Oral pressure therapy (OPT) is a relatively new form of therapy for obstructive sleep apnoea (OSA). Paradoxically it seems to work even though it creates a vacuum in the oral cavity as opposed to the gold standard of continuous positive airway pressure (CPAP). The idea is that it draws the soft palate anteriorly allowing more space in the retropalatal area for nasal breathing. There are only a few studies in the literature of variable quality, but the authors have done a good job explaining the heterogeneity and differences between the papers, particularly with regards what each author considered to be a successful result. The obvious conclusion is that OPT is ideal for patients who want to avoid CPAP or who are intolerant of it and who only have OSA secondary to soft palate obstruction. This would suggest that the nasal airway was normal and more importantly the tongue base is not involved. Considering OSA requires a multilevel approach in the majority of cases, it is not surprising that OPT results are not as good as CPAP. It is reputably quieter and more easily tolerated than CPAP, but you are still attached to a machine similar to an entonox delivery mouth piece all night. Broadly speaking the success rate was between 20-70%, but most results were around the 45% region. My opinion of OPT is that it is a clever idea for a small number of OSA patients, the difficulty is the selection process for this therapy. Here again the controversy surrounding drug induced sedation endoscopy vs clinical examination will inevitably enter the debate. I suspect however that OPT would mainly benefit patients with ‘simple snoring’ particularly those with a predominant palatal flutter.