How to Treat Sleep Apnoea: NHS Options

Sleep apnoea is a common but often underdiagnosed condition that can seriously affect your health, wellbeing and daily functioning. Knowing how to treat sleep apnoea effectively is essential, as untreated cases carry real risks including hypertension, cardiovascular disease and dangerous daytime sleepiness. Treatment options range from CPAP therapy and mandibular advancement devices to targeted lifestyle changes, and the right approach depends on the type and severity of your condition. This article explains the main treatments available on the NHS, when to seek medical advice, and what to expect from diagnosis and ongoing management, in line with current NICE guidance.

What is sleep apnoea and how is it diagnosed in the UK?

Sleep apnoea is diagnosed in the UK via GP referral to a sleep service, where a home respiratory polygraphy or polysomnography study confirms the condition and grades severity using the apnoea-hypopnoea index or oxygen desaturation index.

Sleep apnoea is a condition in which breathing repeatedly stops and starts during sleep, most commonly because the upper airway collapses or becomes obstructed. The most prevalent form is obstructive sleep apnoea (OSA), though central sleep apnoea, where the brain fails to send correct signals to the breathing muscles, also occurs. Central sleep apnoea requires specialist assessment and is managed differently from OSA; this article focuses primarily on OSA. Symptoms include loud snoring, witnessed apnoeas (pauses in breathing noticed by a partner), waking unrefreshed, excessive daytime sleepiness, and morning headaches.

In the UK, diagnosis typically begins with a GP assessment. NICE guidance (NG202) recommends that clinicians take a structured clinical history and may use validated tools to assess OSA risk (such as STOP-Bang or OSA-50) and to quantify daytime sleepiness (such as the Epworth Sleepiness Scale). Where OSA is suspected, the GP will usually refer to a specialist sleep service or respiratory clinic.

Diagnosis is confirmed by a sleep study. Many NHS services now offer home-based limited-channel respiratory polygraphy, which records airflow, oxygen saturation, chest movement and heart rate overnight. More complex cases may require in-laboratory polysomnography, which additionally monitors brain activity, eye movements and muscle tone. The severity of OSA is classified by the apnoea-hypopnoea index (AHI) or, in some UK services, the oxygen desaturation index (ODI), both of which count the number of relevant events per hour of sleep. NICE NG202 permits either measure for severity grading:

• Mild OSA: 5 to 14 events per hour

• Moderate OSA: 15 to 29 events per hour

• Severe OSA: 30 or more events per hour

Accurate diagnosis is important because it guides treatment choice and helps identify patients at higher cardiovascular risk, who may need more urgent management.

What are the main treatments for sleep apnoea available on the NHS?

CPAP therapy is the main NHS treatment for moderate to severe OSA, with mandibular advancement devices offered for mild to moderate cases or when CPAP is not tolerated; surgery is reserved for specific anatomical causes.

Continuous positive airway pressure (CPAP) therapy is the most effective treatment for moderate to severe obstructive sleep apnoea and is the first-line option recommended by NICE (NG202) for these patients. CPAP works by delivering a continuous stream of pressurised air through a mask worn during sleep, which acts as a pneumatic splint to keep the upper airway open and prevent collapse. When used consistently, CPAP reduces daytime sleepiness, lowers blood pressure and improves quality of life.

For patients with mild OSA, or those who cannot tolerate or prefer not to use CPAP, mandibular advancement devices (MADs) are an evidence-based alternative. NICE NG202 recommends MADs as an option for mild to moderate OSA and for patients with moderate to severe OSA who are unable to tolerate CPAP.^[1][2] These custom-fitted oral appliances hold the lower jaw slightly forward to widen the airway. Access to custom MADs through NHS dental or sleep services varies by local Integrated Care Board (ICB) commissioning and specialist pathway, so patients should confirm availability with their GP or sleep service.

Surgical options are generally reserved for patients with specific anatomical abnormalities contributing to airway obstruction, such as enlarged tonsils or adenoids, or significant nasal obstruction. Procedures such as tonsillectomy, septoplasty or, less commonly, uvulopalatopharyngoplasty (UPPP) may be considered after specialist assessment. Surgical intervention is not a routine first-line treatment for OSA in adults.

Weight management is also a core component of treatment for overweight or obese patients, as excess weight is a major modifiable risk factor for OSA. NHS services may offer referral to structured weight management programmes alongside device-based therapy. Patients seeking further information about weight-management consultations can speak to their GP or explore services such as Bolt Pharmacy, a pharmacy registered with the General Pharmaceutical Council (GPhC) in Great Britain, offering online weight-management consultations with prescriber review and pharmacist support, where a weight-management medicine may be one option a prescriber considers following a consultation if it is clinically appropriate.

Can lifestyle changes really help with sleep apnoea?

Lifestyle changes, particularly weight loss and reducing alcohol intake, can lower OSA severity and complement device-based treatment, though they are unlikely to resolve moderate or severe OSA on their own.

Lifestyle changes can meaningfully reduce the severity of obstructive sleep apnoea, particularly in patients with mild to moderate disease or those whose OSA is closely linked to modifiable risk factors. Weight loss is the most impactful lifestyle intervention: adipose tissue around the neck and upper airway narrows the pharyngeal lumen, and even modest reductions in body weight can lower the AHI and improve symptoms.^[16][9] NICE NG202 acknowledges weight management as an important adjunct to device-based treatment.

Alcohol and sedative medications relax the pharyngeal muscles and worsen airway collapse, so reducing or avoiding alcohol, particularly in the evening, is consistently recommended.^[6][9] Similarly, patients prescribed benzodiazepines or opioids should discuss the implications with their prescriber, as these drugs can suppress respiratory drive and exacerbate apnoeas.^[12][13]

Positional therapy is relevant for patients with positional OSA, where apnoeas occur predominantly or exclusively when sleeping on the back (supine position). Strategies to encourage side-sleeping, ranging from positional pillows to wearable vibrotactile devices, can reduce AHI in this subgroup. However, positional therapy is generally considered an adjunct rather than a standalone treatment for moderate or severe OSA.

Smoking cessation is also advisable, as smoking causes upper airway inflammation and increases the risk of OSA.^[6][9] Patients can access NHS Stop Smoking services through their GP or local pharmacy.

While lifestyle changes alone are unlikely to resolve moderate or severe OSA, they complement device-based therapy. Any adjustment to CPAP pressure settings or device type should be made with the guidance of your NHS sleep service, not independently. If you feel your treatment is no longer controlling your symptoms, contact your sleep service for a review.

Central sleep apnoea, mentioned above, requires specialist assessment and different management approaches, including treatment of any underlying cause. If you have been told you have central sleep apnoea, your specialist team will advise on the most appropriate pathway.

What side effects and risks should you know about with CPAP therapy?

Common CPAP side effects include mask discomfort, nasal dryness and aerophagia, all of which can usually be managed with mask adjustments or heated humidification; serious adverse events are rare.

CPAP therapy is generally safe and well tolerated, but a range of side effects can affect adherence, particularly in the early weeks of treatment. The most commonly reported issues include:

• Mask discomfort or pressure sores: Ill-fitting masks can cause skin irritation or pressure marks around the nose and cheeks. Most sleep services offer mask-fitting reviews and a choice of mask styles (nasal, nasal pillow or full-face) to improve comfort.

• Nasal congestion and dryness: Pressurised airflow can dry the nasal passages and throat. Heated humidifiers, which are built into many modern CPAP devices, significantly reduce this problem.

• Aerophagia: Some patients swallow air during CPAP use, causing bloating or discomfort. Adjusting pressure settings or switching to auto-titrating CPAP (APAP) can help; any such changes should be made with your sleep service's guidance.

• Claustrophobia: Anxiety related to mask-wearing is common initially. Gradual acclimatisation, starting with short daytime sessions, is often recommended by sleep technicians.

Serious adverse events from CPAP are rare, and the benefits of treatment for moderate to severe OSA are well established. By contrast, untreated severe OSA itself carries significant risks, including hypertension, increased risk of cardiovascular events and impaired driving performance.^[9][10] The DVLA requires drivers with OSA to inform them if sleepiness affects their ability to drive safely; you should stop driving if you feel too sleepy to do so safely and seek prompt treatment review.^[7] Group 2 licence holders (lorry and bus drivers) are subject to stricter standards and should consult DVLA guidance directly.^[7][8]

Consistent use of CPAP for at least four hours per night is associated with the greatest clinical benefit, and most NHS sleep services offer follow-up support to help patients achieve this.^[9][11]

If you experience a new or unexpected side effect from any treatment, you or your healthcare professional can report it to the MHRA via the Yellow Card scheme at yellowcard.mhra.gov.uk.

When should you see a GP or specialist about sleep apnoea symptoms?

See your GP if you experience witnessed breathing pauses, persistent loud snoring, unrefreshing sleep or significant daytime sleepiness, especially if you have cardiovascular disease, obesity or work in a safety-critical role.

You should see your GP if you regularly experience symptoms that suggest sleep apnoea, particularly if a bed partner has witnessed pauses in your breathing during sleep. Other symptoms that warrant a GP appointment include persistent loud snoring, waking frequently during the night, unrefreshing sleep despite adequate hours in bed, significant daytime sleepiness that affects work or daily activities, and morning headaches. These symptoms are not always caused by OSA, but they require clinical assessment to identify the underlying cause.

Certain groups should seek assessment promptly rather than waiting to see whether symptoms resolve on their own. These include:

• People with established cardiovascular disease, hypertension or type 2 diabetes, as OSA worsens these conditions

• Commercial drivers or those in safety-critical occupations, where daytime sleepiness poses a risk to others

• People with obesity (BMI of 30 kg/m² or above), as excess weight significantly increases OSA risk and severity, with risk rising further at higher BMI values

• Individuals who have had a stroke or transient ischaemic attack (TIA)

If you are already using CPAP and your symptoms return despite treatment, or if your device develops a fault, contact your NHS sleep service directly rather than waiting for a routine appointment. Support routes vary between services, so check the contact details provided when your treatment was set up.

For urgent concerns, such as severe breathlessness at rest or chest pain, call 999 or go to your nearest accident and emergency department. For non-emergency medical advice outside GP hours, contact NHS 111. Do not drive if you feel too sleepy to do so safely. If daytime sleepiness is affecting your ability to drive, inform your GP and follow DVLA guidance on notifying the DVLA; Group 2 drivers (lorry and bus licence holders) must meet stricter fitness-to-drive standards and should seek specific advice.

Scientific References

1. Obstructive sleep apnoea/hypopnoea syndrome and obesity hypoventilation syndrome in over 16s (NG202).
2. NG202 Chapter 1: Obstructive sleep apnoea/hypopnoea syndrome — CPAP recommendations.
3. NG202 Terms used in this guideline — AHI severity thresholds.
4. NG202 Full guideline PDF — Epworth Sleepiness Scale and STOP-Bang Questionnaire.
5. NG202 Evidence appendix M: demonstration of efficacy — AHI and ODI outcomes.
6. Sleep apnoea.
7. Excessive sleepiness and driving.
8. General information: assessing fitness to drive.
9. Long term management of obstructive sleep apnea and its comorbidities. Multidisciplinary Respiratory Medicine..
10. Overcoming an underdiagnosed respiratory condition: should more patients with cardiovascular complications be screened for obstructive sleep apnea? Expert Review of Cardiovascular Therapy..
11. Brain stem activity changes associated with restored sympathetic drive following CPAP treatment in OSA subjects. Journal of Neurophysiology..
12. Impact of central nervous system depressants on prognosis in obesity hypoventilation syndrome — the DISCOVERY study. Annals of the American Thoracic Society..
13. The Physiology and Maintenance of Respiration: A Narrative Review. Pain and Therapy..
14. Efficacy of vibrotactile positional therapy devices on patients with positional obstructive sleep apnoea: a systematic review and meta-analysis. Thorax..
15. Vibrotactile positional therapy for the treatment of positional obstructive sleep apnoea: a systematic review and meta-analysis..
16. De-escalating Therapy in Obstructive Sleep Apnoea After GLP-1 Receptor Agonist-Induced Weight Loss: A Narrative Review. Cureus..

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