You have tried CPAP and cannot get on with it
Needing something other than a mask is common and it is not a failure. What is available depends on why the machine did not work, and on what your sleep study showed, so the honest first step is working out which of these you are actually a candidate for.
- Make the machine work after all Often a mask or settings problem rather than a verdict
- Oral appliance therapy A custom dental device that holds the jaw forward
- Inspire and implanted stimulation For a specific group, with strict criteria
- Zepbound The first medicine approved for sleep apnea, alongside diet and activity
- Weight, position and alcohol The conservative measures named in the guidelines
“Intolerance” means two different things
Worth knowing before you are told you do or do not qualify for something. Clinically, intolerance is broad: an inability or unwillingness to use the machine because of leak, pressure, claustrophobia, nasal obstruction, swallowing air, insomnia or simply life. There is no single numeric definition of it in the sleep guidelines.
For insurance purposes, and specifically for implanted stimulation, Medicare defines it far more narrowly: use under four hours a night on five nights a week, or the device having been returned, with a documented shared decision. That is a coverage rule, and it is not the same as the coverage adherence rule for the machine itself, which is four hours on 70 per cent of nights. Those three numbers get mixed up constantly, including by clinicians.
Which one applies to you depends on what you are applying for.