CPAP (continuous positive airway pressure)
The reference treatmentCPAP, continuous positive airway pressure, is the reference treatment for moderate to severe obstructive apnea. You wear a mask connected to a device that delivers pressurized air, holding the airway open while you sleep.
Advantages
✓ Works from the very first night
✓ Reimbursed by the NIHDI (convention)
✓ Removes the apneas and the snoring
✓ Lowers blood pressure
✓ Improves how you think and concentrate
Drawbacks
− Takes getting used to (one to four weeks)
− Wearing a mask is a constraint
− Needs regular cleaning
− A little noise
Oral appliance therapy (MAD)
A good alternativeAn oral appliance is a custom-made dental device, worn at night, that moves the lower jaw forward to widen the airway. It is prescribed by a dentist trained in sleep medicine and made to measure.
Advantages
✓ More comfortable than CPAP
✓ Small, ideal when traveling
✓ Silent
✓ Reimbursed by the NIHDI under conditions
✓ Well tolerated over the long term
Drawbacks
− Less effective in severe apnea
− Can cause jaw joint pain
− Needs a dentist trained in sleep medicine
− Takes time to be made (it is custom-fitted)
Positional therapy
For positional apneaIn some patients, apneas happen almost only when lying on the back. Devices such as belts, special pillows or connected trainers keep you sleeping on your side, which removes the apneas without any medication.
Advantages
✓ Simple and inexpensive
✓ No bulky equipment
✓ Works well when properly indicated
✓ Can be combined with another treatment
Drawbacks
− Only works for positional apnea
− Can disturb your sleep
− Not suitable for severe apnea
Surgery
Selected casesSurgery is considered when a precise anatomical cause is found: enlarged tonsils, a deviated septum, a maxillofacial abnormality. It does not replace CPAP in severe cases, but it can lower the pressure needed or make another treatment easier to tolerate.
Advantages
✓ Potentially a permanent fix
✓ Can correct an anatomical cause
✓ Makes other treatments easier to tolerate
Drawbacks
− The risks that come with any surgery
− Results vary and are hard to predict
− Rarely brings the AHI all the way down
CBT-I: cognitive behavioral therapy for insomnia
For the insomnia that comes with itMany patients with apnea also have insomnia. CBT-I is the reference treatment for chronic insomnia, recommended ahead of sleeping pills. It works on the thoughts and habits that keep the insomnia going.
Advantages
✓ Lasting results, unlike sleeping pills
✓ No medication
✓ Treats what is underneath
✓ Can run alongside CPAP
Drawbacks
− Needs a trained therapist
− Asks real effort from you
− Results take six to eight weeks
At a glance
| Treatment | Effectiveness | NIHDI reimbursement | Comfort |
|---|---|---|---|
| CPAP | Yes | ||
| Oral appliance | Yes, under conditions | ||
| Positional | No | ||
| Surgery | Partly |
So which one is right for you?
There is no answering that without a sleep study. Your AHI, your anatomy, the way you live: all of it counts. The first step is an appointment at an accredited sleep center.
Find a sleep center in Belgium →Tools and guides for CPAP patients
Starting treatment, or trying to get more out of it? These practical pages are there for the day to day.
Getting started with CPAP
Practical advice for the first nights
Choosing your CPAP mask
An interactive quiz to find the right one
Reading my CPAP report
Decoding AHI, leaks, pressure, adherence
Pressure calculator
An indicative estimate of your CPAP pressure
Traveling with a CPAP
Flights, customs, batteries: the full guide
Buying a CPAP in Belgium
Suppliers, prices, NIHDI reimbursement
Frequently asked questions
Next step
Has your doctor prescribed CPAP?
The NIHDI convention covers your device. Here is how it works in practice: conditions, costs, and the steps to take.
Sources
- Patil SP, et al. Treatment of Adult OSA With Positive Airway Pressure: AASM Clinical Practice Guideline. J Clin Sleep Med. 2019;15(2):335-343.
- Gottlieb DJ, Punjabi NM. Diagnosis and Management of Obstructive Sleep Apnea. JAMA. 2020;323(14):1389-1400.
- Veasey SC, Rosen IM. Obstructive Sleep Apnea in Adults. N Engl J Med. 2019;380(15):1442-1449.
- Yu M, et al. Long-Term Efficacy of Mandibular Advancement Devices in the Treatment of Adult OSA. PLoS One. 2023;18(11):e0292832.
- Marklund M, et al. Non-CPAP Therapies in OSA: Mandibular Advancement Device Therapy. Eur Respir J. 2012;39(5):1241-7.
- Sharples LD, et al. Meta-Analysis of Oral Mandibular Advancement Devices and CPAP for OSA-Hypopnoea. Sleep Med Rev. 2016;27:108-24.
- Kohler M, et al. Predictors of Long-Term Compliance With CPAP. Thorax. 2010;65(9):829-32.
