What Sleep Position is the Best for Sleep Apnea?

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Written by: Alex Savy
Read 10 minLast updated November 5, 2020

Aside from causing discomfort to those who share a bed with you, obstructive sleep apnea (OSA), if left untreated, poses a threat to your overall health. Research links this condition to increased risks of cardiovascular problems, such as hypertension, heart failure, and stroke (1).

“ If you think you have obstructive sleep apnea, (OSS) or your symptoms have worsened, we recommend speaking with your healthcare provider if you have not already.” says Dr. Debra Sullivan. 

While getting proper treatment is, obviously, important, you can also alleviate the symptoms to some extent by choosing an appropriate position to sleep in.

But the question is, what sleep position is the best for sleep apnea? Let’s find this out.

Best Sleep Position for Sleep Apnea: On the Left Side

The sleeping position that can help relieve mild sleep apnea symptoms is lateral, or side sleeping. In this position, the airways are less likely to collapse from the gravity impact, which makes breathing easier and may help decrease your apneic episodes. 

But there may be other reasons   left side sleeping preferable? 

Research shows a relationship between OSA and Gastroesophageal Reflux Disease (GERD), . Interestingly, 58-62% of patients with OSA may develop GERD symptoms, and the relationship between these two disorders might be bidirectional (3).

GERD is is considered a chronic form of acid reflus. Sleeping on your left side can reduce the chances of acid reflux also known as heartburn. This condition occurs when gastric juices travel up to the esophagus and irritate it, causing the heartburn. If the episodes of heartburn repeat more than twice a week and worsen at night, then you should be evaluated by your doctor for GERD. 

Now, how does sleeping on the left side help?

In this position, your stomach is lower than the esophagus, which prevents gastric juices from getting out. At the same time, the lateral position keeps your airways open, and you can breathe more easily.

How to Do It Like a Pro?

Now, even though side sleeping is the predominant sleep position in adults (4), there are some who don’t feel fully comfortable on their side.

So, here are some tips to help yourself start sleeping on the side with comfort:

  • Pick a suitable mattress. A good mattress for a side sleeper should offer enough sinkage to conform to the pressure points but distribute the weight evenly on the surface.
  • Use extra pillows (or get a U-shaped model for the body). Another way to add some comfort is to use more pillows. Put one between your knees and hug the other with your upper hand. Or, you can get a full-body pillow and adjust it to your sleeping style as you like.
  • Make sure you have the right CPAP mask. There is a wide variety of mask designs, and there are even some full-face models available for side sleepers. Consider models with an elastic headgear and flexible elbow that allows you to place the tubes more comfortably.

You can also check out CPAP-compatible pillows. These models feature ergonomic design with dips for tubes.

Fun fact: 

Sewing a tennis ball to the pajamas appeared to be pretty effective in preventing patients from sleeping on their back and thus improving the symptoms of sleep apnea. In particular, one study showed that 68% of patients adhered to this method and alleviated their condition (5).

Can You Sleep on Your Back with Sleep Apnea?

The supine position, or back sleeping, is generally considered the best for spinal health. But there is no data that would prove that sleeping on one’s back reduces the symptoms of sleep apnea

In fact, it does quite the opposite: 

According to a 2013 systematic review, positional obstructive sleep apnea impacted about 56% of the patients, and the severity of apnea episodes was worse in those who slept on the back (6).

That’s because when you sleep on your back, the gravity pulls the soft tissues of your throat and the palate closer together so that they might completely block the airways and cause an apnea episode.

However, you can still sleep on your back if you have sleep apnea. Just be sure to follow these recommendations:

  • Properly position your head. If your OSA is position-dependent and not too severe, you can treat it with positional therapy. The best head position for sleep apnea in those who sleep on the back is slightly elevated, and studies show that even a 7.5-degree tilt can improve sleep apnea symptoms by 31.8% (7). To reach this tilt, you need a pillow that is about 6-inches high, and wedge-shaped ones may work best in this case. They also reduce the gravity impact on the chest area, which can make breathing even easier, especially for overweight users.
  • Use a chin strap. If your sleep apnea is mild and you mostly breathe through your mouth, then attaching an elastic strap that will help keep your mouth closed might do the trick, forcing you to breathe through your nose.
  • Choose the right mattress. The best mattress for sleep apnea sufferers should not just support you properly, but it also shouldn’t worsen your condition. That’s why it’s important to make sure that the bed you’ve chosen is compatible with your weight and sleep position.

Note:

Those who suffer from allergic rhinitis may have more prolonged and frequent episodes of sleep apnea (8). If this sounds like you, you may want to opt for mattresses made of natural materials, such as latex, as well as bedding sets with natural fabrics.

Does Sleeping on Your Stomach Help Sleep Apnea?

The short answer is yes. 

Stomach sleeping is a good sleep position for sleep apnea relief, as most sleepers typically turn their head to the side, which prevents the blockage of the airways.

However, this sleeping position also has several downsides when it comes to overall health and comfort. First, the lower back curve may flatten a bit when you sleep on your stomach, which can cause muscle strains and lead to morning lower-back pain. 

Second, the cervical area suffers as well. When you twist your neck to the side and lie down like that for a couple of hours, your neck muscles may strain so that it can be painful to move your head.

Finally, those who have gastrointestinal problems, such as the aforementioned GERD, may feel worse when sleeping in the frontal position because the esophagus and the stomach are on the same level, and this might cause gastric acid to travel into the esophagus.

Plainly speaking, you can try sleeping on the stomach, but only if it feels comfortable for you, and you don’t have other health conditions that may prevent you from feeling comfortable.

Quick tip:

Stomach sleepers might benefit from firmer mattresses, as they will keep their lower back supported and won’t allow it to sink too deep into the mattress layers.

So, What Is the Best Position to Sleep With Sleep Apnea?

According to science, left side sleeping is considered the best position for sleep apnea sufferers. It feels comfortable to most users and relieves the symptoms of OSA pretty well. 

Also, you might try to sleep on your stomach if you find this position comfortable and don’t have chronic health problems or back pain.

The supine position isn’t generally recommended, but you can make it work if you elevate your upper body a bit — for example, by using a recliner chair or an adjustable bed. This will reduce the gravity impact on your soft tissues. 

Have you tried to correct your sleep apnea with positional therapy? What was your experience? Feel free to share below!

F.A.Q.

Does sleeping with your head elevated help sleep apnea?

Yes. Studies show that creating an incline may reduce the severity of sleep apnea episodes.

Is it better to sleep on your side with sleep apnea?

Yes. Side sleeping, particularly on your left side, has shown to be effective in alleviating sleep apnea.

References

  1. Massimo R.Mannarino, Francesco Di Filippo, Matteo Pirro  (October 2012). Obstructive sleep apnea syndrome. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S0953620512001525 
  2. Purna Kashyap, M.B.B.S. (2019, July 31). Acid reflux and GERD: The same thing? Retrieved from https://www.mayoclinic.org/diseases-conditions/heartburn/expert-answers/heartburn-gerd/faq-20057894
  3. Hye-Kyung Jung, M.D., Rok Seon Choung, M.D., and Nicholas J. Talley, M.D., Ph.D. (2010, January 31). Gastroesophageal Reflux Disease and Sleep Disorders: Evidence for a Causal Link and Therapeutic Implications. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2879818/
  4. Eivind Schjelderup Skarpsno, Paul Jarle Mork, Tom Ivar Lund Nilsen, and Andreas Holtermann (2017, November 1). Sleep positions and nocturnal body movements based on free-living accelerometer recordings: association with demographics, lifestyle, and insomnia symptoms. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5677378/
  5. Grietje E. de Vries, MSc, Aarnoud Hoekema, MD, Ph.D., Michiel H.J. Doff, DMD, Ph.D., Huib A.M. Kerstjens, MD, Ph.D., Petra M. Meijer, NP, Johannes H. van der Hoeven, MD, Ph.D., and Peter J. Wijkstra, MD, Ph.D. (2015, February 15). Usage of Positional Therapy in Adults with Obstructive Sleep Apnea. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4298770/
  6. Akshay Menon and Manoj Kumar (2013, October 8). Influence of Body Position on Severity of Obstructive Sleep Apnea: A Systematic Review. Retrieved from https://www.hindawi.com/journals/isrn/2013/670381/
  7. Fábio José Fabrício de Barros Souza, corresponding author Pedro Rodrigues Genta, Albino José de Souza Filho, Andrew Wellman, and Geraldo Lorenzi-Filho (2017, June 24). The influence of Head-of-Bed Elevation in Patients With Obstructive Sleep Apnea. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5700252/
  8. W. T. McNicholas, S. Tarlo, P. Cole, N. Zamel, R. Rutherford, D. Griffin, E. A. Phillipson Obstructive Apneas During Sleep in Patients With Seasonal Allergic Rhinitis (October 1982). Retrieved from https://pubmed.ncbi.nlm.nih.gov/7125355/

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