Obstructive Sleep Apnea (OSA) is a common sleep disorder defined by the recurrent collapse of the upper airway during sleep, leading to reduced or halted breathing. While Continuous Positive Airway Pressure (CPAP) therapy remains the most effective treatment, many people with mild to moderate OSA utilize behavioral and positional strategies. Simple changes to sleeping posture and pre-sleep habits offer actionable ways to manage symptoms and improve nighttime breathing.
Positional Therapy: Sleeping on Your Side
The supine (back) sleeping position is the most common trigger for increased apnea events. When lying flat, gravity pulls the tongue base and soft tissues backward, narrowing the airway and making it prone to collapse. For the majority of patients whose condition is significantly worse on their back, positional therapy is a direct and effective intervention.
Shifting to the lateral (side) position leverages gravity to help keep the airway open by pulling the soft tissues away from the throat. This simple change reduces the likelihood of obstruction, leading to fewer apnea events and better oxygen saturation throughout the night. It is often recommended as a first-line approach for those with position-dependent OSA.
To maintain the side position throughout the night, various methods can be employed. Specialized body pillows can be used to brace the body and prevent unconscious rolling onto the back. A low-tech method involves sewing a tennis ball into the back of a pajama top, creating discomfort to prompt a position change. Modern devices utilize mild vibrational feedback from a wearable sensor to signal a positional shift when the wearer rolls supine. While avoiding the back is the primary goal, some studies suggest the right side may be slightly more beneficial for cardiac function.
Head Elevation and Upper Airway Support
Elevating the head and torso uses gravity to further support an open airway. This technique reduces the backward gravitational pull on the soft tissues of the throat, which helps minimize the chance of collapse. Effective elevation requires lifting the entire upper body, not just the head and neck.
A specialized wedge pillow is the most common tool for this, providing a stable, gradual incline that supports the upper torso. The optimal angle for this elevation is typically between 30 and 45 degrees, which is sufficient to allow gravity to work without causing the sleeper to slide down the bed. Piling up regular pillows should be avoided, as this often flexes the neck forward, which can kink the airway and worsen an obstruction.
Oral Appliances
Professionally fitted oral appliances offer a targeted mechanical solution for the upper airway. Mandibular Advancement Devices (MADs) are custom dental mouthpieces worn during sleep that gently push the lower jaw forward. This movement pulls the tongue and soft palate forward, effectively enlarging the space at the back of the throat and preventing tissue collapse. MADs require a prescription and fitting by a dental professional experienced in sleep medicine.
Pre-Sleep Routines and Lifestyle Adjustments
Certain habits and substances weaken the muscular structure of the upper airway, making it more susceptible to collapse during sleep.
Avoiding Depressants
Avoiding alcohol and sedatives, particularly within four hours of bedtime, is a key behavioral adjustment. These substances act as central nervous system depressants, causing the throat muscles to relax excessively and delaying the brain’s arousal response to an obstruction, leading to longer and more severe apnea events.
Managing Nasal Congestion
Addressing nasal congestion can also improve airflow and reduce the need for mouth breathing, which is associated with increased airway collapse. Using saline nasal rinses or over-the-counter nasal strips before bed can help maximize nasal patency. These simple measures ensure that the upper airway’s natural structure is not compromised by congestion, improving the overall effectiveness of other positional or device-based therapies.
Weight Management and Smoking Cessation
Long-term strategies, such as maintaining a healthy body weight and smoking cessation, provide systemic benefits. Excess weight contributes to fatty deposits around the neck and throat, increasing external pressure on the airway. Studies indicate that losing even 10% of body weight can result in a measurable reduction in the severity of sleep apnea. Smoking irritates and inflames the upper airway, which also contributes to obstruction.
Sleep Hygiene
Adopting general sleep hygiene practices supports overall respiratory stability during sleep. A consistent bedtime, a cool and dark sleeping environment, and avoiding large meals close to sleep time help promote deeper, less disrupted sleep cycles. While these practices do not directly treat the physical obstruction, improving the quality and continuity of sleep helps the body better manage the physiological stress imposed by apnea events.