Is Exercise a Realistic Alternative to CPAP Therapy for Sleep Apnea?

by Martin Reed Patient Advocate

CPAP therapy is widely considered to be the best treatment option for sleep apnea. However, CPAP therapy can be difficult to tolerate. Others find it a hassle and choose to avoid it. Could exercise be an alternative treatment option?

Managing obstructive sleep apnea

Obstructive sleep apnea (OSA) can be difficult to manage if an individual doesn't comply with standard facial mask treatment options. Keep in mind that CPAP therapy doesn't actually treat any of the underlying causes of OSA.

A study published in Respiratory Medicine set out to determine whether exercise could improve symptoms of OSA.

The study

Researchers conducted a systematic review and meta-analysis on previous studies that evaluated the effect of exercise on Epworth Sleepiness Scale and apnea hypopnea index (AHI) scores.

Sleep apnea severity is measured by the number of apnea or hypopnea events per hour of sleep. This is represented by the apnea hypopnea index:

  • Less than five per hour: None/minimal OSA

  • Five or more but less than 15 per hour: Mild OSA

  • 15 or more but less than 30 per hour: Moderate OSA

  • 30 or more per hour: Severe OSA

The Epworth Sleepiness Scale measures daytime sleepiness through the scoring of eight questions related to a daytime situation in which an individual may fall asleep. Scores range from:

  • Zero to five: Lower normal daytime sleepiness

  • Six to 10: Higher normal daytime sleepiness

  • 11 – 12: Mild excessive daytime sleepiness

  • 13 – 15: Moderate excessive daytime sleepiness

  • 16 – 24: Severe excessive daytime sleepiness

Researchers found that exercise was associated with a reduction in AHI scores and a reduction in ESS scores after treatment.

The best form of exercise for sleep apnea

It would appear that the actual type of exercise isn’t especially important.

After examining data from eight studies involving 180 participants, researchers found that the reduced AHI and ESS scores remained consistent regardless of the form of exercise, duration of exercise, or frequency of exercise sessions. Simply exercising is what’s important.

Why exercise can improve sleep apnea symptoms

Exercise has already been found to improve insomnia symptoms. Why does it also appear to improve sleep apnea symptoms?

Obstructive sleep apnea is more common in obese individuals. Obesity is linked to increased adipose tissue, which can collapse the airway, leading to apnea or hypopnea events.

Previous studies have suggested that a reduction in BMI can lead to a reduction in adipose tissue, which may explain the reduction in AHI and ESS scores.

Interestingly though, the study in Respiratory Medicine found that exercise improved OSA symptoms regardless of any reduction in BMI. It would appear that simply getting regular exercise is the key to reducing OSA symptoms. You don't need to do strenuous or challenging exercising.


This study suggests that exercise may be an appropriate primary treatment and management option for obstructive sleep apnea, and that low-calorie diets and surgical interventions may not be required.

If you find life with a CPAP machine difficult, you may wish to speak with your doctor about putting together an exercise regimen that could help relieve your symptoms.

In the meantime, continue to follow your doctor's advice — particularly if you have been prescribed CPAP therapy.

Martin Reed
Meet Our Writer
Martin Reed

Martin is the creator of Insomnia Coach, an eight-week course that combines online sleep education with individual sleep coaching. His course helps clients improve their sleep so they can enjoy a better life with more energy and start each day feeling happy, healthy, rested, and refreshed. Martin also runs a free sleep training course that has helped over 5,000 insomniacs. He holds a master’s degree in health and wellness education and studied clinical sleep health at the University of Delaware.