Sleep Apnea Timeline: Positional Therapy

In many people, sleep apnea is worse when lying on the back, because the tongue and soft palate fall back toward the throat. Positional therapy keeps the sleeper off the back, most often with a small device that vibrates gently until the person turns onto the side.

 

This page is one of seven treatment-track timelines for adult obstructive sleep apnea. The sleep study, how a track is chosen and how to read the outcomes row are covered on the sleep apnea treatment timelines page.

Sleep apnea: positional therapy (keeping off the back) Sleep apnea: positional therapy (keeping off the back) For apnea that happens mostly on the back: a small vibrating device signals a turn to the side during sleep Diagnosis and planning Treatment Side effects and adjusting Outcomes AHI Sleepiness Daily life Nightly use average results in studies Check-ups and sleep tests Long-term care FIRST 6 MONTHS (BY WEEK) 6 TO 12 MONTHS YEARS 1 TO 5 AND BEYOND Wk 0 Wk 4 Wk 8 Wk 12 Wk 16 Wk 20 9 mo 1 yr 2 yr 3 yr 4 yr 5 yr + Check-ups: a sleep test 1 to 3 months after starting, a review at 6 months, then yearly. AHI: events per hour; Epworth 0-24, lower is better Week 0 is the sleep study that confirms sleep apnea. Times are typical ranges and vary from person to person. General education only. doctorlansford.com Sleep study at home or in a sleep lab Results visit: AHI and oxygen levels give the severity; Epworth sleepiness score Sleep study shows apnea mostly when lying on the back Device worn on the chest or neck; starts with a few nights of monitoring Used nightly, alone or added to another treatment Gradual build-up of the vibration Some back or chest discomfort, lighter sleep at first Use tends to drop over time; older methods such as a tennis ball are rarely kept up Sleep test with the device, about 1 to 3 months after starting Sleep test with the device; use reviewed at 6 months Yearly review: apnea can stop being positional with age or weight gain Often combined with an oral appliance or weight loss Repeat sleep study if snoring or sleepiness return About 43% fewer events with a vibrating device; under 5 in about 1 in 4 to 4 in 10 11 before 8 at 6 months Better at 6 months in one study 64% over 4 h a night at 6 months

Teal words in the timeline are links. On a phone, swipe sideways to see the whole graphic.

Who follows this track

About 6 in 10 people with sleep apnea have more breathing events on their back, and about a quarter of these have events almost only on the back. A common definition of positional sleep apnea is a back-sleeping AHI at least twice the side-sleeping AHI. When there is little sleep apnea in other positions, positional therapy can be used on its own; otherwise it is added to another treatment, such as an oral appliance or weight loss.

Timeline

  • Week 0: the sleep study records body position and shows the position-dependent pattern.

  • Weeks 1 to 3: a small device is worn on the chest or the back of the neck. Many devices start with a few nights of recording only, then build up the vibration gradually so the sleeper gets used to it.

  • Months 1 to 3: a sleep test with the device in place shows how much it helps.

  • Month 6: a review of how much it is used (most devices record this).

  • Yearly: a check-in, because sleep apnea can stop being positional with age or weight gain.

Older methods, such as a tennis ball sewn into the back of a shirt or a special pillow or belt, also work while they are used, but few people keep using them: in one study, only about 6 in 100 were still using the tennis-ball method after 2½ years.

Side effects

Mostly mild back or chest discomfort and lighter, more broken sleep at first. No serious harms have been reported.

Outcomes on this track

  • Breathing (AHI): vibrating devices lowered the AHI by about 9 events an hour on average, about 43 percent, and cut the time spent on the back by about a third of the night. The AHI fell below 5 in about 1 in 4 people in one trial and about 4 in 10 in another. Compared with CPAP, the AHI is somewhat higher on positional therapy, but the device tends to be worn longer each night: in one trial, about an hour longer, and over half of people preferred it.

  • Sleepiness: in one study the Epworth score fell from about 11 to 8 at 6 months; across trials, the change compared with no treatment was small (about 1.6 points).

  • Daily life: sleep-related functioning improved at 6 months in the same study.

  • Use: at 6 months, about 2 in 3 used the device more than 4 hours a night.

These are averages from groups of people, not a prediction for any one person.

Check-ups and long-term care

  • A repeat sleep study if snoring or sleepiness return, or after a change in weight.

  • Positional therapy is often combined with other treatments for a larger effect.

  • Avoiding alcohol and sedating medicines near bedtime helps, because they relax the throat further.

Go to Sleep Apnea Treatment Timelines >>
Go to Oral Appliance Timeline >>
Go to Sleep Apnea and Snoring Treatments >>
Go to Obstructive Sleep Apnea >>
 

This page