For the estimated 8 million people in the UK affected by obstructive sleep apnea (OSA), the standard treatment – a continuous positive airway pressure (CPAP) machine – is often a nightly struggle. While effective, the CPAP machine, which requires wearing a mask over the nose and mouth to keep the airway open, is frequently abandoned by patients due to discomfort, claustrophobia, or disruption to partners.
OSA occurs when throat muscles relax excessively during sleep, leading to temporary breathing cessations and reduced oxygen to the brain. This disrupts sleep and is associated with an increased risk of heart disease and stroke due to surges in blood pressure. Now, a range of new treatments are offering hope to those who find CPAP unbearable.
Alternative Therapies
One established alternative is a custom-fitted mandibular advancement splint, a mouthguard that holds the lower jaw forward during sleep to maintain an open airway. According to Dr. Amanda Sathyapala, an associate professor at the National Heart and Lung Institute at Imperial College London, these splints can reduce breathing pauses by 50% or more in 50-60% of patients, often normalizing readings and reducing daytime sleepiness for those with mild OSA. While privately fitted splints can cost between £700 and £1,500, they may be available on the NHS.
Neuromodulation Devices
For patients seeking less invasive options, a small, stick-on patch worn under the chin, called the Zeus device, is under development. Developed at King's College London, it delivers electrical pulses to the hypoglossal nerve, stimulating tongue muscles to prevent airway collapse. A 2023 study in eClinicalMedicine showed that breathing interruptions decreased to normal levels in about half of the patients using the patch. A larger trial is currently underway in NHS patients, with potential UK prescription by 2027. A consumer version for snoring is available privately for around £220, though not approved for OSA.
For more severe cases, an implantable device like Inspire, surgically placed under the skin in the upper chest, stimulates tongue and throat muscles. Wires connect the device to an electrode around the hypoglossal nerve and a breathing sensor. The Inspire device has been shown to reduce breathing interruptions by 50% in about two-thirds of patients, as reported in The New England Journal of Medicine in 2014. It has been available to NHS patients since 2023 but is limited to those with moderate to severe OSA and a BMI under 32. Fewer than 100 NHS patients have received it, and private costs are approximately £40,000.
A newer implantable device, Genio, about the size of a 50p coin, is inserted through a single incision under the chin and stimulates two nerves controlling the tongue. It uses an adhesive patch and a wirelessly powered activation chip. Genio was fitted to its first two NHS patients in December 2024 and aims to reduce breathing interruptions by at least half in about 60% of patients, according to a 2025 study. It is approved for NHS use but currently only at a few specialist centers, with private costs comparable to Inspire.
Other Treatment Avenues
Weight-loss medications are also showing promise. The jab tirzepatide (Mounjaro) has been found to reduce breathing interruptions by approximately half in obese adults with moderate to severe OSA, according to a 2024 report in The New England Journal of Medicine. US regulators have approved tirzepatide for OSA in adults with obesity, marking the first such approval globally. However, for some, weight loss alone may not suffice if OSA is related to jaw or throat structure.
A daily pill, AD109, combining atomoxetine and aroxybutynin, is designed to keep tongue and throat muscles more active during sleep. A small study in the American Journal of Respiratory and Critical Care Medicine in 2023 indicated a 45% reduction in breathing interruptions after four weeks in adults with mild to severe OSA. Larger trials are ongoing, with US approval anticipated this year and potential UK availability in 2027.
Improving CPAP Adherence
Researchers are also developing tools to improve adherence to existing treatments. A smartphone app called CPAP Buddy, created by Imperial College London, aims to help new CPAP users navigate common challenges and maintain motivation. Dr. Sathyapala notes that CPAP remains the sole treatment capable of preventing all breathing pauses by directly counteracting airflow disruption, and that improving CPAP use through support tools could yield significant benefits.