Positional therapy is a treatment approach for obstructive sleep apnea that involves adjusting a person’s sleeping position to prevent airway obstruction during rest. This method helps keep the upper airway open, reducing the frequency and severity of breathing interruptions. Obstructive sleep apnea, a common sleep disorder, is characterized by recurrent episodes where the airway partially or completely collapses, leading to pauses or reductions in breathing while asleep.
The Link Between Sleep Position and Apnea
Sleeping on the back, known as the supine position, can worsen obstructive sleep apnea. In this position, gravity pulls the tongue and soft palate towards the back of the pharynx. This gravitational effect increases the collapsibility of the upper airway, making it more prone to narrowing or complete blockage. The result is an increased number and severity of apnea and hypopnea events.
This position-dependent breathing disturbance defines Positional Obstructive Sleep Apnea (POSA). Individuals with POSA experience a higher severity of apnea events when sleeping on their back compared to sleeping on their side. Clinically, POSA is often identified when the Apnea-Hypopnea Index (AHI) is at least twice as high in the supine position as in non-supine positions. Research indicates that approximately half of all individuals diagnosed with obstructive sleep apnea may have POSA, with this percentage being even higher among those with mild to moderate forms of the condition.
Identifying Candidates for Positional Therapy
Positional therapy is suited for individuals diagnosed with mild to moderate Positional Obstructive Sleep Apnea. A formal diagnosis from a comprehensive sleep study is necessary to determine if a person’s apnea events are position-dependent. This diagnostic test provides information about sleep patterns and breathing, including how apnea severity changes with different body positions. Identifying positional dependency is important.
Individuals with severe obstructive sleep apnea or central sleep apnea are not suitable candidates for positional therapy alone. Central sleep apnea, unlike obstructive sleep apnea, involves a lack of effort to breathe due to a problem with brain signals, rather than a physical blockage. For these more complex cases, other forms of treatment are often recommended.
Methods and Devices for Positional Therapy
Various methods and devices are available to help individuals maintain a non-supine sleeping position. Low-tech and do-it-yourself (DIY) strategies are often the starting point. A common example is the “tennis ball technique,” where tennis balls are sewn into a pocket on the back of a nightshirt or pajama top. This creates an uncomfortable sensation when the wearer attempts to roll onto their back, prompting them to shift to a side-sleeping position. Specialized pillows and wedges also support side-sleeping and discourage back-sleeping by making the supine position uncomfortable.
Beyond these simple approaches, several commercial products offer more structured solutions. These include bumper belts or sleep vests worn around the chest or waist. These devices often incorporate firm elements or inflatable chambers on the back, physically preventing the user from lying flat on their spine. Modern, high-tech options involve wearable electronic devices, worn on the chest or neck, that detect when the user is in the supine position. These smart devices then deliver a gentle vibration or subtle alarm to alert the individual to change their sleeping posture without fully waking them.
Comparing Positional Therapy to Other Treatments
Positional therapy fits into a broader landscape of sleep apnea treatments, often compared with Continuous Positive Airway Pressure (CPAP) therapy, a common treatment for obstructive sleep apnea. CPAP works by delivering a continuous stream of pressurized air through a mask, which acts as an air splint to keep the airway open during sleep. While CPAP is effective across various severities of obstructive sleep apnea, positional therapy is tailored for individuals with position-dependent apnea.
Studies show that positional therapy can reduce the Apnea-Hypopnea Index (AHI) and improve oxygen saturation levels for those with positional obstructive sleep apnea. However, some research indicates that CPAP may be superior in reducing overall sleep apnea severity and increasing oxygen saturation levels, even in positional cases. Patient comfort and compliance are often factors in treatment choice; positional therapy is considered non-invasive and can achieve better compliance rates than CPAP for some individuals, as it avoids the need for a mask. From a cost perspective, positional therapy options are often less expensive than CPAP machines and associated supplies, making it a more economical choice. While CPAP provides consistent airway support, positional therapy offers a less intrusive alternative.