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Sleeping Positions, OSA and CPAP

If you have obstructive sleep apnea (OSA) and you are using CPAP therapy, you may be wondering whether right_side_sleep.jpgsleeping position matters when it comes to having or treating sleep apnea. 

Believe it or not, sleeping positions have a big influence on how well we sleep, not only with regard to OSA, but in relation to other health conditions.

And comfort matters. Who can sleep when they're not comfortable?

How does sleeping position affect sleep in general?

According to the Sleep Bleft_side_sleepetter Council, side sleeping is generally recommended because it can help to alleviate insomnia (and the sleep deprivation it leads to) as well as provide some relief for digestive concerns like gastroesophageal reflux disease (GERD). 

  • Left side: This is perhaps the most recommended position because it provides the best blood flow and creates the least resistant breathing conditions. Pregnant women are encouraged to sleep on their left side to improve circulation to the fetus.
However, people with congestive heart failure should avoid left-side sleeping to prevent the discomfort that can come with an enlarged heart and to help reduce breathing problems and other related cardiac stress
  • Supine (back): Generally speaking, back sleeping can lead to pain in the lower back. Placing a pillow or rolled-up towel under the knees helps to prevent strain and supports your spine's natural curve.
    Sleeping on your back may be helpful if you have GERD, however, if your head is elevated above your stomach. Some people add 3-inch blocks under the legs at the head of the bed to achieve enough elevation to counteract GERD.
  • Right side: Because of the location of the esophagus, right-side sleeping is not recommended for those with GERD because gravity will make it easier for the contents of the stomach to splash back into the upper airway when the sphincter that should seal this out is compromised.
  • Prone (stomach): This is another position which can lead to lower back pain, as well as neck pain. If youd default position is stomach sleeping, try using an extra soft pillow or no pillow at all to prevent strain of the musculature around the upper spine and neck vertebrae. 

What if I have obstructive sleep apnea?

Here's how body position could affect you.

  • Left and right side: The posture of your upper airway on either side may help to open up space for you to breathe while in this position. If you are not obese and have mild OSA, left-side sleeping may be recommended as "positional therapy" for this reason.
  • Supine (back): You are twice as likely to experience sleep apnea while sleeping supine. You are also more likely to snore, as the tissues in your upper airway (tongue, adenoids, and uvula) are more likely to crowd the back of the throat and create upper airway resistance.
    If you sleep supine and phase into REM sleep, apnea may even worsen, as your upper airway is the least "patent" at this time (meaning the muscle tone is lost during this stage). 
  • Prone (stomach): People who sleep prone are less likely to experience apneas, but the resulting neck pain may not be worth it.

What is REM-related sleep apnea?

Some people only experience OSA during rapid-eye movement (REM) sleep. This happens more commonly in people with mild to moderate sleep apnea, and especially in women and people under the age of 55. 

It's an important form of sleep apnea to recognize. Studies published in the Journal of Clinical Sleep Medicine reveal a twofold increase in risk for developing type 2 diabetes among those who only have REM-related OSA. 

In addition, there are specific changes to the body that occur during REM sleep—surges in blood pressure and heart rate—which could trigger cardiovascular problems in patients who are at a higher risk for stroke or cardiac problems. Having OSA during REM for these people can lead to severe changes in blood oxygen levels and cause more stress hormones to be released as a result. 

For patients with REM-related OSA who are using CPAP, here's an important tip that relates to CPAP compliance:

Since most REM phases occur in the second half of the night, it's important to make sure that, if you are using your CPAP for only part of the night (ideally 5 hours or more), you use it in the second half of the night to treat the apneas that take place during REM at this time, as they are likely to be more severe.

CPAP and sleep positions

prone_sleep or stomach sleepingIf you are using CPAP to treat sleep apnea, good job! You're taking a major step toward preventing major chronic health problems that come from not treating your sleep breathing disorder.

However, let's face it: one of the challenges you may encounter could be with finding a comfortable position while wearing a mask.

There are different kinds of CPAP masks and they fit your face differently. 

Nasal pillows are the easiest to sleep with because they rest just beneath the nostrils and the headgear is typically unobtrusive. 

Full-face masks (also called oronasal masks) can press into your skin when you sleep on either side and this may even compromise the seal. The same can be true for users of nasal masks. 

Even when the seal remains intact, there can still be problems with comfort. Less concerning, but still bothersome, could be facial marks (also known as "sleeping marks") that result from laying on your mask. 

One solution is to purchase a CPAP pillow, which has been designed with special indentations in its construction to accommodate the presence of a mask so that it doesn't press into your face. 

CPAP users who are stomach sleepers, however, must deal with any neck pain associated with their position. In addition, they need to make sure the exhale port on the mask is not blocked: this is where carbon dioxide is released and it should never be blocked.

If you struggle with using CPAP because you can't find the best sleeping position, you are encouraged to contact your DME provider for solutions. They can hook you up with specialty items like a CPAP pillow, help you choose a better mask for your needs, or give you insider tips for how to find the best position while wearing the one you already have.


American Academy of Sleep Medicine
The Better Sleep Council
Journal of the American College of Cardiology
Journal of Clinical Sleep Medicine
National Institutes of Health

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