If you can’t wear your CPAP, you’re not alone.
Roughly half of people prescribed CPAP can’t or won’t wear it consistently. The mask, the noise, the partner waking up, the dry mouth, the travel burden — there are real reasons it doesn’t fit most lives. The airway problem still needs treating. Here’s what the alternatives actually look like.
Oral appliance therapy (OAT)
The most common evidence-backed CPAP alternative. A custom-fitted dental appliance, worn at night, that advances the lower jaw to hold the airway open. For mild-to-moderate cases this is often first-line; for severe cases that won’t tolerate CPAP it’s often second-line. Symmetry fits these directly — Dr. Deal is double-board-certified in dental sleep medicine.
Read more about oral appliance therapy →
Positional therapy
Some sleep apnea is positional — significantly worse on the back. For these patients, devices that prevent back-sleeping (wedge pillows, tennis-ball shirts, vibratory positional therapy) can produce meaningful reductions in apnea-hypopnea index. Often combined with OAT, not used alone.
Weight management & lifestyle
Obstructive sleep apnea correlates with body weight, alcohol use, and sleep position. For some patients, weight loss alone substantially reduces symptoms. We talk about this honestly — it’s not a quick fix, and it isn’t the whole answer for most adults — but it’s on the table.
Airway-aware orthodontics
For some patients, the underlying anatomy created the airway problem decades ago. Expanding the maxilla in adolescence (or, more conservatively, in adulthood) can change the shape of the airway in a way that makes other interventions more effective. This is the long game — measured in months and years, not weeks — but for the right patient it’s the only intervention that addresses the cause.
Hypoglossal nerve stimulation (Inspire)
An implanted device that stimulates the hypoglossal nerve during sleep to keep the tongue forward. FDA-approved for moderate-to-severe OSA in CPAP-intolerant patients. We don’t implant these; we coordinate with the sleep-medicine specialists who do, when it’s clinically indicated.
Surgical options
Soft-tissue surgeries (UPPP, tongue base reduction, maxillomandibular advancement) can resolve sleep apnea in carefully selected patients. These are last-line for most cases. We refer to the right surgical specialists when conservative measures aren’t enough.
What we recommend, in plain language
Start with the screener. If it flags as intermediate or high risk, book an evaluation. The visit looks at your specific airway anatomy, your sleep history, and what you’ve tried already. The plan that comes out of it is built for you — not the average patient.