Did you know that millions of sleep apnea sufferers could reduce (or even eliminate) their sleep apnea by simply sleeping on their side, instead of their back?
That’s because it’s estimated between 53% and 77% of people with obstructive sleep apnea have “positional” apnea – which means their condition is much worse when they sleep on their back. (We briefly cover why below.)
But first, let’s do a quick recap of what positional therapy for sleep apnea is…
What is Positional Therapy for Sleep Apnea?
Positional therapy is a behavioral strategy to treat the disorder. More than that, it is a set of practical procedures used to keep your airways clear as you sleep.
There are a number of sleeping positions to keep in mind and habits that need to be broken as a start. The first habit, and potentially the easiest to break, is sleeping on your back. This is also referred to as "sleeping in the supine position." It's natural. It feels good. But according to The Journal of Clinical Sleep Medicine, sleeping in this position is associated with obstructive sleep apnea.
Gravity is the culprit here. When you sleep on your back, your lower jaw, tongue, and the soft tissues of the uvula and palate block your airway when it pulls everything down, blocking your airway. This immediately causes breathing issues and exacerbates the disorder. The idea is obvious and simple: you have to find a way to sleep in any position but on your back. There are a number of ways to do this, however.
For some people, improving or eliminating sleep apnea is as simple as sleeping on their side instead of on their backs.
But how easy is it to train yourself to do something that comes so natural? You still have options. You could go the negative reinforcement route. There are special devices or wearable belts that fit around a person's waist or back that make sleeping on your back close to unbearable. Another strategy is to use alarms or buzzers that affix to your clothes to wake you as soon as you lay on your back. Or you can take it easier on yourself and get special pillows or pads that encourage sleeping on your side.
These products are available online. Lots of them exist to help you manage your sleep posture. Every one of them fall under Positional Therapy for sleep apnea and with constant use can be very effective over time, potentially. This typically depends on the individual, however. This makes it difficult to determine how effective positional therapy is for most people.
What Are the Different Types of Positional Therapy?
The habit of sleeping on your back is a hard habit to break to be sure. But, as mentioned before, this habit is a catalyst to sleep apnea.
There are a few alternative positions to consider while you sleep. These positions have been proven over time to reduce the number of apnea “events” (i.e. when you stop breathing) and, in some instances, eliminate the disorder entirely.
The idea is simple: you have to keep your airways clear while you sleep at night.
Here are three ways to change your sleeping position to keep your airways open:
Lateral Body Position
The lateral body position is what it sounds like. You lie on your side, right or left. You can also place a pillow in between your legs for added comfort.
Lateral Head Position
As mentioned before, your tongue, lower jaw, and uvula all play a major part in blocking your airway while you sleep. When that happens, you stop breathing for a few seconds, every other minute. These minutes turn to hours and the results can be devastating.
Sleeping in a lateral head position is the perfect counter to this. Same as with lateral body positioning, this is about sleeping with your face against your pillow, on its side, as opposed to on the back of the head.
So, it’s not even necessary to keep your entire body on its side – you can lie on your back with your head tilted to the side. This keeps your tongue, uvula and such from falling to the back of your throat, keeping the airway clear.
Prone Body Position
If sleeping on your side is something you just don't see yourself getting comfortable with, there is a third alternative: sleeping on your stomach.
Also called the “prone” position, this could be an even more effective way to keep your airway clear during the night.
Doing this is using gravity to your advantage instead of against it. Lying on your stomach, the same parts responsible for blocking your upper airway are now being pulled in the opposite direction – away from your upper airway.
At this point, you might be thinking: “That sounds easy in theory – but how do I actually do it in practice?”
Sleeping on your side or stomach for the entire night could be even more difficult if you’ve slept on your back for years or decades.
So how can you force yourself to sleep laterally or prone?
That’s where positional devices come in.
Positional Devices for Sleep Apnea: 8 Types of Devices for an Apnea-Free Night
There are a surprising number of positional therapy devices that have been created to keep you from sleeping on your back. These devices are often situated at the waist, neck or back, and influence sleeping positions and movement.
In an experiment with 112 sufferers of sleep apnea, the National Institutes of Health reported that 75 percent of patients who tried positional therapy were able to achieve normal sleep and have no episodes of apnea.
During the experiment, patients in a sleep laboratory used aids, such as backpacks or long supportive pipes, to sleep in a lateral left or lateral right position. Positional therapy relies on the willingness of the sleeper to commit to using these types of aids on a regular basis.
In this section we’re going to cover the following positional devices in detail, including what they are, how they work, and the scientific evidence supporting them:
Positional pillows come in different styles and are a practical aid to reduce your sleep apnea and the snoring that comes with it.
Wedge pillows placed under your upper half, for example, work by elevating you at an angle that allows you to sleep on your back and keep your airway from obstruction because of the elevation. They are made of foam, not unlike the material memory mattresses are made from, providing comfort while keeping you on your back.
Cervical pillows, also known as contour pillows, are another alternative aid. Not only does it keep your airway open by keeping the neck in a certain position, it can also relieve neck and shoulder pain as well as headaches if used long term. While cervical pillows can be used by those who prefer sleeping on their back, they are actually intended for side sleepers.
In a study done on sleepers with obstructive sleep apnea, researchers tested the use of positional therapy pillows and found that users went from having 17 cases of paused breathing an hour to having less than five. The pillow also reduced instances of snoring.
Positional T-Shirts (aka “Tennis Ball T-Shirts”)
A positional therapy T-shirt is a shirt with a special pocket in the back that stores a “bumper”, such as a tennis ball, a balled-up pair of socks, or another object. This uncomfortable bumper prevents the sleeper from rolling over and lying in a supine position (i.e. on their back).
An inexpensive and simple strategy, this T-shirt keeps the sleeper on their side and therefore prevents gravity from allowing internal tissue (such as the soft palate) from blocking their upper airway; it also reduces snoring while anchoring the body in a lateral sleeping position, which is one of the best positions for apnea sufferers.
Many users of positional therapy T-shirts report waking up and adjusting their sleeping to a safer position thanks to the uncomfortable bumpers. The T-shirt also encourages some apnea sufferers to sleep on their stomachs, which can also help users avoid sleep apnea. However, the stomach position puts stress on the neck and back so it is not as recommended as the lateral position.
This bumper T-shirt trick is an old one, at least dating back to 1984 when a wife sewed a pocket onto her husband’s nightshirt and inserted a plastic ball to cure his snoring and apnea. Sleep researchers refer to this treatment as the “Tennis Ball Technique” (TBT).
In a study of 12 sleepers with obstructive sleep apnea who experimented with affixing a tennis ball to the back of their shirts, researchers found that most sleepers were able to reduce the time they slept in a supine position from 79% to just 12%. One caveat, however, is that researchers say TBT was so uncomfortable that many sleepers stopped using it after a few months and sought other positional therapy devices.
Simple, but potentially effective reinforcement. You can make your own or purchase already made tennis ball t-shirts that include a pouch in the back that you can zip and unzip. Just place the ball in the pouch, zip it up, and you're good to go.
A positional therapy vest is often made of linen and has a tubular-shaped piece of hard foam attached to the upper back or upper side to prevent the supine position, thereby stopping the upper airway from collapsing and causing abnormal breathing. This reduces the risk of obstructive sleep apnea.
These vests are made in a range of sizes to fit different chests’ and waists’ circumferences. The foam inserts curve and adjust to the shape of one’s spine to give a custom fit. Sleepers put the vests on before bed and fasten them in the front with snaps or Velcro. The vests are typically so lightweight and comfortable that they do not disturb sleep.
Sleep technicians using polysomnograph machines found that those who added positional therapy vests to their sleeping routines reduced their respiratory disturbance by more than 75 percent. These sleepers were able to increase their oxygen levels as well. Snoring was not always cured by the vests; some users experienced reduced snoring while others noticed increased snoring in the study.
Positional Belts (aka “Bumper Belts”)
A positional therapy belt consists of a wide strap and an oblong rear pack filled with a foam block. The belt can be worn high around the chest or around the waist, depending on the design.
Some belts have one large foam bumper in the back while others have multiple small bumpers. Some positional therapy belts come with inflatable air bladders that can be used to create an adjustable fit by increasing or decreasing the bumper size. Apnea sufferers should choose whatever style feels most comfortable.
The foam blocks prevent the wearer from sleeping on his or her back. If the user tries to lie in a supine position, the belt will cause a rocking motion that will tip the wearer back into a lateral position. The belt usually fastens with Velcro straps and is loose enough to not constrict the body while sleeping.
Positional therapy belts have had great success in keeping the tongues and soft tissues of sleepers from falling back and stopping respiration in clinical trials.
Sleep Position Trainers
A positional trainer is a device worn on the body that vibrates or sounds an alarm whenever a sleeper rolls onto his or her back. Some trainers are worn around the neck while others are worn on the chest. The trainer’s vibrations or alarm becomes more intense the more the sleeper stays in a supine position. The alarms and vibrations also change patterns to get the attention of the supine sleeper.
These signals encourage the user to return to a lateral position and over time conditions them to not seek the supine position at all, thus eliminating the danger of soft tissue blockage, which can cause obstructive sleep apnea.
Many neck styles require a sensor to be worn on the back of the neck to detect when the sleeper is rolling backwards to sleep. However, chest styles use a digital accelerometer to sense when a sleeper is lying supine. The latter device often needs a period of analysis where the monitor records data of the user’s sleeping position for the first few days.
Studies show that positional trainers can reduce supine sleeping within three to nine days of use. In a study comprised of 106 users, 97 percent of people had no incidents of supine sleeping after six months of consistent belt use.
A more expensive, but more comfortable alternative, is to spring for an adjustable bed, which is exactly what it sounds like.
Beds beneficial for reducing sleep apnea include those with adjustable inclines or those with wedge mattress toppers. These beds, some of which conveniently use remote controls, can lift the sleeper six inches or more so that they are not lying flat on the back. Upper body elevation will prevent breathing obstruction and snoring in apnea sufferers by reducing upper airway collapsibility.
Adjustable beds are helpful for those who feel they won’t get a good night’s rest when sleeping in a lateral position and those who simply prefer back sleeping. Since the beds don’t include any bumpers or uncomfortable aids, they do not disturb sleep or comfort in any way. Many sleepers who use inclined beds combine them with other positional therapy devices.
In studies where the head of the bed was elevated to a 30-degree or 60-degree angle, breathing improved drastically for those with sleep apnea. Even if the incline was little as seven degrees, a 30 percent reduction in respiratory obstruction was observed in some patients.
A recliner, which is a chair that can tilt backwards, can be a sleeping aid for sleep apnea sufferers because it keeps the sleeper in a semi-upright or inclined position, which reduces the pull of gravity on the soft tissues. This makes breathing easier. In addition, a recliner, due to its ample cushioning, can mitigate neck and back pain, offering high-quality sleep.
To be effective for treating sleep apnea, a recliner should elevate the upper body to a 30-degree angle, according to the book “Obstructive Sleep Apnea: New Insights for the Healthcare Professional.”
However, studies show that a 60-degree angle works even better to enhance breathing and increase oxygen levels. Another benefit of sleeping in a recliner is that apnea sufferers are not awakened from their sleep by discomfort as they might be with trainers and bumpers.
An oral appliance is a plastic dental device placed between the upper and lower teeth that either holds the tongue in place so that it won’t fall back or that shifts the lower jaw forward and down to relax soft tissues and keep the airway open during sleeping.
Whether you choose the tongue-suppressor style or the mandible-shifting design, each should be custom made to fit your mouth by a dentist in order to be the most effective. An oral appliance will work in any sleep position. So, apnea sufferers wearing them are not required to lie on their sides or be inclined.
According to the Journal of the American Medical Association, these dental guards are effective for those with mild to moderate apnea but may not work as well for those with severe apnea. While they can reduce the snoring associated with apnea, they may not work to reduce daytime sleepiness.
A Final Word
It really is about keeping the airway from being obstructed while you sleep.
Having a disorder can be humbling, maybe even a bit scary. But when it all comes down to it, it really can be as simple as trading old habits for new ones. You are certainly not alone.
Obstructive sleep apnea is common all over the world. It all comes down to behavior and using whatever you can to change your situation for the better.
Sleep apnea can cause a host of ailments and does so because of the toil it takes on the body and the many functions it uses while you sleep. Changing your habits won't just benefit you, it will be of great relief to your partner as well.