Best Sleeping Position For Sleep Apnea

Sleeping Position For Sleep Apnea: Best And The Worst

Obstructive sleep apnea or OSA is a sleep disorder characterized by recurrent episodes of breathing difficulties or complete breathing cessation. OSA is causing sleeping problems to millions of people and is one of the leading issues of the modern world. Luckily, there is a treatment option for sleep apnea patients, known as CPAP (continuous positive airway pressure), and so far the treatment has shown effective.

However, research has shown that it isn’t only enough to use CPAP for OSA improvement and all it a day. The way sleep apnea patients sleep can significantly affect their OSA symptoms and effectiveness of the therapy.

Because the number and duration of breathing difficulties with OSA patients largely depends on body position during sleep, we’ll look at the best sleeping positions for OSA patients.

We’ll also take a look at the worst sleeping positions for OSA patients, so you know whether or not the way you sleep is affecting and worsening your sleep apnea.

Recommended For Sleep Apnea: Sleeping On The Side

Woman sleeping on her side with CPAP machine
Image Source: Terry Cralle, MS, RN, CPHQ

Sleeping on the side is a recommended sleeping position for numerous reasons. For example, side sleeping ensures you rest more comfortably and have uninterrupted sleep. This is especially important for sleep apnea patients who are known to have an incredibly low quality of sleep due to regular interruptions.

Moreover, the side sleeping position decreases the chances of insomnia, chronic sleep deprivation, back issues, hip pain, etc. This sleeping position is so good that it’s even recommended for pregnant women. There are two types of side sleeping; left-side sleeping and right-side sleeping. So, let’s take a look at the benefits of each position;

Left-Side Sleeping

As mentioned before, side sleeping is excellent against insomnia and sleep deprivation. Left-side sleeping is especially helpful when it comes to the quality of sleep. When sleeping on the left side, chances are you won’t experience stomach or digestion issues, issues with gastroesophageal reflux disease (GERD), or insomnia. Lef-side sleeping allows the best blood-flow throughout the body and ensures there is no breathing resistance.

This is rather useful for sleep apnea patients, who experience regular breathing difficulties due to closed airways and breathing resistance. While sleeping on the left side, you’re more likely to reduce snoring, as your throat won’t be blocked. Not to mention that during the CPAP therapy, sleeping on the side won’t disrupt the mask fit.

Right-Side Sleeping

Sleeping on the right side is reserved for people who cannot sleep on the left side due to certain health conditions (like cardiac issues, jaw pain, shoulder pain, etc). OSA patients should sleep on the right side for numerous reasons. For example, this position promotes proper airflow, opens the airways more than in other sleeping positions, and reduces snoring, which is a common issue with sleep apnea. Sleeping on the right side is also more stable for breathing because it prevents the tongue and the throat muscles to collapse and restrict air, which is a huge deal for OSA patients.

Studies have shown that side sleeping, especially on the right side is associated with reduced occurrences of breathing difficulties and complete cessation of breathing in OSA patients. Even if these difficulties do occur, when sleeping on the side, they last significantly shorter than in other sleeping positions. These findings are especially prominent in sleep apnea patients with congestive heart failure.

Note: side sleeping is one of the most natural sleeping position for the majority of people. Turns out that 47% of all Americans sleep on their side, usually in the fetal position.

Women are more likely to sleep like this; 54% of all women in America sleep on their side, usually curled up, while 39% of men prefer to sleep like this. However, sleeping in a fetal or curled-up side position is not usually recommended for sleep apnea patients, but it doesn’t pose a threat. But, this sleeping position can, in fact, cause serious neck and back issues.

Side Sleeping Tips

So, how do you become a side sleeper? Here are a few useful tips you can utilize easily;

  • Ensure a pillow that fits your head, neck, and collarbone relation. The pillow should support and provide stability to these parts of your body without causing discomfort or pain.
  • Ensure a firm pillow that you will place between your bent knees while laying on the side. This will help stabilize your hips and prevent soreness and pain in the lower back area.
  • You can use an extra pillow that you can hug as you sleep on the side. This will ensure that your right arm doesn’t get tired throughout the night. Plus, this will feel more comfortable and cozy, which should help with sleep onset and reduction of sleep anxiety and restlessness.
  • If you want to sleep on the side, make sure to consult your doctor about nasal CPAP masks. These masks are recommended for side sleepers as they’re more flexible and have less facial touch points than the full face masks, for example.
  • For the best side sleeping experience, make sure to purchase special or contoured CPAP pillows that ensure proper spinal alignment during sleep. These pillows ensure your head and shoulders are properly aligned, therefore, the airway is open and there is no obstruction to cause snoring or to worsen sleep apnea.

Left-side sleeping is not recommended for OSA patients who have;

  • Congestive heart failure – sleeping on the left side can cause unnecessary stress and discomfort to the heart.
  • Shoulder pain – sleeping on the left side can cause shoulder pain or worsen the already existing pain.
  • Jaw discomfort – this can occur in OSA patients, especially when breathing difficulties are common. Side sleeping can put further pressure on the jaw which can cause pain and soreness.

Right-side sleeping is not recommended for OSA patients who have;

  • Issues with GERD – sleeping on the right side is known to aggravate symptoms of GERD because in this position the lower esophageal sphincter relaxes completely.
  • Shoulder pain – (sleeping on the right side can also cause shoulder pain or worsen the already existing pain).

Also Read: How to Prevent Choking on Vomit While Sleeping?

Works For OSA Patients: Sleeping On The Stomach

Sleeping On The Stomach (Prone Sleeping)
Image Source: Terry Cralle, MS, RN, CPHQ

Even though often deemed as the worst sleeping position possible, sleeping on the stomach is not the worst position for OSA patients. Sure, sleeping on the stomach has its negative effects on the spine, lower back, neck, head, shoulder position, etc. It can surely cause or worse pain in all of the body’s pressure points. But, what does the prone sleeping position do for sleep apnea patients?

For a long time, it was believed that OSA patients experience a significant reduction of breathing obstructions and cessations only in non-prone positions. However, recent evaluations of prone positioning in OSA patients provided new, promising information. Namely, prone positioning reduces airway collapse and prevents breathing obstructions and cessations, as concluded in a study of 27 sleep apnea patients.

AHI in different positions
Terry Cralle

The study explains such results by stating that our bodies largely work together with gravity. Because of gravity, when in the prone position, the tongue and the soft tissue in the throat are pulled forward. This eliminates airway obstructions as well as snoring because there is no collapsed airway and tongue.

However, there need to be more studies where the focus should be the evaluation of long-term prone sleeping position effects on OSA patients.

Note: The graph presentation from the study shows the apnea-hypopnea index (AHI) in different sleeping positions (supine or back sleeping position, lateral or side sleeping position, and prone or stomach sleeping position).

For each sleeping position, the patients were provided with a mattress and pillow for better positioning. As the graphs shows, patients that were sleeping on their stomach had the lowest AHI when compared to other positions.

Prone/Stomach Sleeping Tips

So, how do you become a stomach sleeper? Here are some useful tips that will ensure you sleep in the prone position properly;

  • Try not to bury your face into the pillow as you sleep. Firstly, you will completely disrupt your CPAP mask if receiving therapy. And, secondly, you will worsen your breathing abilities, since you’ll be blocking the nose and the mouth from getting enough air or inhaling/exhaling capacity.
  • Try not to put additional stress on the back and the neck area. Make sure to adjust your pillow so that it promotes proper spinal alignment even when your head is twisted to the side.
  • Make sure your arms are placed next to your head, and not the body. Arms should be parallel to your head; this way, you will avoid putting additional stress on the shoulders and neck.

Sleeping on the stomach is not recommended to OSA patients who have;

  • Back problems – OSA patients with back and lower back issues, as well as back conditions like scoliosis, fibromyalgia, or sciatica, shouldn’t sleep on their stomach.
  • Issues with sleep anxiety and restlessness – OSA patients who experience sleep anxiety and restlessness shouldn’t sleep on their stomach. This sleeping position is known to cause anxiety, stress, and discomfort because it is hard to get comfortable in these positions, especially at an awkward angle.

Worst Sleeping Position: Sleeping On The Back (Supine Sleeping)

Sleeping On The Back (Supine Sleeping)
Image Source: Terry Cralle, MS, RN, CPHQ

Supine position or sleeping on the back is probably the worst sleeping position for OSA patients. Studies show that there is a tendency in sleep apnea patients to experience tongue relapse in a supine position. This means that the soft tissue in the mouth and throat as well as the tongue fall backward and close the airway.

Furthermore, there is an increased chance of loud snoring, breathing cessation, and prolonged apneas when compared to other sleeping positions. Sleep apnea patients who sleep on their back experience the loudest snoring and most disturbed breathing patterns. These patients are often the most sleep-deprived and generally experience insomnia more often than patients who sleep on their side or their stomach.

Final Words

To summarize, we would say that the best sleeping positions for sleep apnea patients are side and stomach positions. In these positions, your airway will be more open and there will be less of a chance of tongue and tissue collapse. You will notice a significant reduction in snoring and an improvement in sleep quality.

Of course, before you change your sleeping position, make sure to consult with your doctor or sleep specialist. These people will know exactly which sleeping position is best suitable for your particular case.

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