Written by Lisa Bowman, Writer
EPAP is a relatively new therapy that was developed as an alternative to CPAP therapy for the treatment of obstructive sleep apnea (OSA). OSA is a sleep-related breathing disorder that occurs when the upper airway collapses as a result of muscles around the throat relaxing too much while sleeping. This causes lapses in breathing due to the airway being blocked, ultimately leading to poor quality sleep.
CPAP is the most common treatment1 for obstructive sleep apnea, and it’s used by patients at home while sleeping. It works by forcing the upper airway open with a steady stream of pressurized air, which allows for improved breathing and a better night’s sleep. However, some people find CPAP machines uncomfortable and cumbersome, so it’s no wonder that people are looking for smaller, less invasive EPAP devices. Are these EPAPs a legitimate alternative?
The AASM gathered this data by establishing a 15-person panel of sleep medicine specialists and researchers that came to a consensus on the amount of sleep each night that should provide optimal physical, mental, and emotional health. This means that if you’re an adult sleeping less than 7 hours a night, you’ll likely experience sleep deprivation.
What Is an EPAP Device?
EPAP stands for expiratory positive airway pressure. An EPAP is a small nasal device2 consisting of valves that sit in each nostril, creating a seal.
These valves allow for a normal inhale but provide resistance during the exhale. This creates a level of pressure that should prevent the upper airway from narrowing, allowing the patient to breathe normally. EPAP devices do not require electricity to function.
Some EPAP devices have been approved by the FDA to reduce snoring, while others have been cleared to treat obstructive sleep apnea3.
What Is a CPAP Machine?
CPAP stands for continuous positive airway pressure. A CPAP machine sends a steady stream of air into your nose and/or mouth through a hose and mask. This flow of air comes from a small motorized unit that draws in air from the room and cleans it of contaminants, before delivering it to the patient at a pressure specified by their healthcare professional.
The pressurized air helps to keep the airway open, which is useful in cases of obstructive sleep apnea because the muscles relax around the upper airway while sleeping. This relaxation causes the muscles to collapse, creating an obstruction that can lead to lapses in breathing.
Differences Between EPAP and CPAP Therapies
- Size – A major difference between EPAP and CPAP devices is their size, with EPAPs being much smaller in comparison.
- Power socket needed – CPAPs require a nearby power socket, as well as a secure surface to sit on, whereas an EPAP simply sits in the user’s nostrils without being attached to a machine.
- Different air pressure systems – CPAP machines send pressurized air into the patient’s airway, and EPAP devices create their own pressure when the user exhales. A sleep specialist has to calibrate a CPAP machine to the required pressure level, but pressure cannot be calibrated on an EPAP device; studies show that resistance varies across different FDA-approved EPAPs4.
Who Would Benefit from an EPAP Device?
Recent research5 shows that long-term adherence to CPAP may be as low as 25 percent in cases of mild obstructive sleep apnea, with people discontinuing for reasons including physical discomfort and psychological distress. People with mild to moderate obstructive sleep apnea who struggle to sleep wearing a CPAP mask6 may benefit from the less cumbersome design of an EPAP, which doesn’t require you to be connected to a machine.
Those who find the noise of a CPAP bothersome may also prefer the quieter design of an EPAP. Although you can buy travel CPAP machines, patients who travel frequently may still prefer the significantly lighter, more compact design of an EPAP, which also doesn’t require the lengthy, regular cleaning process that a CPAP does.
Who Would Benefit from a CPAP Machine?
CPAP is considered a popular treatment for sleep apnea7 because its effectiveness has been verified by clinical studies since its inception in the 1980s. Some research indicates that CPAP may be better than EPAP8 for the treatment of more severe cases of sleep apnea.
People who breathe through their mouth while sleeping will likely find a CPAP machine more effective as they can wear a full-face mask that delivers air to the mouth.
Effectiveness of EPAP Compared to CPAP
Current research shows conflicting evidence about the efficacy of EPAP compared to CPAP, and further investigation needs to be done before researchers can verify that EPAP is as good as CPAP when it comes to treating sleep apnea, especially when it comes to long-term treatment.3
Initial studies show that EPAP can be effective at reducing sleep apnea8 and daytime sleepiness, as well as improving quality of life in patients with obstructive sleep apnea.8 A small study of 40 people with moderate to severe obstructive sleep apnea showed no difference9 between the safety or efficacy of CPAP versus EPAP.
However, some data suggests EPAP may be more suitable for those with milder sleep apnea, as the level of improvement seen with EPAP devices is notably less than with CPAP devices.8
The general consensus of researchers is that patients are more likely to continue using an EPAP than a CPAP, which minimizes the effectiveness of a CPAP if it’s not used properly. So, in some cases, even if CPAP is more effective, using an EPAP could be preferable to not using anything at all.
Frequently Asked Questions
What is EPAP therapy?
EPAP therapy is a fairly new alternative to CPAP therapy that consists of a small device that sits in the nostrils. The device creates a seal that allows the user to inhale normally but then creates resistance on the exhale, which increases pressure in the upper airway to prevent it from collapsing. Airway collapse occurs in patients who have obstructive sleep apnea and happens as a result of the muscles around the throat relaxing too much, which compresses the airway.
Are EPAP devices FDA-approved?
Some EPAP devices are FDA-approved, though some have only been cleared to reduce snoring, while others have been approved to treat obstructive sleep apnea.3
Do EPAP devices cost less than CPAP machines?
The initial cost of an EPAP is significantly less than a CPAP, which might cost between $500 and $1,000. However, EPAPs must be replaced more frequently than CPAPs, so costs can add up. The cost of a typical FDA-approved EPAP starter kit is around $199.
It’s important to note that many insurers consider EPAP an experimental therapy, so it may not be covered by your insurance provider.
Do I need a prescription for an EPAP device?
Not all EPAP devices require a prescription, as some are designed to just treat snoring as opposed to sleep apnea. If you suspect you have sleep apnea, it’s important to get checked out by your physician for a proper diagnosis, rather than self-diagnosing and purchasing an EPAP without a prescription. Your doctor will be able to confirm a diagnosis and assess which type of PAP therapy is best suited to relieve your symptoms.
Lisa Bowman
Writer
About Author
Lisa is a content writer for Sleep Advisor, which combines two of her greatest passions – writing and sleeping. She can also be found writing about fitness, sustainability and vegan food.
Combination Sleeper
- 1. “CPAP Machine”. Cleveland Clinic. Last modified November 9, 2021. –
- 2. Waters MD, Tina. “Alternative interventions for obstructive sleep apnea”. Cleveland Clinic Journal of Medicine. 2019. –
- 3. Hakim, Tawfic S., et al. “EPAP Devices Optipillows, Bongo Rx, and Theravent: Flow Resistance and The Pressures They Generate”. Journal of Sleep Medicine and Disorders. 2021. –
- 4. Sleeper, Geoffrey., et al. “Comparison of expiratory pressures generated by four different EPAP devices in a laboratory bench setting”. Sleep Medicine. 2022. –
- 5. Qiao, Min., et al. “Long term adherence to continuous positive Airway pressure in mild obstructive sleep apnea”. BMC Pulmonary Medicine. 2023. –
- 6. Wu, Hao., et al. “A review of EPAP nasal device therapy for obstructive sleep apnea syndrome”. Sleep Breath. 2015. –
- 7. “Test your CPAP IQ”. Mayo Clinic Health System. 2022. –
- 8. Schiza, Sophia E., Mermigkis, Charalampos., Bouloukaki, Izolde. “Expiratory positive airway pressure (EPAP) nasal device therapy: a welcome addition to obstructive sleep apnea syndrome therapy”. Sleep and Breathing. 2015. –
- 9. Liu, Yaxuan., et al. “Efficacy and safety assessment of expiratory positive airway pressure (EPAP) mask for OSAHS therapy”. Auris Nasus Larynx. 2019. –