The VA and DoD Just Changed Their Sleep Apnea Guidelines — Here’s What That Means for You
- Asher Diamond, DDS D.AMDSM
- Jul 28
- 2 min read
When most people think about sleep apnea treatment, they picture a CPAP machine. And for many, that’s still the gold standard. But for a growing number of patients—especially veterans—CPAP isn’t the best fit. Whether it’s due to discomfort, lifestyle, travel, or other medical issues, not everyone can stick with it.
That reality is now reflected in the updated 2025 clinical practice guidelines from the Department of Veterans Affairs and Department of Defense. These guidelines, released earlier this year, offer a more flexible, patient-centered approach to treating obstructive sleep apnea (OSA). And that’s a welcome change.
Not Just CPAP Anymore
One of the most notable updates is the official recognition of mandibular advancement devices (often referred to as oral appliances) as a first-line treatment for patients with mild to moderate OSA. That means oral appliance therapy now stands beside CPAP—not behind it—as an evidence-supported option from the start.
For those unfamiliar, oral appliances work by gently positioning the lower jaw forward during sleep to help keep the airway open. They’re small, portable, and quiet. And for many patients, they’re simply easier to live with.
Positional Therapy and Weight Management Get a Boost
The new guidelines also give more weight to positional therapy, especially for patients whose apnea episodes are worse when they sleep on their back. Combined with lifestyle changes or another therapy, this can be surprisingly effective.
And in a long-overdue update, the guidelines now recommend evidence-based weight management programs as part of a comprehensive OSA treatment plan, particularly for those who are overweight or obese.
When CPAP Doesn’t Work — Patients Now Have Backed-Up Options
The VA/DoD also addressed a question many providers hear regularly: “What if I can’t tolerate CPAP?”
The updated response? You’re not out of options.
Patients who struggle with CPAP may be good candidates for:
• Auto-titrating CPAP (APAP)
• Oral appliance therapy
• Referral for nasal surgery if anatomical obstruction is a barrier
• A short trial of a sleep aid like eszopiclone (in specific situations)
This shift makes it easier for providers to tailor care based on what will actually work for the individual, not just what works best in theory.
Some Treatments Still Lacking Data
The guidelines also clarify that certain interventions still need more evidence. These include:
• Myofunctional therapy
• Expiratory positive airway pressure (EPAP)
• Intraoral negative pressure
• Electrical stimulation
They’re not off the table but they’re not formally recommended yet either.
Why This Matters
For those of us treating sleep apnea in diverse populations, especially veterans, these changes matter. They recognize what we've long known in practice: one size doesn't fit all. The best treatment is the one a patient will actually use, consistently and comfortably.
By acknowledging alternatives like oral appliance therapy in the guidelines, the VA and DoD have opened the door for more patients to get effective care that fits their lives.
Are you a veteran wondering what this means for your care?
Reference:
VA/DoD Clinical Practice Guideline for the Management of Chronic Insomnia Disorder and Obstructive Sleep Apnea (2025):
Comments