Sleep apnea care now goes well beyond CPAP, and mouth tape isn’t part of it

Key takeaways

• A 2019 estimate, funded by the company ResMed, put the number of adults aged 30 to 69 with obstructive sleep apnea at about 936 million worldwide¹.
• The U.S. Preventive Services Task Force found too little evidence to screen adults without symptoms, but loud snoring, gasping at night or heavy daytime sleepiness call for an evaluation²⁴.
• In the 2,717-person SAVE trial, CPAP didn’t prevent heart attacks or strokes in people who used it about 3.3 hours a night, though it eased snoring and sleepiness and improved mood⁶.
• In December 2024, the FDA approved tirzepatide (Zepbound) for moderate-to-severe sleep apnea in adults with obesity; in Lilly-funded trials, breathing events fell by about 20 to 24 more per hour than with placebo⁹¹⁰.
• A 2025 review of 10 mouth-taping studies found little benefit and warned of suffocation risk when the nose is blocked¹¹.

Taping your mouth shut at night has become a social media sleep hack, promoted for snoring, dry mouth and deeper sleep¹¹¹².

In May 2025, a team at Western University in Ontario, with ear, nose and throat specialist Brian Rotenberg as senior researcher, checked the evidence¹¹¹². They found 10 studies with 213 people in all, using tape or chin straps¹¹.

Only two studies suggested any help, and only for mild sleep apnea¹¹. Four warned of a suffocation risk when a blocked nose forces mouth breathing, as with hay fever, a cold, a crooked septum or big tonsils¹¹.

Rotenberg added a warning: tape won’t treat a problem you don’t know you have, and it could pose real risks, especially for people with sleep apnea¹². Loud snoring, the very thing many people tape their mouths to stop, is a common sign of that disorder³.

Obstructive sleep apnea is common, easy to miss and treatable in more ways than most people realize. Below, we cover how to spot it, what testing involves, what CPAP can and can’t do, and how the newer options compare.

Your airway closes, your brain rouses you, and you may never know

In obstructive sleep apnea, or OSA, the airway collapses or gets blocked during sleep, so breathing stops or turns very shallow³. Each pause can last from a few seconds to minutes, and it can happen 30 or more times an hour³. Pauses are often followed by a snort or choking sound³.

Doctors count those events. The U.S. Preventive Services Task Force (USPSTF) defines an apnea as a complete blockage lasting more than 10 seconds². A hypopnea is a partial blockage that drops blood oxygen by at least 3% or briefly wakes the brain². The number per hour, called the apnea-hypopnea index (AHI), sets severity: 5 to 15 is mild, 16 to 30 moderate and above 30 severe².

The sleeper may have no idea. The USPSTF notes that some people aren’t aware of their symptoms, and several of the warning signs listed by MedlinePlus, the National Library of Medicine’s health site, are things a bed partner notices²⁴.

The costs show up by day. Interrupted sleep brings drowsiness, and people with sleep apnea face higher risks of car crashes and work accidents³. Untreated OSA is also linked to high blood pressure, heart disease and stroke². Severe OSA goes with higher death rates, though the USPSTF says its role apart from age, weight and other risks is less clear².

Close to a billion adults may have it, and few bring it up

In 2019, an international team writing in The Lancet Respiratory Medicine estimated that about 936 million adults aged 30 to 69 worldwide have at least mild OSA, and about 425 million have moderate or severe disease¹. They pulled data from 17 studies in 16 countries¹. China had the most cases, followed by the United States, Brazil and India¹.

The paper lists one funder, the company ResMed¹. The estimate drew on published studies, but readers should know who paid for it.

For the United States, the USPSTF cites 2007 to 2010 data: about 13% of men and 6% of women aged 30 to 70 had moderate to severe OSA². It adds that the current prevalence isn’t well established².

Part of the reason is silence. Most primary care clinicians don’t routinely screen for OSA, and most patients don’t raise sleep symptoms, the USPSTF says². In one study it cites, only 20% of patients with sleep-related symptoms mentioned them to their primary care clinicians on their own².

Risk rises with male sex, ages 40 to 70, the years after menopause, higher body weight and airway features such as large tonsils². Family history matters, too³. Rates are higher among Black, Hispanic and Native American or Alaska Native people, which may partly reflect higher rates of obesity, asthma and smoking². Our menopause sleep article covers the rise in women’s risk.

Apnea also overlaps with insomnia. The 2025 guideline from the Department of Veterans Affairs (VA) and Department of Defense (DoD) urges clinicians to screen anyone with sleep complaints for both¹³. Our insomnia article covers that side.

Screening vs. testing: why the task force said “not enough evidence”

In November 2022, the USPSTF concluded that the evidence was too thin to weigh the benefits and harms of screening adults who have no signs of OSA². That “I statement” is neither a yes nor a no². It doesn’t apply to anyone with symptoms, who should be evaluated as usual².

Part of the problem is the tools. STOP-Bang, a widely used questionnaire, combines four questions about snoring, tiredness, observed pauses and high blood pressure with body mass index, age, neck size and sex². In studies, it caught 87% to 94% of people with OSA, but its specificity ran from 0% to 38%, meaning it flagged many people who didn’t have it².

The Epworth Sleepiness Scale, another common questionnaire, rates how sleepy you are by day². The USPSTF found that none of the screening tools had been well tested in ordinary primary care².

If you have symptoms, testing is the next step. An overnight sleep study in a lab, called polysomnography, remains the standard²¹³. The 2025 VA/DoD guideline, as summarized by Guideline Central, suggests home sleep apnea testing as an alternative for suitable patients and recommends more testing if a home result doesn’t settle the question¹⁴.

CPAP eases sleepiness, but its heart protection is unproven

Continuous positive airway pressure, or CPAP, is a breathing device worn during sleep³. It delivers air pressure through a mask to hold the airway open. In trials reviewed by the USPSTF, positive airway pressure lowered Epworth sleepiness scores by about 2.3 points and slightly lowered daytime diastolic blood pressure, the bottom number².

The big hope was that CPAP would also prevent heart attacks and strokes. The SAVE trial tested that, publishing in the New England Journal of Medicine in 2016⁶. It enrolled 2,717 adults aged 45 to 75 with moderate to severe OSA and existing heart or brain blood-vessel disease⁶.

After an average of 3.7 years, 17.0% of the CPAP group and 15.4% of the usual-care group had a major cardiovascular event, a difference that could be chance⁶. CPAP cut breathing events from about 29 an hour to under 4, but people used it for an average of only 3.3 hours a night⁶. On the plus side, people on CPAP snored less, felt less sleepy by day, and reported better mood and quality of life⁶. Funding came from Australia’s National Health and Medical Research Council and others⁶.

So CPAP’s proven payoff is how you feel and function. Whether longer nightly use protects the heart remains an open question.

Side effects tend to be short-lived. Trials report dry nose or mouth, eye or skin irritation, rashes and pain². The VA/DoD guideline suggests starting with an auto-adjusting machine, offering coaching in person or by telehealth, and, for some patients, up to two weeks of the sleeping pill eszopiclone to help them get used to the mask¹³¹⁴. Most of these VA/DoD treatment suggestions carry its “weak” rating rather than “strong,” according to Guideline Central’s summary¹⁴.

The Philips recall. In June 2021, Philips Respironics recalled certain CPAP machines, BiPAP machines and ventilators, about 15 million devices worldwide⁷. Foam meant to muffle noise could break down, and users might breathe in or swallow black bits of it or invisible chemicals⁷. On April 9, 2024, a federal court entered a consent decree. It requires a recall fix plan and, with limited exceptions, bars Philips from making or selling new sleep and breathing machines at several of its plants in Pennsylvania and California until it meets set conditions⁷.

The FDA’s recall pages, last updated in November 2024, list no later milestones⁷⁸. Its advice for people with a recalled device: don’t stop using it without talking with your provider, because stopping may be riskier for some; don’t use ozone or ultraviolet cleaners; and report problems through MedWatch⁸.

Beyond the mask: mouthpieces, side sleeping and implants

Oral appliances. A mandibular advancement device is a mouthpiece that holds the lower jaw forward during sleep. The VA/DoD guideline lists it alongside positive airway pressure as a first-line choice for mild to moderate OSA¹³¹⁴. In the USPSTF review, these devices improved sleepiness less than the amount patients usually notice, and 17% to 74% of users reported mouth, tooth or jaw symptoms². The task force calls them an alternative for people who prefer them or who have side effects from CPAP².

Side sleeping. Some people’s apnea happens mostly when they lie on their backs. For this positional OSA, the VA/DoD guideline suggests positional therapy¹⁴.

Nerve stimulation implants. Hypoglossal nerve stimulation uses an implanted device to stimulate the nerve that moves the tongue. The VA/DoD guideline suggests referring people for evaluation if they couldn’t succeed with positive airway pressure and have an AHI of 15 or more¹⁴.

Surgery and oxygen. Surgery generally isn’t a first-line treatment². If a blocked nose keeps you from using CPAP, the guideline suggests evaluation for nasal surgery¹⁴. It advises against using oxygen alone as a treatment¹⁴.

Weight loss helps, and now a prescription drug is approved for it

For people with overweight or obesity, the USPSTF notes that weight loss is recommended as part of OSA treatment². The VA/DoD guideline includes weight management alongside other treatments¹³¹⁴.

On Dec. 20, 2024, the FDA approved tirzepatide (Zepbound) as the first prescription treatment for moderate to severe OSA in adults with obesity, to be used with a reduced-calorie diet and more physical activity¹⁰.

The approval rested on two 52-week trials, published in the New England Journal of Medicine in 2024⁹¹⁰. One enrolled people not using positive airway pressure and one enrolled people who were⁹. Participants started with about 50 breathing events an hour⁹.

On tirzepatide, events fell by about 25 an hour without CPAP and about 29 with it, compared with roughly 5 on placebo⁹. Weight dropped about 18% to 20%, versus 2% on placebo¹⁰. In figures reported at approval, about 42% to 50% of people on the drug reached remission or mild apnea without symptoms at one year, versus 14% to 16% on placebo¹⁰.

Digestive side effects were the most common, mostly mild to moderate⁹. The trials were funded by Eli Lilly, the drug’s maker⁹. They also lasted one year, so longer-term results are still to come.

A didgeridoo beat the waiting list, but tape hasn’t earned that trust

One drug-free idea has an unusual trial behind it. In a study published in the BMJ in December 2005, researchers randomly assigned 25 adults with moderate apnea who snored to four months of didgeridoo lessons or a waiting list¹⁵. Players practiced about 25 minutes a day, nearly six days a week¹⁵.

Compared with the waiting list, players scored 3 points lower on the Epworth sleepiness scale and had about 6 fewer breathing events an hour, a borderline result, and their partners reported less disturbed sleep¹⁵. Sleep quality scores and overall quality of life didn’t change¹⁵. It was one small trial, and the drop in breathing events was much smaller than CPAP’s in SAVE, though the two trials studied different people⁶¹⁵. The VA/DoD guideline found the evidence for mouth and throat exercises, called myofunctional therapy, too thin to recommend for or against¹⁴.

Mouth tape fares worse. In the 2025 review, 80% of studies showed no benefit, and the 20% that did showed changes too small to matter clinically, Rotenberg said¹². The researchers concluded that the trend seems “guided by poor evidence” and that many people aren’t suitable for it¹¹.

For readers drawn to drug-free care, this field has real options: losing weight through food and movement, sleeping on your side when apnea is positional, and even an unusual kind of music lesson. The order matters, though. Get a diagnosis first, so you know what you’re treating and whether it’s working.

How strong is the evidence?

Treatment	What the research shows	Evidence level
CPAP for sleepiness and snoring	Lower sleepiness scores; better mood and quality of life in SAVE26	Strong evidence
CPAP to prevent heart attacks and strokes	Tested and failed in SAVE at about 3.3 hours a night; this rates the heart claim, not CPAP’s safety6	Evidence says no, or unsafe
Oral appliances	First-line option for mild to moderate OSA; sleepiness gains smaller than patients usually notice; jaw symptoms common214	Strong evidence of a small benefit
Tirzepatide for OSA with obesity	Two 52-week, Lilly-funded trials; about 20 to 24 fewer events an hour than placebo9	Strong evidence for one year
Positional therapy	Suggested for apnea that happens on your back14	Promising but early
Hypoglossal nerve stimulation	Suggested for evaluation after CPAP fails14	Promising but early
Didgeridoo playing	One 25-person trial15	Promising but early
Myofunctional exercises	Too little evidence to rate for or against14	Not enough evidence
Mouth taping	Most of 10 small studies showed no benefit; suffocation concerns1112	Evidence says no, or unsafe

Your apnea next-steps guide

This guide is our own, built from the sources above.

Signs to report to a clinician:

• loud snoring, or pauses in breathing followed by a snort or choking sound³;
• a bed partner who hears snoring, snorting, gasping, choking or pauses in your breathing⁴;
• waking up gasping or short of breath⁵;
• feeling sleepy during the day, napping often or dozing off at the wrong times⁴;
• dozing off or struggling to stay awake during routine tasks, especially driving⁵;
• unrefreshing sleep, trouble thinking or mood changes².

Before your visit: Ask your bed partner what they hear and see at night, and write it down. Ask whether a home test or a lab study fits your situation, and what happens if a home result is unclear¹⁴.

Option	Questions to ask
CPAP	Could I start on an auto-adjusting machine? Who helps if the mask bothers me, in person or by telehealth1314?
Oral appliance	Is my apnea mild to moderate? Which jaw or tooth problems should I watch for214?
Side sleeping	Is my apnea worse on my back14?
Implant	Am I a candidate if CPAP hasn’t worked14?
Tirzepatide	Do I meet the obesity and severity criteria, and what side effects are common910? What happens if I stop?

If CPAP is hard to live with: Tell your team about dryness, irritation or pain; these effects usually pass². Ask about coaching, an auto-adjusting machine and, if your nose is blocked, a nasal evaluation¹⁴. If you have a recalled Philips device, follow the FDA’s advice above⁸.

Drowsy driving: If you’re sleepy, don’t drive; pull over somewhere safe. People with sleep apnea have more car crashes³, so tell your clinician how often you doze off or struggle to stay awake while driving⁵. The USPSTF statement doesn’t cover work-related fitness-for-duty exams², so if you drive or run equipment for a living, ask your employer or examiner which rules apply. Our article on sleep debt lists warning signs. For chest pain or trouble breathing, call 911.

Questions readers ask

The bottom line

Sleep apnea is common, often silent and frequently missed. If you snore loudly, stop breathing in your sleep or fight to stay awake by day, ask for a sleep test rather than reaching for tape.

CPAP reliably eases sleepiness, though it didn’t prevent heart attacks or strokes at the hours people used it in a major trial. Oral devices, side sleeping, implants, weight loss and now a prescription drug give people more ways to treat apnea that fit their lives.

Related reading

• Doctors’ first choice for insomnia is retraining your sleep with CBT-I
• Short sleep blunts insulin and stokes appetite, and adding sleep cut calories
• Two weeks of six-hour nights can impair you like an all-nighter
• “FDA registered” isn’t “FDA approved”: a buyer’s map to wellness devices
• Hot flashes aren’t the only thing stealing sleep in menopause

Sources

1. Benjafield AV, Ayas NT, Eastwood PR, et al. “Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis.” Lancet Respiratory Medicine, 2019 (eScholarship record). pubmed.ncbi.nlm.nih.gov
2. U.S. Preventive Services Task Force. “Obstructive Sleep Apnea in Adults: Screening.” Final recommendation statement, November 15, 2022. uspreventiveservicestaskforce.org
3. MedlinePlus. “Sleep Apnea.” National Library of Medicine, updated September 28, 2025. medlineplus.gov
4. MedlinePlus. “Sleep Disorders.” National Library of Medicine, updated December 4, 2025. medlineplus.gov
5. National Heart, Lung, and Blood Institute. “Sleep Deprivation and Deficiency: Diagnosis.” National Institutes of Health, updated July 30, 2026. nhlbi.nih.gov
6. McEvoy RD, Antic NA, Heeley E, et al. “CPAP for Prevention of Cardiovascular Events in Obstructive Sleep Apnea.” New England Journal of Medicine, 2016;375(10):919-931 (RECERCAT repository record). pubmed.ncbi.nlm.nih.gov
7. U.S. Food and Drug Administration. “Recalled Philips Ventilators, BiPAP Machines, and CPAP Machines.” Content current as of November 20, 2024. fda.gov
8. U.S. Food and Drug Administration. “Recommendations for Recalled Philips Ventilators, BiPAP Machines, and CPAP Machines.” Content current as of August 15, 2024. fda.gov
9. Malhotra A, Grunstein RR, Fietze I, et al. “Tirzepatide for the Treatment of Obstructive Sleep Apnea and Obesity.” New England Journal of Medicine, 2024;391(13):1193-1205 (abstract via Ovid). ovid.com
10. NeurologyLive. “FDA Approves Tirzepatide as First Treatment for Obstructive Sleep Apnea With Obesity.” December 23, 2024. neurologylive.com
11. HealthDay News (republished by Powers Health). “Mouth Taping For Better Sleep? Little Benefit, Lots Of Risk, Review Says” (on Rotenberg B, et al., PLOS One, May 21, 2025). May 22, 2025. powershealth.org
12. Global News. Report on the 2025 mouth-taping review led by Brian Rotenberg. May 22, 2025. globalnews.ca
13. Aker JA. “New clinical practice guideline recognizes insomnia and sleep apnea can occur together.” Defense Health Agency, January 22, 2026. dha.mil
14. Guideline Central. “2025 VA/DoD Chronic Insomnia & Obstructive Sleep Apnea Clinical Guideline: Guideline Summary.” 2025. guidelinecentral.com
15. Puhan MA, et al. “Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome: randomised controlled trial.” BMJ, 2006 (published online December 27, 2005; University of Fribourg record). pubmed.ncbi.nlm.nih.gov