For decades, CPAP has been the default treatment for obstructive sleep apnea — and for most patients it still is. But CPAP is not the only effective option, and AAIRS Clinic & Troy Sleep Center sees a steady stream of adult patients who either cannot tolerate the mask or have tried it long enough to know it isn't the right long-term answer for them. This article covers what comes next.
The conversation has shifted meaningfully over the last several years. Inspire upper-airway stimulation therapy is now an established treatment for moderate-to-severe obstructive sleep apnea in selected adults, oral appliance therapy has matured into a credible option for mild-to-moderate disease, and positional therapy continues to have a real role for the subset of patients whose apnea is largely a function of supine sleep. AAIRS Clinic is recognized as an Inspire Center of Excellence and has been on the leading edge of that shift in southeast Michigan. The discussion below covers each option, who it is for, and how the team at AAIRS Clinic decides among them.
What Inspire therapy actually does
Inspire is an implanted upper-airway stimulation system. A small device is placed under the skin of the upper chest, with one lead sensing the breathing pattern and a second lead delivering mild stimulation to a branch of the hypoglossal nerve, which controls tongue movement. During sleep, the system delivers timed pulses synchronized with the breathing cycle that move the tongue forward — opening the airway from the inside rather than holding it open with positive pressure from outside.
The patient turns the system on with a small handheld remote before bed and turns it off in the morning. There is no mask, no tubing, no humidifier, no daily cleaning. For patients who never adapted to CPAP — typically because of mask claustrophobia, persistent leaks, nasal obstruction, or sheer fatigue with the daily ritual — Inspire is a fundamentally different therapeutic concept rather than a marginal improvement on the same idea.
Who Inspire therapy is for
Inspire is not for every patient with sleep apnea, and the candidacy criteria matter. The standard adult indications are moderate-to-severe obstructive sleep apnea (AHI in a defined range), documented inability to tolerate or benefit from CPAP, a BMI under a specified threshold, and an absence of complete concentric collapse at the velopharynx on a drug-induced sleep endoscopy. That last criterion is the one most patients are not expecting — Inspire works by moving the tongue, so a patient whose airway closes primarily at the soft palate in a circumferential pattern is not a candidate even if the other criteria are met.
AAIRS Clinic's status as an Inspire Center of Excellence means the practice handles candidacy evaluation, drug-induced sleep endoscopy referrals, peri-procedural coordination, post-implant titration, and long-term follow-up in-house, working with surgical partners for the implant itself. For patients who are not Inspire candidates, the conversation moves to the other options on the list. The decision typically starts with the diagnostic study results — and the trade-offs between home and in-lab sleep studies shape how much of the picture the team has at the first treatment conversation.
Oral appliance therapy and positional approaches
For adult patients with mild-to-moderate obstructive sleep apnea, oral appliance therapy is often the second-line option after CPAP and the first-line option for those who decline CPAP up front. A properly fitted mandibular advancement device — fabricated by a dentist with specific sleep medicine training — holds the lower jaw slightly forward during sleep, opening the upper airway. Done well, the response rate in appropriate patients is meaningful; done casually with a one-size-fits-all device, it isn't. AAIRS Clinic coordinates directly with local sleep-trained dentists, and the workup includes a follow-up sleep study with the device in place to verify that the treatment is actually working.
Positional therapy is the most under-recognized option in the menu. A subset of patients have apnea that is dramatically worse when they sleep on their back and substantially mild when they don't — and for that subset, a position-restricting device that keeps them off their back can produce a clinically significant reduction in AHI without any other intervention. The team identifies position-dependent cases from the sleep study itself, and positional therapy gets considered specifically rather than handed out as a catch-all suggestion.
Why upstream conditions matter
A point that gets lost in the treatment conversation: sleep apnea is rarely a clean isolated diagnosis. Untreated allergic rhinitis worsens nasal resistance and undermines mask therapy. Poorly controlled asthma drives nocturnal awakenings and complicates the symptom picture. Reflux drives upper-airway inflammation that contributes to the obstruction itself. The patients who do best on any sleep apnea treatment — CPAP, Inspire, oral appliance, or otherwise — are usually the ones whose upstream contributors are addressed at the same time.
That coordination is the rationale for AAIRS Clinic's multi-specialty model. Sleep medicine, allergy, asthma, and immunology services share the same physicians and the same chart, so the patient who comes in for a CPAP intolerance conversation gets the allergic rhinitis worked up at the same visit rather than waiting six weeks for a separate referral. The fuller picture of how the practice coordinates care across specialties is on the about page, and the broader practice profile is on the main AAIRS Clinic website. Parents asking about pediatric versions of these conversations can also see the pediatric sleep evaluation guide for what the workup looks like in children.
Conclusion
CPAP intolerance is not the end of the road for an adult patient with obstructive sleep apnea. Inspire therapy, oral appliance therapy, positional treatment, and combined approaches all have a place, and the right choice depends on the diagnostic picture, the patient's anatomy, and the upstream conditions that influence the airway. AAIRS Clinic & Troy Sleep Center handles that full conversation in-house, and adult patients in Troy, Sterling Heights, and across Oakland and Macomb counties can reach the AAIRS Clinic team through the contact page to ask about candidacy for Inspire or any of the other treatment options described here.