A new generation of treatments for obstructive sleep apnoea, including a daily pill and a stick-on patch worn under the chin, is offering alternatives to the standard CPAP machine, which more than half of patients abandon within a year.
Obstructive sleep apnoea (OSA) affects about 8 million people in the UK. It occurs when throat muscles relax too much during sleep, cutting off breathing for seconds at a time and temporarily starving the brain of oxygen. The condition disrupts sleep and is linked to a greater risk of heart disease and stroke over time, as repeated drops in oxygen can cause surges in blood pressure.
For decades the standard treatment has been a continuous positive airway pressure (CPAP) machine, which pumps air through a mask worn over the nose and mouth to hold the airway open. It is highly effective, but more than half of patients stop using it within a year because they find the mask uncomfortable or claustrophobic, or because it keeps their partner awake.
Mandibular splints
One popular alternative is a custom-made mouthguard fitted by a dentist, called a mandibular advancement splint, which holds the lower jaw slightly forward during sleep to keep the airway open.
Dr Amanda Sathyapala, an associate professor at the National Heart and Lung Institute at Imperial College London, said: "A mandibular splint produces a 50 per cent or greater reduction in breathing pauses in around 50 to 60 per cent of patients. For people with mild sleep apnoea, that often means their readings go back to normal, and they feel less sleepy during the day."
Custom-made devices from a private dentist cost £700 to £1,500 for patients not eligible for one on the NHS.
A stick-on patch
A small patch worn under the chin, developed by King's College London and called the Zeus device, delivers electrical pulses to the hypoglossal nerve, which controls the muscles of the tongue, helping to stop the airway collapsing. Patients wear a new adhesive patch each night, and the chip that generates the pulses clips on to the patch and needs to be recharged daily.
A study published in eClinicalMedicine in 2023 found that in around half of the 56 patients who wore the patch, breathing interruptions fell back to within the normal range of fewer than five an hour.
A major sleep apnoea trial is now under way to test the device in NHS patients. If successful, it could be prescribed across the UK by 2027. A consumer version of Zeus for snoring is already available privately for around £220, though it is not approved or marketed as a treatment for OSA.
Nerve implants
For severe sleep apnoea, defined as stopping breathing more than 30 times an hour, another option is a small battery-operated device called Inspire, inserted under the skin in the upper chest under general anaesthetic. Two thin wires are tunnelled from the battery and generator: one is passed up through the neck and wrapped around the hypoglossal nerve via an incision in the jaw, while the other is attached to a breathing sensor implanted between the ribs that detects pressure changes as the patient tries to breathe in. The device times an electrical pulse that moves the tongue forward with each breath.
The New England Journal of Medicine reported in 2014 that Inspire reduced breathing interruptions by 50 per cent in about two-thirds of patients. It has been available to NHS patients since 2023, but Dr Sathyapala said it is restricted to those with moderate to severe OSA who have a BMI under 32.
The implant only works for patients whose throat collapses from front to back during sleep, rather than side to side. "The only way to tell which kind a patient has is to sedate them and send a tiny camera down the throat to see what happens," Dr Sathyapala said.
Fewer than 100 NHS patients have been fitted with Inspire since the roll-out began in 2023. Privately, the surgery costs around £40,000.
A newer device called Genio, roughly the size of a 50p coin, is inserted through a single 6cm incision under the chin and stimulates two nerves that control the tongue. It has no battery; instead, the patient sticks a small adhesive patch under their chin at bedtime, and an activation chip weighing 12g clips on to the patch and wirelessly transmits power through the skin to the implant. The chip is removed and recharged each morning.
Genio, aimed at adults with moderate to severe OSA, was fitted to the first two NHS patients in December 2024. A study published in the Journal of Clinical Sleep Medicine in 2025 found around 60 per cent of patients had their breathing interruptions cut by at least half after a year. It is approved for NHS use but currently available only at a few specialist centres, and privately costs around the same as Inspire.
Weight-loss jabs and a daily pill
For some patients, losing weight may help, since extra fat around the neck and throat can press on the airway, making it more likely to close during sleep. The New England Journal of Medicine reported in 2024 that the weight-loss jab tirzepatide, sold as Mounjaro, cut breathing interruptions by about half in obese adults with moderate to severe OSA. US regulators have approved tirzepatide for OSA in adults with obesity, the first weight-loss drug approved for the condition anywhere in the world. But because sleep apnoea in many patients is linked to the shape of the jaw or throat, or the muscles that relax at night, weight loss alone may not be enough.
A daily pill called AD109 works by keeping the tongue and throat muscles more active during sleep. It combines atomoxetine, already used for ADHD, and aroxybutynin, a newer drug related to one used for bladder problems, a combination thought to boost the nerves that keep the tongue and throat muscles toned. A small study published in the American Journal of Respiratory and Critical Care Medicine in 2023 found the pill cut breathing interruptions by 45 per cent after four weeks in adults with mild to severe OSA. Larger trials are ongoing, and manufacturer Apnimed plans to seek US approval this year; it is thought the pill will become available in the UK in 2027.
An app to help with CPAP
One of the most immediate changes may not be a new gadget but better support for people prescribed CPAP to help them stick with it. Researchers at Imperial College London are developing a smartphone app, CPAP Buddy, to help people through the difficult first weeks with tips on dealing with common problems, from air leaks to dry mouth caused by mouth breathing and lapses in motivation.
Dr Sathyapala, who is leading the project, said CPAP remains the only treatment that can prevent all breathing pauses, as it is the only one to counteract the disrupted airflow directly. "The sleep field has spent 30 years trying to develop interventions to improve CPAP use," she said. "If they work, and patients engage with them, the benefit is likely to be larger than that of any one new non-CPAP therapy."
