Even if you’re no longer experiencing classic sleep apnea symptoms after starting sleep therapy, you may be, much to your disappointment, still tired after CPAP.

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Although CPAP remains the treatment of choice for many people with obstructive sleep apnea, several alternatives are available to help reduce breathing issues and resolve daytime symptoms.

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Nasal CPAP: Nasal prongs that fit directly into the nostrils or a small mask that fits over the nose

This device stimulates the hypoglossal nerve that causes the tongue to move forward in the mouth and expand the airway. A remote control is used to turn on the device at bedtime.

Reducing alcohol and tobacco use may be helpful for lessening the symptoms of OSA. Drinking alcohol before bed can worsen OSA, promote snoring, and depress the central nervous system.

CPAP cannot be used in individuals who are not spontaneously breathing. Patients with poor respiratory drive need invasive ventilation or non-invasive ventilation with CPAP plus additional pressure support and a backup rate (BiPAP).

Lifestyle change including weight loss and exercise can help to improve sleep apnea and its related health problems.  Sleep positioning and oral appliances have also been found to be effective.

EPAP: Expiratory positive airway pressure (EPAP) therapy is a newer alternative to CPAP. Instead of using a machine that delivers pressurized air, a nasal EPAP device uses valves to create air pressure when the user exhales, keeping the upper airway from collapsing.

Some issues—including mask leaks, incorrect air pressure, and mask discomfort—can have relatively simple solutions. Open communication with your physician could be the difference between feeling better sooner rather than later.

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As the use of any sedative or anxiolytic agent can lead to decrease in consciousness and decrease in respiratory drive these patients more info should be monitored very closely. If adequate minute ventilation and or oxygenation cannot be achieved, then management should include escalation to BiPAP or intubation with mechanical ventilation following the code status and goals of care.

Bubble CPAP is a mode of delivering CPAP used in neonates and infants where the pressure in the circuit is maintained by immersing the distal end of the expiratory tubing in water.[seis] The depth of the tubing in water determines the pressure (CPAP) generated. Blended and humidified oxygen is delivered via nasal prongs or nasal masks and as the gas flows through the system, it “bubbles” out the expiratory tubing into the water, giving a characteristic sound.