Obstructive Sleep Apnea Positional Therapy and Devices

Snoring is more than just an annoying noise people sometimes produce in their sleep, it can be a signal of a significant sleep disturbance caused by respiratory problems. In the most severe cases, snoring can be a symptom of positional or obstructive sleep apnea, which may become life-threatening if left untreated for too long. Many sleep partners of snorers report that often all they have to do to stop the snoring is to get the snorers to roll off their backs and onto their sides to sleep and the snoring stops.

This suggests that sleep position is a possible therapy for snoring and other sleep disturbances. Research on obstructive sleep apnea positional therapy was undertaken and indicates that positional therapy is effective. This research led to the development of sleep apnea positional therapy devices that help to keep a patient in a lateral (side sleeping) position to prevent the person’s airway from collapsing during sleep and obstructing breathing. The more air is kept moving through the throat, the less likely the patient is to snore or have episodes of apnea or hypopnea. It is now known that body position can greatly affect the number and severity level of apnea episodes, back sleepers have at least twice as many episodes as side sleepers.

Positional therapies attempt to keep patients with snoring or sleep apnea off their backs when they sleep. Some patients have position-dependent sleep apnea. This is diagnosed by the measurement of a difference of fifty percent or more in the apnea index between episodes in the supine (back) position and lateral (side) position. These patients must sleep on their sides and positional therapy is very important for them. Many snore pillows, nasal strips, alarms, and other devices have been developed for positional therapy. Nasal strips are place across the nose in an attempt to hold the nostrils open wider for better breathing in sleep. Sleep alarms are designed to alert when the sleeper rolls over to his or her back.

A homemade remedy is to sew a pocket on the back of your pajamas and put a tennis ball or some other small ball in it. When you roll over on your back, the discomfort makes you roll back on your side to maintain that lateral sleeping position. A more professional way to keep a patient in a lateral sleeping position is with a sleep apnea belt. Such a device has bumpers on the back that prevent the wearer from rolling over to sleep supine and help them maintain the lateral position all night. Rematee makes one called the Neoprene Anti-snore Bumper Belt that is designed for this service. Such a sleep apnea bumper belt comes in many sizes and helps maintain a lateral sleep position. Studies have shown that patients who sleep on their backs and have between 50 and 80 apneas each hour are sometimes able to practically eliminate them altogether when they shift to side sleeping. Shifting positions is less effective the more overweight a patient is, but it does help some.

A sleep shirt with a bumper on the back is another way to maintain lateral positional therapy. A shirt that the patient wears to sleep in, such as SleepTZ Sleep Shirt-Side Sleep Aid, has a pouch with a bumper insert in it on the patient’s back. It works in much the same way as the sleep apnea positional belt.

Specially designed pillows also serve to improve body and neck positions in sleep. Triangular foam pillow wedges are available to support the neck and upper body postures of patients during sleep, to elevate and support the patient’s neck and airway. They have been shown to be effective for those with mild to moderate apnea, reducing or completely eliminating their snoring. Their blood oxygen saturation levels improve also.

The effectiveness of positional therapy for the treatment of positional obstructed sleep apnea is such that it has been adopted by medical guidelines as an accepted treatment for POSAS. The difficulty is that rarely is it recommended to patients in clinical practice because of the typically low patient compliance rates to the therapy. Because there are few available positional therapy treatments and because the patients that have tried them do not always stick with them for the long term, doctors prefer to recommend more traditional CPAP therapies.

Learning to fall asleep on your side is a fundamental long-term change in most people’s sleep habits and many find the change difficult. The benefits of learning to be a lateral sleeper, however, far outweigh the initial difficulties. Like any major therapy for treating a major illness, the patient must become serious about committing to his or her own treatment success.

Many patients with sleep apnea find they just cannot tolerate the masks, CPAP and other forced air pressure therapies and stop using them. Obstructed sleep apnea positional therapy has been used with such patients and studies have shown that after three months of consistent positional therapy, obstructed sleep apnea can be effectively treated by positional therapy. The treatment, however, must be used consistently. Clinical effectiveness requires constant use.









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