Sleep apnea is a common disorder where breathing repeatedly stops and starts during sleep. The most prevalent form, obstructive sleep apnea (OSA), occurs when the muscles supporting the soft tissues in the throat temporarily relax. These breathing interruptions disrupt restorative rest and can lead to serious health issues, but changing how you position your body while sleeping is a highly effective management strategy.
Understanding Why Position Matters
The severity of sleep apnea is often directly linked to a person’s sleeping posture, a phenomenon known as positional sleep apnea. Over half of people with obstructive sleep apnea experience more severe symptoms when lying on their back (the supine position). When lying flat, gravity pulls on the soft tissues of the throat, causing them to collapse into the airway and significantly narrowing the passage for air.
This collapse increases the resistance to airflow, leading to characteristic snoring and frequent episodes of apnea and hypopnea. For approximately 20% of patients, airway obstruction occurs exclusively in the supine position. Altering the sleep position can decrease these breathing disruptions, improving both sleep quality and oxygen levels.
The Primary Recommended Position
The lateral position, or side sleeping, is widely recommended as the most beneficial posture for individuals with sleep apnea. When the body is turned onto its side, gravity no longer pulls the soft tissues directly backward onto the pharyngeal wall. Instead, the tissues fall to the side, allowing the airway to remain more open and stable throughout the night.
This position is effective because it reduces the collapsibility of the upper airway. Side sleeping also helps improve the function of the genioglossus muscle, which works to keep the airway open. While both sides are better than the back, the left side may be preferable for those with coexisting conditions like nocturnal gastroesophageal reflux disease (GERD).
Tools and Techniques for Positional Training
Positional therapy aims to train the body to consistently maintain a side-sleeping posture throughout the night. This therapy is particularly effective for those with positional sleep apnea and can be a valuable alternative or supplement to other treatments.
Behavioral Techniques
One simple, low-cost behavioral technique is the “tennis ball trick,” which involves sewing tennis balls into the back of a pajama top. The physical discomfort of lying on the balls prompts the sleeper to roll back onto their side without fully waking up, encouraging the avoidance of the supine position.
Positional Devices
More sophisticated positional devices are also available and are often preferred for their comfort and consistency. These aids include full-length body pillows, specialized anti-snore backpacks or belts, and modern devices that use vibro-tactile feedback. The feedback devices gently vibrate when a position sensor detects the user rolling onto their back, prompting a change in position without disrupting sleep.
Optimizing Sleep with Upper Body Elevation
In addition to side sleeping, elevating the head and torso can significantly optimize sleep by helping prevent the relaxation of throat muscles. This technique, known as Head-of-Bed Elevation (HOBE), uses gravity to reduce the likelihood of airway collapse. Raising the entire upper body, typically to an angle between 7.5° and 30°, has been shown to reduce the severity of obstructive sleep apnea.
It is important to use a wedge pillow or an adjustable bed to elevate the entire torso from the waist up. Propping only the head with multiple pillows can flex the neck forward, potentially straining the cervical spine and restricting the airway further. Proper elevation increases the upper airway volume and decreases airway collapsibility, offering a simple method that can be used alone or combined with other positional strategies.