Best Sleeping Position for Sleep Apnea

A person’s sleep position can have direct impacts on comfort, pain, and sleep quality. Sleep position can also affect sleep apnea. In general, experts identify side sleeping as the best position for sleep apnea while back sleeping is the worst.  

Below, we’ll cover how sleep position affects sleep apnea. We’ll also offer tips for modifying your sleep posture and describe other ways to manage sleep apnea symptoms.

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Why Sleep Position Matters for Sleep Apnea

Sleep position has been linked to both types of sleep apnea. Obstructive sleep apnea (OSA) occurs when a narrowed airway repeatedly interferes with breathing. Central sleep apnea (CSA) arises when the brain fails to properly regulate breathing.

Back sleeping (the supine position) has been linked to both OSA and CSA. Research shows over half of people with OSA have worse symptoms when sleeping on their back.

Because back sleeping can exacerbate sleep apnea, changing positions may improve breathing during sleep. We’ll explain the impact of sleep posture and discuss strategies for finding the right sleeping position for your needs.

Best for Sleep Apnea: Sleeping on Your Side

Generally, side sleeping is better for reducing sleep apnea than back sleeping. Research shows that in many cases, sleeping on your side can significantly reduce breathing disruptions Trusted Source European Journal of Heart FailureView Source from both OSA and CSA. However, the reasons for symptom improvement differ between the two types of sleep apnea.

When sleeping on your side, it’s less likely that tissues in your mouth and throat will move into a position where they can block your airway. For this reason, many doctors recommend side sleeping as part of a plan to address OSA. Sleeping on your side can also reduce snoring Trusted Source Merck ManualFirst published in 1899 as a small reference book for physicians and pharmacists, the Manual grew in size and scope to become one of the most widely used comprehensive medical resources for professionals and consumers.View Source , which is a common symptom of sleep apnea.

One study found that sleeping on your right side is the best position for reducing OSA Trusted Source National Library of Medicine, Biotech InformationThe National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information.View Source , likely due to differences in blood flow to and from the heart. However, left side sleeping can be more appropriate under certain circumstances. 

For example, if you experience gastroesophageal reflux disease (GERD) at night, you may find more symptom relief by sleeping on your left side Trusted Source The American Journal of GastroenterologyView Source . Experts also recommend sleeping on your left side if you are pregnant, since this position may reduce pressure on the liver and promote healthy blood flow.

CSA is not caused by a blocked airway, yet research shows that side sleeping can reduce breathing problems tied to the condition. Experts hypothesize that sleeping position may affect breathing in CSA by altering both the amount of space available in the lungs and the relay of signals between the brain and body that control your rate of breathing. However, it is important to note that the positive effects of side sleeping are generally greater for OSA than CSA.

How to Train Yourself to Sleep on Your Side

Many adults prefer to sleep on their side, but if this is not your natural sleeping position, you can try different approaches to changing your sleep posture. 

One way to stay on your side is to use pillows in one or more places on your bed that help keep from rolling onto your back. You can experiment with different pillow sizes and positions.

In some cases, health care providers may recommend positioning devices that vibrate if you start to sleep on your back. However, research on the effectiveness of these devices is limited. A mattress and pillow that appropriately support your body can help promote comfort when sleeping on your side. You might also benefit from sleeping with a pillow between your knees or a body pillow for additional support.

Second Best: Sleeping With Head Elevated

If you have sleep apnea and struggle to switch away from back sleeping, you may be able to reduce breathing disruptions by elevating the head of your bed by 30 to 60 degrees Trusted Source National Library of Medicine, Biotech InformationThe National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information.View Source Trusted Source National Library of Medicine, Biotech InformationThe National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information.View Source . Sleeping in an elevated position can limit how much gravity pulls the tongue and other tissues into a position where they can block the airway Trusted Source Medscape ReferenceMedscape is on online destination for healthcare professionals worldwide, offering expert perspectives, drug and disease information, and professional education.View Source . Compared to lying flat, it also helps expand your chest area and can improve blood oxygen levels. By helping to keep your airway open, having your head elevated may also cut down on snoring.

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Worst Sleep Position for Sleep Apnea

Back sleeping is the worst position for sleep apnea, especially OSA. Stomach sleeping is slightly better but has notable disadvantages.

Sleeping on Your Stomach

Limited research suggests that stomach sleeping may help with sleep apnea in some ways but comes with significant drawbacks.

Small studies have found that sleeping on your stomach can prevent airway narrowing and reduce pauses in breathing Trusted Source National Library of Medicine, Biotech InformationThe National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information.View Source . 

However, the evidence is not conclusive, and, in practice, many people find it difficult to sleep this way. Stomach sleeping is the least popular position, and it can cause back and neck pain from spinal misalignment and excess neck rotation Trusted Source National Library of Medicine, Biotech InformationThe National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information.View Source .

If you use a continuous positive airway pressure (CPAP) device to treat sleep apnea, stomach sleeping may put pressure on the CPAP mask or push the mask out of place, leading to air leaks and dry mouth as well as reduced CPAP effectiveness.

Sleeping on Your Back

Experts advise that you should try to avoid sleeping on your back if you have OSA. In this position, gravity can cause the tongue to fall back in the mouth where it can obstruct the flow of air through the throat. As a result of its narrowing effect on the airway, back sleeping can also worsen snoring Trusted Source Sleep & BreathingView Source . 

Although CSA is caused by the brain’s failure to regulate breathing rather than a blocked airway, research shows that CSA-related breathing problems occur more frequently when you are on your back Trusted Source UpToDateMore than 2 million healthcare providers around the world choose UpToDate to help make appropriate care decisions and drive better health outcomes. UpToDate delivers evidence-based clinical decision support that is clear, actionable, and rich with real-world insights.View Source . As a result, back sleeping may worsen symptoms of CSA.

Best Head Position for Sleep Apnea

Because OSA is caused by a blocked airway, the best head position for sleep apnea is one that keeps the airway open. You should also make sure your head is aligned with your neck and spine.

Optimal head position can depend on your sleep posture: 

• Side sleepers: If you sleep on your side, you may require a taller pillow to avoid neck strain. 
• Back sleepers: One small study found that you may be able to reduce breathing disruptions if you turn your head to the side Trusted Source National Library of Medicine, Biotech InformationThe National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information.View Source while in this position. You can also consider a wedge pillow or accessory to elevate the upper part of your body.
• Stomach sleepers: In this position, try to position your head to reduce neck strain. That generally means a low-profile pillow that may rest only under your forehead. 

Other Ways to Manage Sleep Apnea Symptoms

Experts typically recommend that people with sleep apnea avoid back sleeping, but they also generally suggest other treatments as well. The most appropriate sleep apnea treatment depends on the type of sleep apnea, its severity, and other aspects of a person’s overall health. There are a number of treatment options available for sleep apnea.

• Continuous positive airway pressure (CPAP): A CPAP machine pumps air into a face mask at a consistent level of pressure. This pressurized air helps hold the airway open. Both people with OSA and people with CSA may benefit from CPAP therapy. 
• Other types of PAP therapy: In some cases, sleep apnea treatment uses another type of positive airway pressure (PAP), such as auto-adjusting PAP (APAP) or bilevel PAP (BiPAP). Like a CPAP, these devices pump pressurized air into the airway, but they use different methods for setting and controlling the amount of air pressure. 
• Oral appliances: For people with OSA, oral appliances help keep the airway open by repositioning the jaw or tongue. Oral appliances are often the next choice of treatment if CPAP therapy is not comfortable or effective. 
• Surgery: Different surgical options are available for some cases of OSA and CSA. Surgery types vary depending on the cause of sleep apnea but include tonsil or adenoid removal, modification of the anatomy of the nose or throat, and phrenic or hypoglossal nerve stimulation. 
• Treating underlying causes: Some conditions, such as heart failure or chronic opioid use, can trigger or worsen CSA. By treating these conditions, people may see their CSA symptoms lessen or resolve. 

In addition to these treatment approaches, doctors may suggest lifestyle changes that can help address sleep apnea.

• Avoiding alcohol: Experts recommend that people with OSA or people who snore avoid drinking alcohol before they go to sleep because alcohol can slow down the nervous system and make tissue more likely to block the airway.
• Evaluating medications. Certain medications can affect OSA or CSA symptoms. A reduction in the use of these drugs or avoidance of them altogether may improve sleep apnea symptoms. Be sure to consult a health care provider before changing or ceasing the use of a medication. 

The optimal treatment and lifestyle changes for sleep apnea can vary based on the individual. For that reason, it is important to discuss treatment options with a doctor who can describe the potential benefits and downsides of each approach and suggest a tailored treatment plan. 

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