Mouth devices and bulky CPAP machines have long been the first-line treatments for obstructive sleep apnea (OSA). But these devices can be uncomfortable and inconvenient, with research showing that 30%-40% of patients stop using them over time.

This high cessation rate is driving researchers to explore new and better ways to fight sleep apnea, including upgraded CPAP machines, “smart” mouth guards, and even a sleep apnea pill. Though these treatments aren’t yet available, they may soon become a viable option for those living with OSA.

Timing Is Everything

CPAP — short for continuous positive airway pressure — is the most commonly recommended treatment for people with OSA, which causes breathing pauses during sleep, increasing the risk of heart disease, high blood pressure, and other serious conditions.

But many people struggle to stick with CPAP machines, which deliver pressurized air through a tube and a nose- or face-mask fitting that can feel uncomfortable. Some CPAP users report sensations of suffocation or claustrophobia, difficulty exhaling, sinus discomfort, or mouth dryness.

To address these issues, William H. Noah, MD, a pulmonologist and founder of SleepRes, has been working to make CPAP easier to use.

“For 20 years, I tried everything to get people adherent,” he said at a recent sleep medicine conference in Singapore.

Noah has developed a new type of CPAP therapy — called KPAP, or kairos positive airway pressure — that delivers more precisely timed air pressure only when it’s necessary. (“Kairos” is Greek for “precise time.”) Traditional CPAP machines maintain a constant level of airway pressure, delivering too much when it’s not needed and not enough when it is.

By contrast, KPAP delivers just the right amount of airway pressure, only when it’s needed, according to the user’s specific breathing cycle.

KPAP devices reduce airway pressure when a user inhales, then strategically increase pressure at the end of a sleeper’s exhale, when the upper airway is most vulnerable to collapsing.

The result? More comfort and better management of sleep apnea.

Research comparing KPAP to standard CPAP has found multiple potential benefits, including:

  • KPAP treated OSA as effectively as CPAP, if not slightly more effectively.
  • KPAP improved comfort compared to CPAP for 69% to 95% of patients.
  • KPAP reduced air leaks by more than 50% relative to CPAP.

KPAP is not yet available in the United States, but the SleepRes website indicates that the company has submitted the device for FDA approval and hopes it may become available to consumers in 2026.

The ‘Smart’ Way to Go

OSA is also commonly treated with a mouth insert called a mandibular advancement device (MAD) — a plastic device that fits over your upper and lower teeth to hold the mouth open for better airflow.

Peter Cistulli, PhD, MBBS, a clinician and professor of sleep medicine at Royal North Shore Hospital in Australia, is working with other researchers to develop an upgraded “smart” MAD device.

The new device uses sensors placed on a patient’s chin to indicate how long the person is lying down and sleeping. Some versions also track other vital signs, such as respiration rate, heart rate, and blood oxygen levels, which can help monitor the MAD’s effectiveness. Cistulli said the technology, which he is testing, could be designed to make automatic adjustments for precise tailoring to individual patients.

The FDA has approved two other “smart” MADs — the eXciteOSA device (which is used while awake to improve tongue muscle function through neuromuscular stimulation) and the SomnoMed MAD (which embeds sensors to monitor effectiveness) — but more advanced next-gen versions (including Cistulli’s) are under development.

The Promise of a Pill

Researchers have also been working to create an oral pill to control OSA.

The first-of-its kind medication, known as AD109, is fresh out of FDA phase III clinical trials and could soon be available to patients, pulmonologist Ana Sanchez-Azofra, MD, said at the Singapore symposium.

AD109 is a combination of aroxybutynin and atomoxetine. Aroxybutynin, also used in the treatment of overactive bladder, stabilizes the upper airway during sleep. Atomoxetine works in the brain by increasing levels of norepinephrine, used to control behavior.

“Together, they work to strengthen upper airway muscle activity and reduce collapse during sleep,” said Sanchez-Azofra, clinical development director at Apnimed, the drug’s maker.

AD109 works by increasing signals to the upper airway muscles throughout the night.

Apnimed plans to submit a new drug application to the FDA in early 2026. AD109 has been granted FDA Fast Track designation, which could potentially expedite the review process, but it’s unclear how soon the drug could hit the market.

These new developments promise to deliver better ways to treat the condition down the road. In the meantime, experts recommend people with OSA talk to their doctor for updates on these advances and the best treatment options available today.