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Sleep Apnea

Sleep apnea means your breathing stops and starts again, many times, while you sleep. It is common, it is often missed, and untreated it is linked to heart disease, stroke, high blood pressure and drowsy-driving crashes. A breathing device (CPAP) is the most common treatment, and there are other options — but chiropractic, acupuncture, herbs and massage are not proven treatments.

Call 911 right away for any of these:

  • Chest pain, heaviness or discomfort in the chest, pain in an arm, the back, neck or jaw, shortness of breath, or heavy sweating for no reason. Call even if you are not sure it is a heart attack, and don’t drive yourself (NHLBI). Untreated sleep apnea raises the risk of heart attack and stroke (NHLBI).
  • Signs of a stroke: sudden confusion or trouble speaking, sudden numbness or weakness (especially on one side), sudden severe headache with no known cause, sudden trouble seeing, or sudden trouble walking or loss of balance. Call an ambulance rather than driving (NHLBI). See our stroke guide.
  • Very high blood pressure with symptoms. A reading above 180/120 is too high and needs medical attention. If a second reading is also that high and you have a sudden severe headache, trouble breathing, sudden severe pain in the abdomen, chest or back, numbness or weakness, a sudden change in vision or trouble talking, call 911 and don’t wait to see if it comes down. With no symptoms, wait 5 minutes and check again; if it is still high, call your provider (NHLBI). Sleep apnea can make blood pressure hard to control (NHLBI). See our blood pressure guide.

See a doctor soon (don’t wait for it to pass) if:

  • Someone has seen your breathing stop and start, or you wake up choking, gasping or snorting. Sleep apnea can be serious if it isn’t diagnosed and treated (NHS).
  • You feel very sleepy when you drive or nod off at the wheel or at work. Untreated sleep apnea makes it hard to pay attention and make decisions while driving and can cause road accidents; do not drive if you feel tired or sleepy (NHLBI).
  • You snore loudly and are tired all day. Not everyone who snores has sleep apnea, but loud snoring with daytime sleepiness is a reason to ask (MedlinePlus, NHS).
  • You have sleep apnea and need surgery or pain medicine afterward. Tell your provider, who may need to take extra steps to keep your airway open (NHLBI).

What is sleep apnea?

Sleep apnea is a common condition in which your breathing stops and restarts many times while you sleep, which can keep your body from getting enough oxygen (NHLBI). The pauses can last from a few seconds to minutes and may happen 30 times or more an hour; breathing often restarts with a snort or choking sound (MedlinePlus). The FDA describes an “apnea” as a pause of at least 10 seconds, and says obstructive sleep apnea is diagnosed when there are at least five pauses an hour. Each time, your brain wakes you enough to take a few breaths but not enough to remember it in the morning — so you can feel exhausted without knowing why (FDA).

It is not rare. In one estimate from U.S. data for 2007–2010, about 13% of men and 6% of women aged 30 to 70 had moderate to severe obstructive sleep apnea (USPSTF statement, 2022). It is also common in people with other heart and blood-vessel conditions: an American Heart Association statement reports sleep apnea in as many as 40% to 80% of people with high blood pressure, heart failure, coronary artery disease, pulmonary hypertension, atrial fibrillation or stroke, and says it is often under-recognized and undertreated in cardiovascular practice (AHA statement, 2021).

Two types: obstructive and central

  • Obstructive sleep apnea (OSA) is the most common type. The upper airway becomes blocked many times during sleep, reducing or stopping airflow (NHLBI). Usually the tongue muscles, soft palate or parts of the throat relax too much and block the airway (FDA).
  • Central sleep apnea is less common. The brain doesn’t send the signals needed to breathe, because of a health condition that affects how the brain controls the airways and chest muscles (NHLBI, FDA). Heart failure, stroke, amyotrophic lateral sclerosis and myasthenia gravis can raise the risk, as can opioid pain medicines used long term or opioid use disorder (NHLBI). Central sleep apnea can also be caused by high altitude (AASM guideline, 2025); the NHLBI says travel to altitudes above 6,000 feet can cause sleep apnea symptoms for a few weeks (NHLBI).

The two types need different care, which is one more reason to get a proper sleep study rather than guess.

Signs to watch for

While asleep, people with sleep apnea may have breathing that starts and stops, frequent loud snoring (more common in men) and gasping for air. You may not know unless someone tells you (NHLBI). Waking up a lot and making snorting or choking noises are also common (NHS). By day, you may notice:

  • Sleepiness and tiredness that make it hard to learn, focus and react, plus trouble concentrating and mood swings.
  • A dry mouth or a headache on waking.
  • Waking often at night to urinate, and sexual problems or a lower sex drive (NHLBI, NHS).

Symptoms can look different in women, who more often have morning headaches, insomnia, tiredness, anxiety, depression and frequent waking, and may not have classic symptoms such as snoring (NHLBI). Fatigue and headache are listed as more common in women, and snoring as more common in men (NHLBI). If this sounds like you, a bed partner or family member can help: ask them to watch for pauses and gasps (NHS).

What raises the risk?

For obstructive sleep apnea, the NHLBI lists age (fatty tissue can build up in the neck and tongue as we age), obesity, a large tonsil, neck or tongue, hormone and endocrine problems (including polycystic ovary syndrome, low thyroid hormone, or high insulin or growth hormone), family history and genetics, heart or kidney failure (fluid can build up in the neck), alcohol and smoking, and male sex (NHLBI). The NHS adds sleeping on your back and chronic obstructive pulmonary disease (NHS). If you have a thyroid problem, see our thyroid guide.

Some risks can be changed. The NHLBI says you may be able to prevent obstructive sleep apnea with a heart-healthy diet, a healthy weight, quitting smoking and limiting alcohol (NHLBI).

Why it matters

Untreated sleep apnea leaves you short of good sleep, which can cause problems with concentrating, remembering things, making decisions and controlling your behavior. It also causes low oxygen levels during sleep, and the effort of restarting breathing many times a night can damage organs and blood vessels. The NHLBI says these factors may raise your risk for atrial fibrillation, atherosclerosis, difficult-to-control high blood pressure, heart attack, heart failure, pulmonary hypertension, stroke, type 2 diabetes, acid reflux, chronic kidney disease, dementia in older adults, certain eye problems, metabolic syndrome, pregnancy complications, some cancers and worsening asthma attacks (NHLBI). The FDA likewise says chronic untreated obstructive sleep apnea may raise the risk of heart attack, stroke, type 2 diabetes, glaucoma and some cancers (FDA). These are links found in research; having sleep apnea does not mean you will develop any of them. For related guides, see our heart guide, stroke guide, blood pressure guide, diabetes guide, acid reflux guide and sleep problems guide and narcolepsy guide. A snoring guide is planned.

Sleepiness is also a safety problem. A review of studies of commercial drivers concluded that people with sleep apnea are clearly at increased risk of crashing, and that untreated sleep apnea is a significant contributor to motor vehicle crashes (systematic review, 2009).

Should everyone be screened?

Not necessarily. The U.S. Preventive Services Task Force concluded that the evidence is insufficient to weigh the benefits and harms of screening the general adult population, including adults with no symptoms or with symptoms nobody has recognized yet (USPSTF statement, 2022). That is different from having symptoms: if you snore loudly, gasp at night or are sleepy by day, ask for an evaluation. The American Academy of Sleep Medicine recommends that questionnaires and prediction tools not be used to diagnose sleep apnea without a sleep study (AASM guideline, 2017). See Conventional medicine below.

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) A history and exam, then a sleep study (at home or in a sleep lab) to confirm the type and severity. Treatment may include a breathing device (CPAP and relatives), a custom mouthpiece from a dentist, weight loss, sleeping on your side, a weight loss medicine approved for some adults with obesity, mouth and throat exercises, or surgery. Central sleep apnea is treated by addressing its cause. Medicare Part B covers sleep studies for people with signs and symptoms of sleep apnea and a 12-week CPAP trial, with 20% coinsurance after the deductible. The Pricer lists online home sleep apnea tests at about $99–$464.50 (median $189), a hospital overnight study at a median of about $2,949, most new CPAP or auto-adjusting machines at about $500–$1,600, and an implanted nerve stimulator at about $30,000–$40,000 or more before insurance. CPAP is the standard treatment and works well when it is used. Many people need weeks of fine-tuning and support to stay with it. Other options suit milder cases or people who can’t use CPAP. Treatment is long term, with regular checkups.
Chiropractic No established role as a treatment for sleep apnea. A chiropractor can encourage you to see a doctor if you snore, gasp or are very sleepy, and support healthy habits; diagnosis needs a sleep study. About $55–$100 for a self-pay follow-up visit and $90–$200 for a first visit. Medicare Part B covers only certain chiropractic services. We found little research: one published case report in which chiropractic care was combined with mouth exercises, weight loss and other changes. It can’t show that chiropractic care helped. Don’t put off a sleep study.
Acupuncture Needle sessions (sometimes with electrical stimulation) offered for sleep apnea, used alongside — never in place of — a proven treatment. About $125–$230 for a first private visit and $90–$185 for follow-ups; community clinics about $50–$90. Medicare covers acupuncture only for chronic low back pain. A review of 9 trials found small average improvements, but the evidence quality was low to very low. A larger comparison found positive airway pressure worked best, with only weak evidence for acupuncture. Not a substitute for CPAP.
Herbal medicine No herb or supplement is an established treatment for sleep apnea. Reviews of Chinese herbal formulas exist, and sedating herbs raise a safety question. Cost estimate being researched. A 2024 review of Chinese herbal medicine trials reported lower event counts, but we read only its abstract. NCCIH says there is very limited research on other complementary approaches. “Natural” doesn’t mean safe; ask your doctor and pharmacist before you add anything.
Massage therapy Relaxing bodywork for comfort. General massage is not a treatment for sleep apnea. About $70–$90 a month for a membership at one national chain (Massage Envy), which includes one 60-minute session a month; each franchise sets its own rates. One small study of a Chinese massage technique (tui na) in people with moderate to severe sleep apnea reported only a small change in breathing events. Massage is pleasant and low risk, but it doesn’t replace testing or treatment.
MBHA Wellness Coach Everyday habits that help: working toward a healthy weight with your doctor, regular activity, side sleeping, less alcohol, no smoking, a steady sleep routine — plus help sticking with CPAP and keeping appointments. Cost estimate being researched. Lifestyle changes may improve sleep apnea; one review found weight loss through diet and exercise may work best for men with moderate to severe disease. They may not make it go away, and they support — not replace — a sleep study and medical care.

Approach 1 of 6

Conventional medicine (AMA)

Conventional care starts by confirming that you have sleep apnea, which type it is and how serious it is, then matching treatment to you. Your provider will ask about symptoms, risk factors and family history (NHLBI). The options below are the main ones. Further sections after the approaches cover weight and lifestyle, heart, brain and driving, using CPAP, alcohol and sedating medicines, and women and children.

1. Getting tested: home or lab sleep study

Your provider may send you to a sleep specialist or a sleep center for a sleep study, which shows which type of sleep apnea you have and how serious it is (NHLBI). It can be done in a sleep lab or at home (FDA). Severity is based on the average number of times an hour your breathing pauses, called the AHI. On the NHS scale, 5 to 14 is mild, 15 to 30 is moderate and over 30 is severe (NHS). Other tests may check for causes such as thyroid problems or polycystic ovary syndrome, and your provider will review medicines that affect breathing, such as opioids (NHLBI).

  • Which test? The American Academy of Sleep Medicine guideline recommends an in-lab study (polysomnography) or a home sleep apnea test with a technically adequate device for uncomplicated adults whose signs suggest moderate to severe obstructive sleep apnea. It recommends against using questionnaires or prediction tools alone. If a home test is negative, inconclusive or technically inadequate, it recommends a lab study. It also recommends a lab study rather than a home test for people with significant heart or lung disease, possible breathing-muscle weakness from a neuromuscular condition, breathing that is too shallow (hypoventilation), regular opioid use, a history of stroke or severe insomnia (AASM guideline, 2017).
  • Medicare. Medicare Part B covers Type I, II, III and IV sleep tests and devices if you have clinical signs and symptoms of sleep apnea. After the Part B deductible you pay 20% of the Medicare-approved amount. Medicare covers Type I tests only when they are done in a sleep lab facility, and your doctor or provider must order the test (Medicare.gov).

2. Positive airway pressure (CPAP, APAP and BPAP)

A positive airway pressure (PAP) machine is the most common treatment for sleep apnea (NHLBI). The FDA calls CPAP the standard treatment: air pressure delivered through a mask over your nose, or your nose and mouth, keeps the airway open (FDA). Types include:

  • CPAP gives constant air pressure.
  • APAP adjusts the pressure automatically during sleep.
  • BPAP (bilevel) gives a different pressure when you breathe in and out; the FDA says it may be prescribed when the constant pressure of CPAP can’t be tolerated (NHLBI, FDA).

What the research says:

  • The AASM guideline recommends PAP over no therapy for adults with excessive sleepiness (strong), suggests it for impaired sleep-related quality of life and for people who also have high blood pressure (conditional), recommends starting with either home auto-adjusting PAP or in-lab titration for people without major other illness, and suggests CPAP or APAP over BPAP for routine treatment (AASM guideline, 2019). The American College of Physicians (2013) recommends CPAP as initial therapy (strong recommendation, moderate-quality evidence) (ACP guideline, 2013).
  • The NHLBI lists the benefits of CPAP as better sleep, less snoring and sleepiness, and in the long run, help preventing or controlling high blood pressure, a lower stroke risk and better memory and thinking (NHLBI).
  • A 2025 comparison of non-drug treatments across 197 trials found PAP (alone or with lifestyle changes) improved breathing events, sleepiness and quality of life more than the other treatments, though it was not always well tolerated; the authors had low confidence in the estimates because adherence was rarely measured (network meta-analysis, 2025).

Side effects can include congestion, dry eyes or mouth, nosebleeds or a runny nose. If you get stomach discomfort or bloating, stop using the machine and contact your provider (NHLBI). See Using and caring for CPAP below for practical help. Whether CPAP prevents heart attacks and strokes is less settled; see Heart, brain and driving below.

3. Oral appliances (made by dentists)

If you don’t want to use or can’t tolerate CPAP, your provider may prescribe an oral appliance, often through a dentist or orthodontist who custom-fits it. Mandibular repositioning mouthpieces cover the upper and lower teeth and hold the lower jaw forward; tongue-retaining devices hold the tongue forward (NHLBI). They are prescription-only; a dentist takes impressions of your teeth (FDA).

  • A guideline from the American Academy of Sleep Medicine and the American Academy of Dental Sleep Medicine suggests that a qualified dentist use a custom, adjustable appliance rather than an off-the-shelf device; recommends that sleep physicians consider oral appliances for adults who can’t tolerate CPAP or prefer another option; and suggests dental follow-up for bite changes and follow-up sleep testing to confirm it works (AASM and dental sleep medicine guideline, 2015).
  • The American College of Physicians (2013) gave a weak recommendation (low-quality evidence) for mandibular advancement devices as an alternative for people who prefer them or have problems with CPAP (ACP guideline, 2013). In the 2025 comparison, these devices improved breathing events and quality of life less than PAP, and less for moderate to severe cases (network meta-analysis, 2025).
  • Plan to see your dentist after 6 months and then every year; some discomfort after an adjustment is common (NHLBI).

The FDA also describes other devices: nasal valves that keep pressure in the airway, a tongue-retaining oral device, and a mouthpiece that gently stimulates the tongue muscle for 20 minutes a day while you are awake (FDA; the NHLBI describes the same kind of tongue stimulator, NHLBI).

4. Sleeping on your side

If your apnea happens mostly when you lie on your back (“positional” sleep apnea), a special pillow or bed device, or a small device worn on the neck or chest that vibrates until you turn over, may help mild to moderate cases. Some people try homemade methods first (FDA). A Cochrane review of 8 small, short trials (323 people) found that CPAP lowered breathing events more than positional therapy, while positional therapy beat doing nothing and may have better adherence than CPAP; the evidence was low to moderate certainty (Cochrane review, 2019).

5. Weight, and a medicine for weight loss

Weight matters for many people; the details are in Weight and lifestyle below. The FDA approved a weight loss medicine, given by injection under the skin, in December 2024 for adults with moderate to severe obstructive sleep apnea and obesity, to be used with a reduced-calorie diet and more physical activity. The FDA says it was approved based on two randomized, placebo-controlled studies of 469 adults without type 2 diabetes, and that the improvement in sleep apnea is likely related to weight loss. The FDA listed side effects including nausea, diarrhea, vomiting, constipation and stomach pain, plus warnings about the thyroid, pancreas, gallbladder, kidneys, eyes and mood (FDA announcement, 2024). In the published trials, the average number of breathing events an hour fell by about 25 with the drug and about 5 with placebo in people not using PAP, and by about 29 versus 5.5 in people already using PAP, starting from an average of about 50; the studies were funded by the drug’s maker (trial report, 2024). An earlier FDA consumer page (February 2024) noted that no drugs had yet been approved to treat sleep apnea itself and that wakefulness medicines can help daytime sleepiness in some CPAP users but do not fix the nighttime breathing problem (FDA). The NHLBI asks you to tell your provider about any personal or family history of depression, thyroid tumors, kidney disease or diabetic retinopathy (NHLBI). Whether it is right for you is a decision for you and your doctor.

6. Surgery

If other treatments don’t work, your provider may suggest surgery to correct the problem that is causing your sleep apnea (NHLBI). The NHLBI lists these categories (NHLBI):

  • Hypoglossal nerve stimulation: a device implanted under the skin of the chest connects to the nerve under the tongue to keep the airway open. The FDA describes it as a pacemaker-like implant placed in an outpatient procedure (FDA). In a 2014 study of 126 people who had trouble with CPAP, the median number of breathing events an hour fell from 29.3 to 9.0 after 12 months, and procedure-related serious problems occurred in under 2%; it was an uncontrolled study funded by the device maker (study, 2014).
  • Tonsil removal.
  • Surgery to remove tissue from the mouth and throat to enlarge the airway. A 2019 review of 11 long-term studies of one common version, uvulopalatopharyngoplasty, found the number of breathing events an hour fell by an average of 15.4 (46%), though the benefit was smaller than in the first 3 to 12 months (meta-analysis, 2019).
  • Upper or lower jaw advancement. A 2016 meta-analysis of 45 studies found an average fall of about 80% in breathing events, in a group of whom nearly three in four had already had other sleep apnea surgery. The authors call it an invasive option (meta-analysis, 2016).
  • Weight loss (bariatric) surgery if obesity contributes and other treatments don’t work. A 2023 analysis of 32 studies (2,310 people) found large average drops in breathing events and a remission rate of about 65%; the authors noted that sleep apnea is not caused by weight alone (meta-analysis, 2023).

The FDA reminds us that any surgery has risks and some treatments suit mild cases while others suit severe cases, so talk through all your options first (FDA).

7. Mouth and throat exercises

Exercises for the mouth and face (orofacial or myofunctional therapy) may help adults and children by strengthening the tongue and muscles of the lips, upper airway and face (NHLBI). A Cochrane review of 9 small trials (347 people) found that, compared with sham therapy, it probably reduces daytime sleepiness and may lower breathing events, but the evidence ranged from moderate to very low certainty, no trial looked at accidents or heart disease, and more studies are needed. In the one small study that compared it with CPAP, CPAP lowered breathing events more (Cochrane review, 2020).

8. Central sleep apnea

A 2025 AASM guideline says treatment should focus on the conditions contributing to the central apneas and on how the person feels, not only on eliminating events. It suggests several options, each with low or very low certainty of evidence: CPAP, a bilevel machine with a backup rate, adaptive servo-ventilation, low-flow oxygen in some situations, a medicine in some situations, and nerve stimulation of the phrenic nerve, which is invasive and costly and may be best considered after other treatments. For heart failure with reduced ejection fraction, adaptive servo-ventilation should be limited to experienced centers with close follow-up (AASM guideline, 2025).

9. Follow-up

After a diagnosis, plan regular checkups to make sure treatment is working. You may need to repeat your sleep study, especially if you gain or lose a lot of weight (NHLBI). The AASM adds that follow-up should include troubleshooting and review of objective use data (AASM guideline, 2019).

What it costs

  • Sleep tests. A survey of 15 online providers found physician-reviewed home sleep apnea test packages priced at $99 to $464.50, with a median of $189. One analysis of hospital cash prices found a median of about $2,949 for an overnight study. Insurance, doctor fees and follow-up testing change the bill, and some low-priced kits charge a fee (one listing, $250) if the device isn’t returned (The Pricer).
  • CPAP. The Pricer reports most new CPAP and auto-adjusting machines at about $500 to $1,600, and bilevel machines at about $1,700 to $3,000, before a mask and replacement supplies. Medicare Part B may cover a 12-week CPAP trial for obstructive sleep apnea, then continued coverage if you see your provider in person and the therapy is helping. After the deductible you pay 20% of the Medicare-approved amount for the rental and supplies, and Medicare pays the supplier to rent a machine for 13 months, after which you own it (The Pricer, Medicare.gov).
  • Implanted nerve stimulator. The Pricer cites a total of about $30,000 to $40,000 or more before insurance, and says insurance coverage criteria can be narrower than the FDA labeling (The Pricer).
  • Other treatments. Oral appliances, surgery, the weight loss medicine and exercises: cost estimate being researched. Ask your plan what it covers.

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractic care is not an established treatment for sleep apnea, and it can’t replace a sleep study, CPAP or other proven care. Sleep apnea is caused by a blocked upper airway or by problems with how the brain controls breathing (NHLBI), and we did not find research showing that spinal adjustments change either.

What we found

We found little research. The one item that turned up was a single case report of one man with obesity who had used CPAP for over 5 years. Over 90 days he received chiropractic adjustments together with mouth and tongue exercises, nutrition changes, posture correction and regular exercise; his breathing events per hour fell and he lost 40 pounds. The authors concluded that the combination was followed by improvement (case report, 2023). Because so much changed at once, including weight loss, a case report can’t show that the adjustments did anything. Beyond this report we found little research.

How a chiropractor can help safely

  • Encourage you to get tested if you snore loudly, gasp or choke at night, or are sleepy by day (NHLBI).
  • Support the habits that do help — a healthy weight, regular activity, less alcohol and not smoking (NHLBI).
  • If you have been diagnosed, work alongside your sleep doctor, not instead of them. Please don’t stop CPAP or another prescribed treatment because of a claim you read.

What it costs

The Pricer lists about $55 to $100 for a self-pay follow-up visit and $90 to $200 for a first appointment (The Pricer). Medicare covers only spinal adjustments by a chiropractor to correct a subluxation, and does not cover other services a chiropractor orders (Medicare.gov).

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Acupuncture is sometimes offered for sleep apnea. The research so far is small and weak, and acupuncture should not stand in for a proven treatment.

What the research says

  • A 2020 review of 9 randomized trials (584 people) of acupuncture and electroacupuncture found average reductions in breathing events (about 6 an hour) and in a sleepiness score, and higher lowest oxygen levels. The authors called for high-quality trials, and noted that the quality of the evidence was mainly low to very low; the sleepiness result reversed in a sensitivity analysis (systematic review, 2020).
  • NCCIH describes a 2020 review of the same size (9 studies, 584 people), notes that three studies looked at safety and none reported side effects from acupuncture, and says there is very limited, if any, research on other complementary approaches (NCCIH).
  • The 2025 comparison of 25 non-drug treatments found that acupuncture might improve apnea-related outcomes, but the evidence was weak, and that PAP did better than all the other treatments (network meta-analysis, 2025).

To put the numbers in context, a difference of about 6 events an hour is much smaller than the fall seen in the CPAP group of a large trial, where the average fell from 29.0 to 3.7 events an hour during follow-up (SAVE trial, 2016). These are different studies in different people, so this is only a rough comparison, but it shows why acupuncture is not a stand-in for CPAP.

If you try it

Keep your sleep study, your CPAP or other treatment, and your checkups. Tell your acupuncturist about your sleep apnea diagnosis and your medicines. Let your sleep doctor know you are trying it.

What it costs

The Pricer lists about $125 to $230 for a first private visit and $90 to $185 for follow-ups, with community acupuncture clinics at about $50 to $90 (The Pricer). Medicare covers acupuncture only for chronic low back pain (Medicare.gov).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

No herb or supplement is an established treatment for sleep apnea. The NCCIH says there is very limited, if any, research on complementary approaches for obstructive sleep apnea other than acupuncture, and advises caution with any sleep product, including dietary supplements and homeopathic remedies: find out about side effects and the risks of combining products, and keep in mind that “natural” does not always mean safe (NCCIH).

What we found

A 2024 systematic review of Chinese herbal medicine for obstructive sleep apnea included 58 studies (4,590 people). In 7 studies, herbal formulas lowered breathing events by about 7 an hour more than placebo, and 28 studies suggested herbs plus CPAP lowered them by about 5 an hour more than CPAP alone. The authors concluded that Chinese herbal medicine could be a viable option. We read only the abstract, which does not describe the herbs used, their safety or how well the studies were done, so we can’t judge the quality (systematic review, 2024). It is a signal for researchers, not a reason to skip CPAP or a sleep study.

A safety point about sedating products

Medicines and aids that slow or lessen breathing can contribute to sleep apnea, and the FDA advises talking to your doctor before starting or stopping any medicine (FDA). NCCIH notes that kava and valerian are said to have sedative properties; kava has been linked to liver injury that is sometimes serious or even fatal (NCCIH). We found little research on whether herbal sleep aids affect sleep apnea, so we can’t say. If you have sleep apnea, ask your doctor and pharmacist about any sleep or relaxation supplement.

What it costs

Cost estimate being researched.

Approach 5 of 6

Massage therapy

Massage is not a treatment for sleep apnea. A relaxing massage may feel good and help you unwind before bed, but it does not open a blocked airway or replace a sleep study or CPAP.

What we found

We found little research. The main item was one small study of tui na, a traditional Chinese therapeutic massage, in 31 people with moderate to severe sleep apnea. Each person had about 15 minutes of treatment twice a week for 10 weeks; only 20 completed the course. The average number of breathing events an hour changed from 43.8 to 37.8, which is still in the range the NHS calls severe. Snoring, daytime sleepiness and quality-of-life scores improved. The authors called for a controlled study (tui na study, 2017; severity ranges from NHS). This is early information and can’t show that massage treats sleep apnea.

A note on mouth and throat exercises

Exercises for the tongue, throat and face (myofunctional therapy) are a different thing from massage and have been studied more (see Conventional medicine). Ask your sleep doctor or dentist whether a referral to a therapist trained in these exercises makes sense for you.

What it costs

One national chain (Massage Envy) lists membership at about $70 to $90 a month, which includes one 60-minute session a month; each franchise sets its own rate (The Pricer).

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

An MBHA Wellness Coach is not a medical provider and can’t diagnose or treat sleep apnea. A coach can help you act on a diagnosis: build healthy habits, stay with treatment and keep appointments.

What a coach can help with

  • Weight, movement and food. The NHLBI says healthy lifestyle changes can be very effective: regular physical activity, healthy sleeping habits, a healthy weight, less alcohol and caffeine, and quitting smoking (NHLBI). The American College of Physicians recommends that all overweight and obese people with sleep apnea be encouraged to lose weight (strong recommendation, low-quality evidence) (ACP guideline, 2013).
  • Sticking with CPAP. A coach can cheer you on, help you troubleshoot the mask routine, and remind you to call your provider about problems. The AASM suggests education and behavioral support when starting PAP (AASM guideline, 2019).
  • Sleeping on your side, evening routines and alcohol. See Weight and lifestyle and Alcohol and sleeping pills below.
  • Getting tested. If you or a partner notice pauses, gasping or heavy sleepiness, a coach can encourage you to talk to a doctor.

What the research says

A 2019 review of 13 randomized trials and 22 uncontrolled studies (1,420 people) found that lifestyle programs — diet, exercise, sleep habits and quitting tobacco or alcohol — were linked to improvements in breathing events and sleepiness, and that programs aimed at weight loss through diet and exercise may be the most effective for men with moderate to severe disease (meta-analysis, 2019). The FDA cautions that these changes may help but may not make sleep apnea go away entirely (FDA).

What it costs

Cost estimate being researched.

Another approach

Weight and lifestyle

The NHLBI says healthy lifestyle changes can be very effective in treating sleep apnea, and your provider may talk with you about making them for life (NHLBI).

  • Weight. People with obesity can have extra fat deposits in the neck that block the upper airway, and keeping a healthy weight can help prevent or treat sleep apnea caused by obesity (NHLBI). The NHS suggests trying to lose weight if you are overweight (NHS). See the weight loss medicine and surgery notes in Conventional medicine.
  • Activity. Regular exercise can improve symptoms and helps you keep to a healthy weight (NHS).
  • Sleeping position. Your provider may suggest sleeping on your side rather than your back to help keep the airway open (NHLBI). The NHS suggests taping a tennis ball to the back of your sleepwear, or using a special pillow or bed wedge (NHS).
  • Smoking. Smoking can inflame the upper airway and raises the risk (NHLBI).
  • Sleep habits. A dark, quiet bedroom and a regular bedtime and waking time (NHS). If you also have insomnia, see our sleep problems guide.

The NHS says these steps may be all you need if your sleep apnea is mild (NHS). The FDA says they may help improve it but may not make it go away entirely (FDA).

Another approach

Heart, brain and driving: what treatment does and doesn’t show

Because sleep apnea is linked to heart attack, stroke and high blood pressure, people often ask whether treating it prevents them. The honest answer is that CPAP clearly helps sleepiness and safety, and the heart and stroke question is still being studied.

  • Blood pressure. The NHLBI says CPAP can help prevent or control high blood pressure (NHLBI), and the AASM suggests PAP for adults with sleep apnea and high blood pressure (AASM guideline, 2019).
  • Driving. A 2010 review of 9 observational studies found a lower crash risk after CPAP (risk ratio 0.278), that sleepiness improves after one night of treatment, and that simulated driving improves within 2 to 7 days (meta-analysis, 2010). Don’t drive when you feel tired or sleepy (NHLBI).
  • Heart attack and stroke. The large SAVE trial randomly assigned 2,717 adults aged 45 to 75 with moderate to severe sleep apnea and heart or brain blood-vessel disease to CPAP plus usual care or usual care alone. CPAP users averaged 3.3 hours a night. After about 3.7 years there was no significant difference in major cardiovascular events (17.0% versus 15.4%), though CPAP reduced snoring and sleepiness and improved quality of life and mood (SAVE trial, 2016). A later analysis of three trials (4,186 people) again found no overall difference, but an on-treatment analysis found a lower risk with good adherence (4 or more hours a night); the authors suggested adherence is a key factor (meta-analysis, 2023). A 2025 review of 30 studies (10 randomized, 20 non-randomized) found lower all-cause and cardiovascular death in people treated with PAP, with more benefit at higher use; it combined randomized and non-randomized studies and was funded by a CPAP maker (meta-analysis, 2025).
  • After a stroke. The AHA statement says that after stroke, experts are still unsure about screening and treatment (AHA statement, 2021). The AASM recommends a lab sleep study rather than a home test for people with a history of stroke (AASM guideline, 2017). See our stroke guide.

Bottom line: treat sleep apnea for better sleep, alertness and safety, and use it as one piece of a heart-healthy plan. See our heart guide and blood pressure guide.

Another approach

Using and caring for CPAP

CPAP takes patience. The NHLBI says to use it every time you sleep, including naps and when traveling, and that getting used to it can take time (NHLBI, NHLBI). Even in the large SAVE trial, average use was only 3.3 hours a night (SAVE trial, 2016), so you are not alone if it is hard.

  • Mask fit: adjust the mask every night while lying down with the machine on; wear it for part of the day, such as while watching TV, to get used to it (NHLBI).
  • Problems to report: feeling claustrophobic or bothered by noise (a different mask or machine, or a setting that ramps the pressure up slowly, may help), a mask that leaks or won’t stay on, trouble falling or staying asleep, or a dry mouth or stuffy or runny nose (a humidifier or nasal spray may help) (NHLBI).
  • Check-ins: your provider, and possibly your insurer, may review data from your machine to see how often you use it and whether it is working. Your insurer may use the data to decide whether to cover it (NHLBI).
  • Cleaning: most masks, hoses and humidifier tanks can be cleaned with mild soap and water as the owner’s manual describes. The FDA says there are currently no FDA-cleared or approved devices for cleaning CPAP machines (only one add-on device has been authorized, to reduce bacteria on certain masks and hoses), and it has received reports of asthma attacks, headaches and breathlessness after use of ozone-gas cleaners (FDA).
  • Recalls: the FDA has alerted people who use certain Philips Respironics CPAP and BiPAP machines about a recall; ask your supplier or doctor if your machine is affected (FDA).

If a mask problem or discomfort is making you stop using CPAP, call your provider before you give up: there are many masks and settings to try (NHLBI).

Another approach

Alcohol, sleeping pills and other medicines

Alcohol and some medicines can make sleep apnea worse.

  • Alcohol can relax the muscles of the mouth and throat, which may close the upper airway (NHLBI). The NHS says not to drink too much alcohol, especially shortly before going to sleep (NHS). MedlinePlus advises cutting down or avoiding alcohol and other sedatives at bedtime if you snore (MedlinePlus).
  • Sleeping pills. The NHS says not to take sleeping pills unless a doctor recommends them, because they can make sleep apnea worse (NHS). The FDA says that sedatives or sleep aids that slow or lessen breathing can contribute to sleep apnea, and that a number of prescription drugs — in addition to alcohol and tobacco — can make it worse, including many for insomnia, anxiety or severe pain. It adds: talk to your doctor before stopping or starting any medicine (FDA).
  • Opioid pain medicines. Long-term use of prescribed opioid pain medicines, or opioid use disorder, raises the risk of central sleep apnea (NHLBI). Tell any surgeon or anesthesia provider that you have sleep apnea, so your airway can be protected during surgery and after it, when pain medicine is used (NHLBI).

Don’t stop a prescribed medicine on your own. Ask your prescriber or pharmacist, and tell them about your sleep apnea. If trouble sleeping is part of the picture, see our sleep problems guide; insomnia can come with sleep apnea, especially in women (NHLBI).

Another approach

Women, pregnancy and children

Women. Risk rises during pregnancy and during and after menopause, partly because of hormone changes, and polycystic ovary syndrome may raise it too (NHLBI). Sleep apnea in pregnancy is often more serious in the third trimester and may improve after the baby is born, and it is linked to complications including cesarean section, gestational diabetes, high blood pressure, low birth weight and preterm birth. CPAP is safe for treating sleep apnea during pregnancy, though settings may need adjusting (NHLBI). Symptoms can be less obvious in women, so mention tiredness, headaches, insomnia or low mood to your provider (NHLBI).

Children. Sleep apnea can occur at any age and is most common between ages 2 and 8. In children it is often caused by large tonsils or adenoids, and obesity is also common. Signs can include snoring, mouth breathing, breathing that starts and stops, bedwetting, overactive or aggressive behavior and trouble paying attention at school. Diagnosis needs a sleep study. Depending on the cause, treatment may include weight management, removal of tonsils and adenoids, a nasal steroid spray, an asthma medicine (which can cause behavior and mood side effects — call the provider right away about changes), a PAP machine (which, used long term, may affect the growth of the child’s face), oral devices and mouth and face exercises. Keep children away from secondhand smoke, which can worsen it (NHLBI).

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This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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