Can sleep position affect obstructive sleep apnoea symptoms?

Quick Takeaways

• Your sleep position can affect obstructive sleep apnoea symptoms. Side or elevated sleeping positions often help keep airways open, while back sleeping may worsen breathing pauses.
• Side sleeping is generally recommended for most people with obstructive sleep apnoea (OSA), though comfort and individual needs can vary.
• Wedge or speciality pillows can make side or inclined sleeping easier and more supportive.
• Positional therapy works best with medical treatment like CPAP, oral appliances, or other doctor-recommended approaches for managing OSA.

If you live with sleep apnoea — when breathing repeatedly stops and starts during sleep — you’ve probably wondered whether changing how you sleep could help reduce your symptoms. Positional therapy is sometimes used to help people avoid sleeping on their back and encourage side sleeping instead.

While your sleep position can make a difference in managing obstructive sleep apnoea symptoms and improving sleep quality, positional therapy isn’t a substitute for medically recommended treatments like continuous positive airway pressure (CPAP) therapy.

CPAP therapy is a treatment for obstructive sleep apnoea (OSA) that uses a small machine to deliver a steady stream of gentle air pressure through a mask. This airflow keeps the airway open while you sleep, helping you breathe normally, reduce snoring, and improve sleep quality.

When combined with medically recommended treatments, the right sleep position may help support your treatment and contribute to more comfortable, restful sleep.

Understanding sleep positions and obstructive sleep apnoea

The connection between body position and breathing

Your sleep position can influence how well your airway stays open while sleeping. When you sleep, the muscles in your throat naturally relax, potentially making certain positions more problematic for people living with obstructive sleep apnoea.

Gravity can play a role in how soft tissues behave during sleep. Depending on your sleep position, gravity may help keep your airway open or allow tissues like your tongue and soft palate to fall backward, making breathing more difficult. This natural occurrence is why some people notice their OSA symptoms are worse in certain sleeping positions.

Sleep apnoea that occurs mainly in specific sleeping positions is called “positional sleep apnoea.” Research suggests that breathing problems may be more noticeable in some sleeping positions. In one study, the prevalence of positional obstructive sleep apnoea (POSA) among people with OSA was approximately 75%.¹ It further indicated that POSA affects 53% of people aged 40-85 years old.¹

How obstructive sleep apnoea affects the airway

The muscles that keep your airway open become less active while sleeping. This relaxation can cause the tongue, soft palate and throat tissues to either partially or completely block the airway. The amount of airway blockage you experience may vary depending on your sleeping position.

Your neck circumference and individual body structure can also influence how different positions affect your breathing. For example, men with a neck circumference of 43 cm or more and women with a circumference of s40 cm or more are at greater risk of developing obstructive sleep apnoea.²

People with larger necks tend to have more fatty tissue, contributing to crowding around the breathing tube, which can make blockage during sleep more likely. With that in mind, people with larger necks may be more sensitive to position changes, while others might experience similar symptoms regardless of how they sleep.

Optimal sleep positions for managing obstructive sleep apnoea

Side sleeping: The recommended position

Side sleeping is sometimes recommended to help reduce obstructive sleep apnoea symptoms, though individual results can vary. Sleeping on your side may help reduce the chance of your tongue and soft tissues falling backward into your throat, which can help keep your airway more open.

Sleeping on either your left or right side can be effective, though some people find one side more comfortable than the other. Studies consistently show that side sleeping can significantly reduce the apnoea-hypopnoea index (AHI)³, which measures how many times your breathing stops or becomes shallow per hour.

One study found that positional sleep apnoea affects nearly 50% of people with mild sleep apnoea, nearly 20% of people with moderate sleep apnoea and nearly 7% of people with severe sleep apnoea. ⁴

Successful side sleeping hinges on maintaining the position throughout the night, which can be challenging if you’re used to sleeping in other positions. Even if side sleeping seems to lessen your obstructive sleep apnoea symptoms, positional therapy isn’t a substitute for medically recommended treatments like CPAP.

Elevated sleeping positions

Sleeping with your upper body elevated at a 30- to 45-degree angle may help reduce airway blockages for people living with obstructive sleep apnoea. Like side sleeping, an inclined position uses gravity to help limit throat tissue collapse that can contribute to airway blockages.^{16, 17}

You can sleep in an elevated position by using an adjustable bed, which offers flexibility to find a comfortable angle for sleep. Some studies suggest that slightly elevating the head of the bed may help reduce OSA severity without affecting sleep cycles.⁵

Alternatively, wedge pillows or even multiple regular pillows can create an inclined position if an adjustable bed isn’t feasible. Wedge pillows are designed to provide stable support, which may help you maintain an inclined position more comfortably.

Some people find combining elevation with side sleeping more comfortable and supportive. This means sleeping on your side while remaining slightly propped up. The goal is to find an elevation that feels comfortable enough to maintain throughout the night and helps ease obstructive sleep apnoea symptoms.

Back sleeping considerations

Sleeping on your back, called a supine position, may make sleep apnoea symptoms worse. When lying on your back, gravity can cause the tongue and soft palate to fall backward, which may narrow or block the airway. Many people with sleep apnoea experience more frequent and severe breathing interruptions when sleeping on their backs, and some only have sleep-disturbed breathing when back sleeping.⁶

If back sleeping is your preferred position, try some modifications. A cervical pillow that supports your neck’s natural curve may help promote better airway alignment. Some people may also benefit from slightly elevating their head and shoulders while sleeping on their backs.

If these methods don’t work, other techniques may help prevent you from rolling onto your back while sleeping. Some people use commercial positional devices or home remedies, such as sewing a tennis ball into the back of a pyjama shirt, to help discourage back sleeping.¹⁸

Stomach sleeping analysis

Stomach sleeping, or a prone position, may not be ideal for people with sleep apnoea, as it can strain the neck and may make using a CPAP device more difficult. The twisted neck position required for breathing while face-down can also create its own difficulties.

Gravity naturally helps keep the airway more open when you sleep on your stomach by preventing the tongue from falling backward. And so, some people with mild sleep apnoea may find that sleeping on their stomach helps their symptoms. If you prefer stomach sleeping, using a very thin pillow or no pillow may help reduce neck strain.

Small studies suggest that stomach sleeping may offer certain benefits for people with mild to moderate OSA.⁷ However, stomach sleeping may be difficult for those using CPAP therapy. Stomach sleeping can present significant challenges with mask fit and comfort, and therefore may not be a practical solution.

Positional therapy and support tools

Specialised pillows and devices

Body pillows can be helpful tools for maintaining side sleeping positions throughout the night. These long pillows provide support and create a barrier that makes rolling onto your back more difficult.

Cervical pillows have a contoured shape designed to support your neck’s natural curve, which may help promote comfortable neck support and better airway alignment in different sleep positions. Alternatively, memory foam and latex pillows are designed to retain their shape and provide steady support throughout the night.

Anti-snore pillows designed for people with obstructive sleep apnoea often feature contours that may encourage side sleeping and help support head and neck alignment. Some include built-in elevation features. However, these devices may not work for everyone. One study found that anti-snore pillows helped participants with mild to moderate OSA but didn’t provide significant improvement for those with severe OSA.⁸

Modern positional devices use gentle vibrations to prompt position changes during sleep, which may help some people stay off their back without fully waking you up.

Pillow Selection Criteria

Several factors can influence a pillow’s comfort and usefulness for people living with sleep apnoea.

Let’s begin with material considerations and how they impact pillow performance. Memory foam pillows⁹ are designed to conform to your head and neck while providing steady support throughout the night, though they may retain heat. Conversely, latex pillows tend to feel more responsive and may help you stay cool while sleeping.

Height and firmness can also affect comfort and neck alignment. For example, side sleepers often prefer higher, firmer pillows to fill the space between their shoulders and neck. The goal is to maintain a neutral head and neck position that may help promote easier breathing during sleep.

Durability and maintenance requirements vary by material and construction. Memory foam and latex pillows typically last longer than traditional fill materials but may require specific care. Consider how often pillows need replacement and whether they’re machine washable. Regular pillow cleaning may help reduce allergens that could make breathing more difficult for people living with sleep apnoea.

When evaluating specialised sleep apnoea pillows, consider the long-term value alongside the initial investment. While these pillows may cost more upfront, their design may help support comfortable sleep and complement your existing sleep apnoea treatment, making them a worthwhile consideration.

Position training techniques

Position training may be helpful for those needing to break the habit of sleeping on their back. The classic “tennis ball technique“¹⁰ involves attaching a tennis ball to the back of your pyjamas to make back sleeping uncomfortable. Modern alternatives include specialised belts with inflatable bumpers, anti-snoring vests or vibrating devices that provide gentler feedback.

Wearable devices that work with sleep position training applications¹¹ to monitor your position and provide feedback may also be helpful.

Gradual adaptation can be helpful when adjusting to a new sleep position. You might start by using positional aids for short naps and gradually work up to full nights as you become more comfortable with the new position.

Mattress considerations

Mattress type can also affect your comfort and influence your sleep position. For example, overly soft mattresses can cause your body to sink, which may lead to poor spinal alignment and make breathing feel more difficult. On the other hand, firmer mattresses may provide supportive comfort for side sleeping but may result in discomfort due to pressure points.¹²

A memory foam mattress topper may add comfort for side sleepers by helping to relieve pressure around the shoulders and hips. Adjustable mattresses tend to cost more but allow you to modify elevation and support for added comfort.

Integrating position therapy with other treatments

Combining CPAP therapy and optimal sleep positions

Your sleep position may influence how well your CPAP mask fits and seals. For some people, side sleeping may lead to mask leaks if the mask shifts against the pillow. And while back sleeping might feel more stable, it can affect natural airway positioning.

Different mask styles may be more comfortable or compatible with certain sleep positions. Nasal pillow cushions may feel more comfortable for side sleepers, while full-face masks can be a good option for people who tend to sleep on their back or breathe through their mouth.

CPAP masks come in different styles, with each style designed to support different face shapes, sleep positions and types of sleep apnoea. Finding the right mask is a personal journey, and you have the freedom to explore what works best for your body and sleep style.

There are masks that let you sleep comfortably in any position, even on your stomach. Their tube-up design keeps the air tubing out of the way, reducing tangles and pressure while giving you more freedom to move naturally throughout the night.

Some CPAP machines can adjust pressure based on your position, though this requires specific equipment and professional setup. Always talk to your doctor before making changes to your sleep apnoea treatment plan.

Complementary approaches

For people with excess weight or obesity, weight management may help reduce obstructive sleep apnoea symptoms and support other treatment approaches, including positional therapy. However, weight loss alone isn’t a cure for sleep apnoea and should be combined with other treatments.

Good sleep hygiene — healthy habits that support better sleep — may help you get the most out of positional therapy. These habits include maintaining consistent sleep schedules, creating a comfortable sleep environment, and avoiding stimulants and heavy meals that can disrupt sleep or worsen obstructive sleep apnoea.

Oral appliances that gently hold the jaw forward to keep the airway open may be a treatment option for some people with sleep apnoea.¹³ While CPAP is highly effective and the most understood method for treating sleep apnoea,¹⁴ some people can achieve results when combining oral appliances with positional therapy under medical supervision.

Monitoring and adjusting your approach

Sleep tracking devices can help you observe how different positions may influence your sleep quality and symptoms. You might notice changes such as improved sleep efficiency, reduced snoring or better daytime alertness.

Waking up feeling more refreshed, experiencing fewer morning headaches, or getting feedback from your bed partner about less snoring may suggest your positional changes are helping you sleep more comfortably.

Your doctor may recommend a home sleep test (HST) or an in-lab sleep test to gather information on your oxygen levels and breathing patterns. A sleep test is a non-invasive, overnight test that can help determine if you have a sleep disorder. Talk with your doctor about which option may be the best option for you.

Special considerations for different groups of people

Older individuals with sleep apnoea may find additional support cushions and gradual position changes helpful for managing joint stiffness or mobility limitations. Comfort and safety should always be prioritised.

Pregnant people with sleep apnoea are often advised to avoid back sleeping, especially in later trimesters, making side sleeping even more important. Many doctors recommend left side sleeping during pregnancy to improve blood flow.¹⁵

People living with other medical conditions like acid reflux, heart problems or chronic pain may need modified positional therapy approaches to accommodate their health needs. Speak with your doctor to find a treatment plan that’s right for you.

Finding your optimal sleep position

Finding the best sleeping position for your obstructive sleep apnoea is a personalised process that may require experimentation. While side sleeping works well for many people, your optimal position depends on your individual face shape, sleep apnoea severity and other health considerations.

Remember that positional therapy may be helpful as part of a comprehensive treatment approach. While changing sleep position may provide benefits, it should complement, not replace, medically recommended treatments like CPAP therapy. To support your overall treatment, talk with your doctor about different strategies that may work together.

Most importantly, work with your doctor to develop a treatment plan that combines positional therapy with approved sleep apnoea treatments. With patience and consistency, finding your optimal sleep position may be an important part of supporting better sleep and overall well-being.

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This blog post contains general information about medical conditions and treatments. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. The information is not advice, and should not be treated as such. You must not rely on the information on this website as an alternative to medical advice from your doctor or other professional healthcare provider.

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