four of the forms above.
Does a mandibular splint work as well as CPAP?
Not on the apnea index, but often on the end result. CPAP pushes the number of breathing stops down harder, but people wear a splint for more hours per night on average. Measured across a whole night, the outcomes therefore converge more than the raw figures suggest.
Pattipati and colleagues pooled the comparative studies in 2022. Their picture comes to the same thing: CPAP wins on the AHI, while the splint does better on adherence and on perceived daytime sleepiness than its reputation implies.
A splint should be fitted by a dentist or maxillofacial surgeon who specialises in them. An off-the-shelf device from a web shop is a different thing from a custom-made one, and the jaw joints are not a place to experiment.
Which advice follows at which severity depends on your AHI and your complaints. How you get those numbers is in sleep study.
Does positional therapy really help?
For a specific group, yes. If your sleep study shows the breathing stops occur mainly while you are on your back, then stopping yourself ending up on your back is a logical and surprisingly effective measure.
The modern version is a small device on your chest or neck that starts vibrating as soon as you roll onto your back. It does not wake you, you just turn over.
The old tennis-ball-in-a-sock works on the same principle and is free. It is simply less comfortable and people stick with it for less time.
Important detail: positional therapy only works if your apnea is genuinely position-dependent. You only know that after a recording in which body position was logged.
What does treatment do to your testosterone and erections?
Less than most men hope, and in a different way than expected. Zhang and colleagues pooled the studies on CPAP and testosterone in 2014 and found no convincing rise from CPAP alone. Weight loss did produce that rise.
That is an honest but uncomfortable answer. The machine repairs your nights, the belly fat keeps pulling on your hormones. Whoever tackles both does better than whoever picks one.
For erections the picture is more favourable. Li and colleagues looked in 2019 at CPAP and erectile dysfunction medication in men with sleep apnea and erection problems. Both improved erectile scores, and the combination did better than either alone.
What else is at play with erection problems is in erectile dysfunction and ED medications compared. The hormonal side is in low testosterone in men.
Which blood values run alongside treatment?
There is no fixed list, because it depends on your situation and on what your doctor wants to follow. There are values that logically move when your nights change, though, and those are worth recording beforehand.
Haematocrit is the first. It can run higher with sustained night-time oxygen dips and is a value that runs alongside anyway in men using testosterone. Beyond that, HbA1c and fasting glucose move with insulin sensitivity, and testosterone with the quality of your deep sleep.
The practical point: record a baseline before you start a treatment. Without a starting point you will not know in six months whether anything has changed.
That can be done with the male hormone panel. The individual values are on haematocrit, total testosterone and HbA1c.
If your blood pressure stays high, that deserves a separate conversation. The Dutch Heart Foundation, Hartstichting, lists sleep apnea among the factors associated with high blood pressure and heart rhythm disorders. More on that in high blood pressure in men.
What it comes down to
A sleep apnea device is a means, not an end. The best device is the one you actually use every night, and that is not the same one for everybody.
What bothers me most about this subject is how often the choice gets framed as CPAP or nothing. For mild to moderate apnea a mandibular splint is a serious option, and with position-dependent apnea a small vibrating device does surprisingly much.
Discuss the options with the doctor assessing your sleep study, and ask explicitly which form suits your AHI and your anatomy. Record your baseline values first, so you can see later what changed. The full picture is in sleep apnea in men.
Every blood test result includes a professional assessment from a BIG-registered doctor. For treatment decisions, discuss your results with your GP.
References
- Pattipati M, et al. Continuous positive airway pressure vs mandibular advancement devices in the treatment of obstructive sleep apnea. Cureus, 2022. PMID 35251830
- Zhang XB, et al. Efficacy of continuous positive airway pressure on testosterone in men with obstructive sleep apnea: a meta-analysis. PLoS One, 2014. PMID 25503098
- Li Z, et al. The effect of CPAP and PDE5i on erectile function in men with obstructive sleep apnea and erectile dysfunction. Sleep Medicine Reviews, 2019. PMID 31715462
- Kuna ST, et al. Long-term effect of weight loss on obstructive sleep apnea severity in obese patients with type 2 diabetes. Sleep, 2013. PMID 23633746
Author
Caliberhealth
Dr. Naimi, BIG-registered physician, oversees the medical standards behind our content and assessments. Read our medical policy
