Obstructive Sleep Apnea (OSA) is a common disorder where the airway repeatedly collapses during sleep, leading to reduced or completely blocked airflow. This interruption in breathing often causes fragmented sleep and daytime fatigue. Positional Therapy (PT) is a non-invasive treatment approach that specifically addresses a subgroup of OSA patients whose breathing disturbances are highly dependent on their sleeping posture. The therapy trains the individual to avoid sleeping on their back, or the supine position, thereby keeping the airway open.
How Sleep Position Influences Apnea
The severity of Obstructive Sleep Apnea is significantly affected by the position in which a person sleeps. When a person with OSA lies on their back, gravity pulls the tongue base and the soft palate downward toward the back wall of the throat. This gravitational effect narrows or completely collapses the upper airway, increasing the frequency and duration of apneas and hypopneas. Switching to a lateral (side) sleeping position alleviates this problem, helping to keep the airway more open. For many individuals, side sleeping can reduce the number of apnea events by as much as 50 percent.
Determining If Positional Therapy Is Appropriate
Positional therapy is reserved for those diagnosed with Positional Obstructive Sleep Apnea (POSA). A sleep study, or polysomnography, confirms this positional dependency. The standard definition for POSA requires the Apnea-Hypopnea Index (AHI) in the supine position to be at least twice as high as the AHI recorded when the patient is sleeping in a non-supine position. PT is frequently recommended as a first-line treatment for patients with mild to moderate OSA who exhibit this positional pattern. Individuals who respond well are often younger, have a lower Body Mass Index (BMI), and experience breathing events almost exclusively while on their back.
Specific Devices and Techniques
Methods for positional therapy range from simple behavioral techniques to sophisticated electronic devices, all designed to encourage or enforce lateral sleeping. One straightforward method is the “tennis ball technique,” which involves sewing a tennis ball or similar object into the back of a pajama top. This creates a physical deterrent that makes rolling onto the back uncomfortable, prompting the sleeper to shift position. Specialized wedge pillows and positional belts, such as the Zzoma, are commercialized versions providing a physical barrier to supine sleep. More advanced options include vibrotactile devices, typically worn around the chest or neck, which use positional sensors to deliver a gentle, non-waking vibration when the wearer rolls onto their back.
Benefits and Scope of Treatment
Positional therapy is an attractive option due to its non-invasive nature and comfort compared to Continuous Positive Airway Pressure (CPAP) therapy. For patients with mild to moderate POSA, PT can significantly reduce the AHI and often has better long-term adherence. These devices are also generally lower in cost than CPAP machines, making them an accessible initial treatment choice. PT is not effective for individuals whose OSA is not position-dependent or for those with severe non-positional sleep apnea. Some patients may initially experience sleep disruption while adjusting, and the therapy is generally less effective than CPAP for reducing overall AHI across all severity levels.