Alternatives To CPAP Therapy for Positional Obstructive Sleep Apnea

Alternatives To CPAP Therapy for Positional Obstructive Sleep Apnea

Philips Respironics announces the launch of a new prescription sleep position therapy unit, the NightBalance Lunoa, for patients with positional obstructive sleep apnea (POSA). As a premier Philips partner, The CPAP Shop is one of the first places to buy this innovative device.

What is Positional Obstructive Sleep Apnea? 

POSA is a specific condition where breathing obstructions can occur twice as frequently when sleeping on your back versus on your side. Individuals with POSA require a different treatment than those with obstructive sleep apnea (OSA). For patients with POSA, the goal is to control sleep positions during the night and therefore, reduce or eliminate apnea episodes. 

What Is CPAP Therapy? 

CPAP, the abbreviation for continuous positive airway pressure therapy, is a treatment method for patients who have sleep apnea. CPAP machines use mild air pressure to keep the airways open and are typically used by patients who have breathing problems during sleep. More specifically, what CPAP therapy helps accomplish is making sure that your airway doesn't collapse when you breathe while asleep. 

CPAP Alternative for POSA 

NightBalance Lunoa:  

NightBalance Lunoa is a compact, lightweight, ultra-thin device that is worn across the chest in a soft, adjustable belt. The prescription sleep position therapy delivers gentle vibrations, encouraging users to alter their sleeping positions from back to side to prevent apneas. The vibrations increase in intensity as needed without disturbing sleep. And the best part, no mask is required! 

NightBalance offers an innovative adaptation program that helps you gradually adjust to POSA therapy. For the first 2 nights of use, the device monitors your sleeping behavior with no therapy. During nights 3-9, mild vibrations are gradually introduced. On day 10 and forward, full treatment is delivered when therapy is needed, reducing the time spent sleeping on your back. 

Wireless connectivity and a mobile app allow patients to monitor their own use and share data with physicians through a cloud-based system. 

Exercise and Weight Loss 

Exercise and weight loss both contribute to better sleep and reduce sleep apnea symptoms. Focusing on exercise and weight loss can help reduce the frequency of sleep apnea. Regular exercise routines help reduce excess energy, so you sleep better at night. Obesity often aggravates sleep apnea as the fatty tissue around the neck can affect airway closure during the night. Losing weight can help you minimize the number of sleep apnea episodes you experience per night.  

Sleeping Position 

Altering your sleep position is one of the easiest ways to help reduce sleep apnea symptoms. Lying on your side or stomach helps keep the airway open while you sleep. Those who sleep on their back habitually may experience sleep apnea episodes more frequently as gravity pulls down on the airway and causes it to fall open. You can also prop yourself up slightly while you sleep if you prefer sleeping on your back. This also helps keep the airway open.  

Avoiding Alcohol 

While many may feel a nightcap may help them sleep, the opposite is true. Alcohol disrupts natural sleep patterns and can contribute to episodes of sleep apnea as it relaxes the throat muscle and allows it to collapse more easily at night. Try to abstain from alcohol as much as possible and if you still want alcohol to be a part of your lifestyle, be sure to avoid alcohol consumption at least four hours before your bedtime.  

Expiratory Positive Airway Pressure (EPAP) Therapy 

Expiratory positive airway pressure (EPAP) is an emerging treatment for sleep apnea. Unlike continuous positive airway pressure (CPAP), EPAP does not require any bulky or noisy machinery. It also doesn't require batteries or electricity. Some healthcare professionals consider it preferable to CPAP because patients are more likely to use it consistently. 

EPAP is a disposable one-way resister valve that is worn over the nostrils. It works similarly to CPAP but only provides minimal resistance on inhaling and positive pressure on exhaling. This opens the airway making it less likely to collapse during inhaling. 

Mandibular Advancement Devices 

The mandibular advancement device is an anti-snoring device that looks much like a mouth guard used in sports. 

This anti-snoring device like the mandibular advancement device helps to diminish any restriction that occurs in the back of the throat by moving the jaw and tongue forward. By advancing them, the jaw and tongue move away from the back of the throat. This increases the size of the upper airway, thus reducing the air resistance that leads to snoring and sleep apnea episodes.  

Orofacial Therapy 

Orofacial myology is a specialized discipline that focuses on the evaluation and treatment of oral and facial (orofacial) muscles. Treatment by your orofacial myologist involves short exercises, a form of physical therapy that trains your oral and facial muscles to function properly, similar to going to the gym to build up other muscles in your body. Myofunctional therapy is dedicated to treating problems in the face, jaw, and mouth by retraining the muscles to function as they should. Problems that result from OMDs may include pain in the face and neck, and poor sleep due to breathing difficulties. 

Tongue Stabilizing Device  

A Tongue Stabilizing Device is a piece of flexible plastic or silicone resin, usually BPA-free and similar to what is used in sports mouth guards or baby pacifiers, shaped to fit comfortably in the mouth. The causes of sleep apnea are related to the partial blockage of the airway to and from the lungs by the tongue or throat tissue. A TSD helps open up the blocked airway by gently pulling the tongue forward and away from the back of the throat. 


Surgery is often the last resort when managing a sleep apnea problem. It is selected when CPAP therapy, other types of therapies, and the use of devices fails to produce results. It may be chosen because the airway is deformed and needs to be altered physically to prevent sleep apnea episodes. Various types of surgeries may need to be performed based on the needs of the patient, either affecting the airway, throat muscle,e or jaw.  

Why Use Alternatives to CPAP Therapy? 

CPAP therapy has always been the first choice among sleep doctors for treating obstructive sleep apnea. But new alternatives are often considered if CPAP therapy fails to provide successful results for the patient for several reasons. They may have structural issues with their airway or throat muscles or they find CPAP therapy too uncomfortable or difficult to perform on a nightly basis.  

In some instances, the OSA is not severe and may not require the extensive use of a CPAP machine or CPAP mask. Other simple devices and therapies may be adequate to produce successful results.  Before embarking on any alternative procedure, you should always consult with your doctor to determine the best path for treatment based on your particular needs.  

Clinically Proven Effective 

Patients with POSA found NightBalance easier to use, easier to adjust to, and more comfortable than other PAP therapy devices. In a study published in the Journal of Clinical Sleep Medicine,1 Positional OSA patient reported better adherence to this treatment than PAP therapy, suggesting the treatment was more effective for POSA. Furthermore, over two-thirds of adults using NightBalance reported that their bed partner noticed a decrease in their snoring severity. 

Available at The CPAP Shop 

For those suffering from positional obstructive sleep apnea (POSA), the NightBalance is an improvement over current devices. It provides an effective way to get restful sleep without uncomfortable or bulky CPAP equipment. In fact, 88% of NightBalance Lunoa users said they would recommend the device.


Berry R, Uhles M, et al. NightBalance sleep position device versus auto-adjusting positive airway pressure for treatment of positional obstructive sleep apnea. J Clin Sleep Med. 2019;15(7):947-956 


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Chris Vasta

Chris Vasta is the president of The CPAP Shop and an expert in sleep and respiratory therapy. He often provides insights on product design and functionality on various manufacturers’ prototypes and is frequently tapped to provide reviews on new releases.