Myofunctional therapy

Treat it as a low-risk add-on to CPAP, a mouthpiece or surgery — something that may make you less sleepy and help you stick with CPAP (continuous positive airway pressure) — not as a treatment for the apnea itself.

What it is

Obstructive sleep apnea (OSA) is the repeated collapse of the upper airway during sleep. Myofunctional therapy tries to work on the muscles involved: a daily set of exercises that retrains the tongue, lips, cheeks and throat muscles to hold a correct resting posture — lips sealed, tongue flat against the roof of the mouth, breathing through the nose. It is taught by specially trained dentists, speech-language pathologists and physical therapists.

The famous numbers, and what they rest on

A 2015 meta-analysis concluded that the exercises cut the apnea-hypopnea index (AHI, the number of full or partial airway blockages per hour of sleep) by about 50% in adults and 62% in children, and also improved the lowest overnight oxygen level, snoring and daytime sleepiness.^[1]

Those figures are still quoted, but the evidence under them is thin. The adult estimate pooled nine studies with 120 patients in total, most of them before-and-after comparisons with no control group; the children's estimate came from two studies and 25 children.

What randomised trials show

A 2025 network meta-analysis that counted only randomised trials — 15 of them, with 473 adults and 139 children — did not reproduce the effect on apnea severity. The AHI fell by 8.7 events an hour on average, but the range compatible with the data ran from a 21-event improvement to a 4-event worsening, so the result cannot be told apart from no effect.^[2]

The symptom side did hold up in the same analysis. Daytime sleepiness improved by about 3.5 points on the 24-point Epworth sleepiness scale, and sleep quality by about 2 points on a standard sleep-quality questionnaire, both clearly beyond chance.

A 2026 re-analysis of nine systematic reviews was more positive: in adults, a pooled AHI reduction of about 9.5 events an hour that did clear chance, and a gain of about 3 percentage points in the lowest overnight oxygen saturation. But it rated the methodological quality of most of those reviews as critically low, mixed randomised trials with uncontrolled before-and-after studies, and judged most of the underlying studies to be at high risk of bias.^[3] The two analyses are not independent of each other: they re-pool largely the same few hundred patients.

Where it fits

The exercises are low-risk and may improve how well people tolerate CPAP, a machine that blows air through a mask to hold the airway open. That makes them a reasonable add-on to CPAP, a dentist-fitted mouthpiece or care after airway surgery. On the best randomised evidence they are a symptom treatment rather than an apnea treatment, and not a substitute for any of those. The full range of treatments is compared on Sleep-disordered breathing.

They are also worth considering for people who breathe through the mouth at night when the cause is muscular rather than structural (a blocked nose, for example) — one step in the sequence that should come before mouth taping.

What to do

1. Get a proper diagnosis first. If you snore or wake unrefreshed, a sleep study tells you whether you have apnea and how severe it is.
2. Don't use the exercises instead of first-line treatment such as CPAP or a mouthpiece.
3. For mild apnea or alongside CPAP, ask about a course with a trained therapist, expecting help with sleepiness rather than a cure.

Further reading

• Camacho M et al. Myofunctional Therapy to Treat Obstructive Sleep Apnea — systematic review and meta-analysis. Sleep 2015.^[4]
• Xu Y et al. Efficacy of myofunctional therapy for obstructive sleep apnea: A systematic review and network meta-analysis. J Evid Based Dent Pract 2025.^[5]
• Pisoni E et al. Myofunctional Therapy in Adults and Children With Obstructive Sleep Apnea: An Overview and Re-Analysis of Systematic Reviews. J Sleep Res 2026.^[6]