Positional Therapy for Snoring and Sleep Apnea

In some cases, the position you sleep in may dramatically impact your ability to breathe and exacerbate snoring and sleep apnea. How do you know if you have positional sleep apnea? What are some of the treatment options that might help you to sleep better?

Man snoring loudly
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Determine Your Risk

In order to assess your potential risk of having snoring or sleep apnea that is dependent on position, it can be helpful to have a formal sleep study that documents your sleep position. Over the recording, breathing disturbances can be noted. At the end of the night, a report will be generated that summarizes the data.

Often your sleep study report will include a table showing the apnea-hypopnea index (AHI) or respiratory-disturbance index (RDI) based on sleep position. These positions include supine (on your back), lateral (on your left or right side), and prone (on your stomach). If the AHI or RDI is normal when you stay off your back, with fewer than 5 events per hour noted, you may benefit from positional therapy. Your sleep specialist will help you to determine if sufficient time was observed in this position to justify this option for you.

Be careful in assuming that your breathing is normal if you sleep on your sides without testing. Many people do sleep better and snore less when they stay off their backs, but it may not completely normalize despite these observed improvements.

When Snoring and Sleep Apnea Worsen by Position

Snoring and sleep apnea may be worse on your back due to the simple effects of gravity. When you lie on your back, the lower jaw (mandible), tongue, and soft tissues of the palate and uvula can easily fall into and block your airway. This can disrupt breathing and disturb sleep.

In order to keep you off your back, there are a handful of effective treatment options, ranging from the simple to the sophisticated, and from cheap to expensive. Some of these therapy options include the following.

Tennis Ball T-shirt

Okay, this one sounds a little weird. Nevertheless, it can be effective if used consistently. By sewing a tennis ball into a t-shirt and wearing it to bed at night, you can keep yourself off your back. Whenever you roll onto your back, the discomfort from the ball will turn you back to your side.


Some people benefit from wearing a backpack to bed at night. As with the tennis ball, placing a firm baseball into the pack can add some discomfort that will keep you sleeping on your sides.

Zzoma and Bumpers

Zzoma is an example of the fabric and foam bumper belts that can be worn to bed at night. These most often include a block and Velcro strap that keeps you from being able to sleep on your back. These are a little more expensive, and some require prescriptions from a doctor.

Night Shift Device

For the technology inclined, the Night Shift device is a simple plastic band worn around the neck that vibrates when you shift onto your back. At a cost of about $350, it is definitely a more expensive option.

Wedges and Stacked Pillows

Sometimes sleeping on a wedge reduces the degree of snoring and sleep apnea that occurs. Gravity is unable to shift tissues and cause the airway to collapse quite as much. It is important not to cause the head to shift forward and bend the neck. This may cause the airway to be crimped, defeating the purpose. Similarly, a stack of pillows may be used to reposition the body.

Adjustable and Adjusting Beds

Finally, some people may benefit from using an adjustable bed that raises the head of the bed. Alternatively, at a reduced cost, it is possible to stack books, bricks, or even cinder blocks under the feet at the head of the bed to put it an incline. Certainly, you don’t want to make this too extreme as you don’t want to be sliding out of the bed in the night.

Getting Started to Assess Positional Therapy as an Option

Start by speaking with your sleep specialist to determine if positional therapy may be helpful in your case. If it seems like a possibility, explore some of these possibilities and see if a proper position helps you to breathe and sleep better. Long-term adherence to these therapies is usually low. For those who still struggle, alternative treatments including CPAP and an oral appliance may effectively relieve the condition.

1 Source
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  1. Harvard Health. Understanding the Results | Sleep Apnea.

Additional Reading
  • Kryger, M.H. et al. "Principles and Practice of Sleep Medicine." ExpertConsult, 5th edition, 2011.

By Brandon Peters, MD
Brandon Peters, MD, is a board-certified neurologist and sleep medicine specialist.