The Most Misunderstood And Often Overlooked Treatment For Sleep Apnea (HINT: It’s NOT CPAP)

John Wooden, UCLA’s legendary basketball coach was a stickler for fundamentals. He looked down on trick plays, fancy footwork, or high-tech strategies. Similarly, before looking for state-of-the-art treatment options for obstructive sleep apnea, you should always first consider the fundamentals. 
If you’ve been newly diagnosed with obstructive sleep apnea, you’re likely to be told to lose weight, diet and exercise. Everyone know this already. Drinking alcohol before bedtime is another big no-no, since it relaxes your throat muscles. 
One option that is mentioned only casually is to avoid sleeping on your back. This is because being on your back allows your tongue and soft tissues of your throat to fall back more severely. When you add muscle relaxation during deeper levels of sleep, then you’ll either snore, or stop breathing altogether (called an apnea). 
In sleep studies, you’ll routinely see that in most cases, being on your back can lead to double, or even triple the number of apneas on your back compared to sleeping on your side or tummy. One study showed that sleep positioning was almost as good as CPAP.
Many people know not to sleep on their backs. The problem is that in most cases, you can’t control your sleep position all night long. 
If you are one of these people, then there’s an opportunity to use gravity to your advantage. 
One of the oldest recommendation is to sew a tennis ball inside a sock to the back of your pajamas. This may work sometimes, but more often than not, you’ll just sleep on top of it, or it’ll keep annoying you causing you to wake up. One of my patients misunderstood me and filled an entire backpack with tennis balls during sleep, and it worked well for him.
There are now multiple options for keeping you off your back during sleep. One popular option is the Rematee Anti-snore shirt. It’s a vest that you wear at night with pockets in the back that’s filled with inflatable bumpers. 
Another variation is the isidesleep mattress, which is an inclined wedge with a cutout at the top that allow you to drop your arm below the mattress, which cradling your head on a pillow that sits above the cutout. 
If you have shoulder or back problems and you can’t sleep on your side, then sleeping on your back on a incline is another option. There are a number of different options that you can find including this wedge pillow. This can be also be good for acid reflux. It’s also why some people can only sleep on recliners.
If you must sleep on your back, then it’s important to use a pillow that will tilt your head back somewhat, which will open up your airway. This is similar to what you do as the first step in CPR, but not as far back. There are many of these “contour memory foam” pillows that are promoted to reduce snoring. It’s not going to cure your sleep apnea, but used in conjunction with various other methods, it can help to various degrees.
Two of my patients wore neck braces (one soft and one hard) with some success. This may work by preventing your chin from dropping forward, while keeping your neck extended.
If you must sleep on your back, there aren’t too may options. One desperate patient actually bought a massage table and slept tummy down with his face inside the hole. 
As a last resort, you can always fly into space, where there’s no gravity. In fact, it’s been shown that astronauts have less snoring and apneas while in space compared to levels found back on earth.
If none of these options work for you, then it’s time to see a sleep physician. If you’re already using CPAP or an oral appliance, you can supplement positional therapy to your current regimen. Oftentimes, you’ll have to combine multiple options for better results.
I’m sure that many of you have tried other creative ways to get rid of snoring using positioning devices or contractions. If so, please share what worked for you in the comments area below.

Please note: I reserve the right to delete comments that are offensive or off-topic.

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13 thoughts on “The Most Misunderstood And Often Overlooked Treatment For Sleep Apnea (HINT: It’s NOT CPAP)

  1. Here is another option that I’ve been told is much better than just the wedge that sits on top of the mattress (You can slide down this type and maybe off it completely during the night.) I don’t have it yet due to the cost, but I intend to get one for my LPR. My friend uses it due to a medical condition where she is not supposed to sleep flat, even it on her side. (It’s not any type of SDB or stomach issue.) Do you feel this would also be beneficial for OSA/UARS?


  2. Thanks, Pam. I’m sure that there are a number of other variation of the wedge or inclined mattresses. It’s difficult to predict if it’s going to work for you as well to justify the investment, since everyone responds to varying degrees. My recommendation is to start simple and low-cost, and then invest in something better at a later time.

  3. This is a really interesting article. In my experience the general consensus is that sleeping on your back is healthiest because it presumably reduces neck and back pain. Clearly that’s not always the case and depends heavily on the individual and what health conditions he has. Great tips on how to change your sleeping position to reduce your sleep apnea.

  4. Thanks for your article about sleeping positions and sleep apnea. You make a good point about how sleeping on your back can increase the number apnea episodes experienced while sleeping. Considering different mattress options can help you change your sleeping position. Some people find that sleeping on their side is much more comfortable if their mattress isn’t as firm.

  5. How did sleeping face down on a massage table work for your patient? I’m thinking of buying one.

  6. “Avoiding alcohol is another big no-no…”

    I had always suspected alcohol is good for me. Thanks for the confirmation. ;-)

  7. Well I had not had a sinus infection in years until I began using a cpap. No matter how much I clean or replace parts I get them about 1 per quarter and it has to stop. I speak with many cpap users and most of them say they do get ear and sinus infections since they use the cpap. Love the way they help me sleep but I must do something different. I am neither over weight or have a fat neck, so I guess its my tonsils etc which create the problem. I do have a syrinx in my spine along the nerve areas which control breathing which could be part of the problem. Surgery options do not sound promising. I guess I can test some method of elevation without buying a car, ur I mean bed which is about the same cost. Beyond the recliner any SAFE way to test sleeping this way? Thx great website.

  8. ” Avoiding alcohol is another big no-no, since it relaxes your throat muscles.” Please clarify, so I should NOT avoid alcohol?

  9. 2 boil and bite mouth guards from Walmart for $2 each. Molded them first, then bit down on super glue and held for 1 minute, waited 24 to dry. Ideas for a better bonding agent?

  10. Upon reading Dave Asprey’s (one of the world’s best known bio-hackers) Game Changers book (fantastic read just out), we learned about the many benefits of an inclined sleep position, in addition to snoring or apnea. The roots of these benefits are due to the head being above the heart when sleeping. For an inexpensive hack we used a “stepped” series of 8-ft long wood 2x4s (we needed about 11 of them for a king size bed) to approximate a roughly 10 degree inclination. All told about $25 to $30 at big box store and roughly 1-1/2 hrs of labor to cut pieces on a mitre saw and then gorilla taped the pieces together. So, this is a quick and inexpensive hack that hopefully will help lessen my wife’s snoring/apnea, but even if it doesn’t there are many other healthful benefits. A win-win.

  11. Using bi pap for 20 years with little problems
    Recently I started to be awaken by extremely parched mouth which is starting to make my front gums sore——never had sore gums before—-
    I have tried all the so called remedies for dry mouth to no avail
    I can’t figure this out—-
    High humidity, secure tape on mouth, breathing through my nose with no blockage—-
    When I try to talk to Docs they look at like I have three heads and have no answer
    Can you shed any light on this matter