Several factors affect the quality and quantity of your sleep. Your sleep environment, bedtime routine, body weight and lifestyle all play a role in how well you sleep.

For millions of people, sleep apnea adversely affects sleep. Twenty five million people in the United States have obstructive sleep apnea (OSA). If you have OSA, you might be surprised to learn that your sleep position can affect how many apneic episodes you have each night.

What is Positional Obstructive Sleep Apnea (POSA)?

Sleep apnea involves brief pauses in breathing. The most common form of sleep apnea is obstructive sleep apnea (OSA). Obstructive sleep apnea occurs when the soft tissues of the upper airway and tongue relax during sleep. When the tissues and muscles relax, they can block the flow of air into the lungs. Although anyone can develop OSA, there are certain risk factors that increase your chances including age, having a thick neck, and being overweight.

Positional obstructive sleep apnea (POSA) occurs when the majority of apneic events happen when a person is in the supine sleep position, which is lying flat on their back. When someone is in the supine sleep position, the upper airway is more likely to relax or collapse. (1)

When you are supine, the shape and size of your upper airway are also altered. This combined with gravity increases the likelihood of obstructing the airway. With positional obstructive sleep apnea, the apnea-hypopnea index (AHI), which measures the severity of OSA, is often twice as high while supine as opposed to other sleep positions. It is thought that about 50 percent of people with obstructive sleep apnea have POSA. 

Complications of Untreated Positional Obstructive Sleep Apnea

Positional obstructive sleep apnea can interfere with getting enough rest. But the complications can go far beyond just being tired. (2) Left untreated, positional obstructive sleep apnea can have serious health consequences.

During an apneic event, breathing pauses for several seconds. Oxygen levels drop, which leads to a response by the sympathetic nervous system. A person’s blood pressure and heart rate increase. The nervous system kicks in and breathing resumes, often with snoring. But the repeated low oxygen levels, elevated blood pressure, and heart rate can wreak havoc on the body, straining the circulatory system and the heart.

People with untreated sleep apnea including POSA have an increased risk of the following:

Stroke: Apneic events cause an increase in blood pressure. Eventually, the nocturnal rise in blood pressure may persist into the daytime and lead to hypertension, which is a risk factor for a stroke.

Heart Attack: Evidence exists that people with untreated sleep apnea may develop increased arterial stiffness and have less heart rate variability, which can raise the risk of a heart attack.  

Type 2 Diabetes: Sleep apnea is associated with an increased risk of developing type 2 diabetes. Being overweight is a risk factor for both OSA and type 2 diabetes. But according to research published in Frontiers in Neurology, OSA is linked to glucose intolerance and insulin resistance independent of obesity. The prevalence of sleep apnea in people with type 2 diabetes is about 71 percent.

Driving Accidents: Untreated OSA  results in poor overall sleep quality. Daytime sleepiness is common. Sleep deprivation is a major cause of driving accidents.

Positional Therapy for OSA

Alternative devices for treatment of positional obstructive sleep apnea may include sleep apnea oral devices that hold the jaw or tongue in a specific position to minimize blocking of the airway, as well as, tennis balls attached to the back.  CPAP has been prescribed to reduce POSA as well.  However, for multiple reason, not all individuals are compliant with CPAP treatment for OSA.

A study published in the Journal of Otolaryngology-Head and Neck Surgery involved a comprehensive systematic literature review. The review involved database searches over a twenty-year period conducted using Embase, Medline, and PubMed. The research indicated that the non-adherence rate for CPAP was 34 percent.

For individuals that cannot tolerate CPAP and who have positional obstructive sleep apnea there are now more choices available for positional therapy.  (3)

Since individuals who have POSA, have the majority of apneic episodes when supine, sleeping in a different position can reduce pauses in breathing.   

These newer devices do just that, they help to prevent sleeping in the supine/flat position thereby decreasing apneic events.  They assist to promote sleeping in other positions, such as on the side. (4)

See the Philips NightBalance for the treatment of positional OSA

Positional Sleep Apnea Device

In a randomized controlled clinical trial published in the Journal Sleep Medicine, people with mild to moderate POSA were randomly assigned to use either positional therapy or an oral device. A sleep study was conducted three months after starting the trial. The results indicated that positional therapy was as effective for treating POSA as an oral device.

Another study published in the Journal of Clinical Sleep Medicine involved adults with POSA. The study participants used positional therapy, and a follow-up sleep study was performed after a median treatment time of 12 weeks. The results showed a significant decrease in apnea-hypopnea index or severity of POSA.

See article: Rethinking positional obstructive sleep apnea management

It is clear from the research that sleep position affects about half of people that have OSA. As we know, when not treating any form of obstructive sleep apnea has health risks. (5) The best treatment option for individuals will vary depending on the severity of the condition, compliance in using the device and personal preferences.

But one thing is clear, the most successful treatment for POSA is the one that patients will adhere to. Evidence strongly suggests that compliance with CPAP and oral devices is often lacking. Fortunately, positional therapy may also be a great option to treat POSA.

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