Pediatric obstructive sleep apnea is a condition where a child’s breathing repeatedly stops and starts during sleep due to a blocked airway. This interruption can lead to disturbed sleep and affect a child’s daytime behavior and overall well-being. Understanding how sleep positions influence a child’s breathing can offer simple adjustments to help manage these symptoms.
How Sleeping Position Affects a Child’s Airway
A child’s airway can narrow or become blocked during sleep primarily because muscles in the back of the throat naturally relax. This relaxation, combined with often enlarged tonsils and adenoids, can significantly impede airflow. When a child lies flat on their back, known as the supine position, gravity can cause the tongue and other soft tissues in the throat to fall backward. This restricts the passage for air, leading to pauses in breathing. The severity of breathing disruptions can increase when a child is on their back, as gravity directly contributes to the narrowing of the airway.
Recommended Sleeping Positions
Side sleeping, also known as the lateral position, is often recommended for children with sleep apnea because it helps maintain an open airway. When a child sleeps on their side, gravity pulls the tongue and soft palate forward, away from the back of the throat, reducing the likelihood of obstruction. This position can help manage mild to moderate cases of sleep apnea and may also reduce snoring, which is frequently associated with the condition. To help a child remain in this position, a body pillow or a small pillow placed behind their back can prevent them from rolling onto their back during the night.
Elevating the head of the bed also assists in keeping the airway open by using gravity to prevent soft tissues from collapsing. This semi-upright position can be achieved by placing firm blocks under the legs at the head of the bed, raising it by about 6 to 9 inches (15 to 23 cm). Alternatively, a firm wedge pillow placed under the mattress can elevate the child’s upper body to a 30 to 45-degree angle, ensuring support from the upper back to the head. For older children, specialized pillows designed to encourage side-sleeping or maintain an elevated position can also be beneficial.
Positions to Avoid and Safety Considerations
Sleeping flat on the back (supine position) is generally the position most likely to worsen sleep apnea symptoms in children, as it allows gravity to pull the tongue and soft tissues backward, obstructing the airway. For children diagnosed with sleep apnea, avoiding this flat-back position is generally advised.
Stomach sleeping (prone position) may open the airway for some individuals by preventing the tongue and soft tissues from blocking the throat. However, for infants, stomach sleeping is strongly associated with an increased risk of Sudden Infant Death Syndrome (SIDS). The American Academy of Pediatrics recommends that all healthy infants younger than one year old should be placed on their backs to sleep to reduce SIDS risk. It is important to adhere to safe sleep guidelines for infants, which include using a firm, flat mattress in the crib without any pillows, loose blankets, or soft toys.
Complementary Environmental and Lifestyle Adjustments
Beyond specific sleeping positions, certain environmental and lifestyle adjustments can support better breathing during sleep. Managing nasal congestion, often caused by allergies or colds, can significantly improve airflow through the nose. Using a cool-mist humidifier in the child’s room can help keep nasal passages moist, and saline nasal sprays or rinses can clear congestion. If allergies are a contributing factor, prescribed antihistamines or nasal steroid sprays may help reduce inflammation and improve breathing.
Maintaining a healthy weight also plays a role in reducing pressure on the airway over the long term, as obesity is a risk factor for sleep apnea in children. A healthy diet rich in fruits, vegetables, and lean proteins, combined with regular physical activity, can support a healthy weight and contribute to improved sleep. These adjustments can complement a comprehensive treatment plan developed by a pediatrician or sleep specialist, working towards more restful and healthy sleep for the child.