What is the Best Way to Sleep if You Have Sleep Apnea?

The best way to sleep if you have sleep apnea is on your side. This position helps keep your airway open by using gravity to prevent your tongue and soft palatefrom collapsing into your throat. Back sleeping, on the other hand, is the worst choice. 

It allows gravity to work against you, increasing the risk of breathing pauses, snoring, and oxygen drops. Sleep posture can mean the difference between restful sleep and a night full of oxygen-starved interruptions. And small shifts in how you lie down can bring major relief.

The Best Position: Sleeping on Your Side

Side sleeping is consistently ranked the best position for people with sleep apnea, both obstructive (OSA) and central (CSA). This is because gravity works in your favor. When you lie on your side, soft tissues and the tongue are less likely to collapse into the airway, keeping the passage open.

• Right-side sleeping is particularly effective for managing obstructive sleep apnea (OSA). This position promotes better airflow by enhancing diaphragmatic movement, due in part to the anatomical placement of the liver on the right side. The result is increased lung capacity and reduced upper airway resistance, which can lead to fewer breathing disruptions during sleep.
• Left-side sleeping might be better for people with acid reflux or heartburn. It allows gravity to keep stomach acid from flowing up into the esophagus. This is key for those who experience both reflux and apnea, which is common.

Doctors often recommend side sleeping as an initial strategy for managing mild to moderate sleep apnea. It’s especially useful for patients who aren’t yet ready to begin CPAP therapy.

The Worst Position: Sleeping on Your Back

Back sleeping is the most problematic position for anyone with sleep apnea, particularly OSA. In this position, gravity pulls the tongue, soft palate, and other tissues toward the throat, narrowing or fully blocking the airway.

• Research shows that supine sleep (on the back) increases the number and length of apneic events in many people with OSA (1).
• Snoring is louder and more frequent on the back. So are drops in oxygen saturation.
• In central sleep apnea, the airway isn’t physically blocked. But back sleeping can still disrupt breathing patterns. It affects chest mechanics and the brain’s signals to the lungs.

For most patients, especially those with moderate to severe OSA, back sleeping should be avoided unless a CPAP or another airway-supporting device is in place.

What About Sleeping on Your Stomach?

Stomach sleeping is more controversial. Some small studies suggest it can reduce breathing interruptions by naturally keeping the airway open, similar to side sleeping. However, it's far from ideal for most people:

• It's the least common sleep position among adults because it tends to be uncomfortable.
• It can cause neck strain, back pain, and poor-quality sleep due to the unnatural alignment required to breathe in that position.
• Many find it nearly impossible to use a CPAP machine while sleeping on their stomachs. The face mask gets pressed into the pillow, leading to leaks, facial discomfort, and reduced therapy effectiveness.

While it may slightly help in some cases of positional OSA, stomach sleeping is rarely recommended by sleep specialists as a primary strategy.

How to Train Yourself to Sleep in a Better Position

Changing your natural sleep posture isn’t easy. But with consistent habits and physical adjustments, it can be done.

Here’s how to train yourself to stay on your side:

• Pillow strategy: Use firm pillows behind your back to prevent rolling over. A full-length body pillow can also provide support and comfort to keep you in position.
• Tennis ball trick: Sew a tennis ball inside a sock and attach it to the back of your pajama shirt. When you roll onto your back, the discomfort will trigger a return to your side, without fully waking you up.
• Vibrating positional trainers: These wearable devices detect when you’re on your back and emit a light vibration. Some people find them effective; others don’t.
• Supportive mattress and pillow: A mattress that contours to your body helps support side sleeping. A pillow that aligns your neck and spine adds comfort. Placing a pillow between your knees also makes it even better.

Consistency is key. Most people take a few weeks to adjust to a new sleep position, but once established, it can significantly reduce apnea severity.

Can Elevating Your Head Help?

Elevating the head of the bed by 30 to 45 degrees can help reduce sleep apnea severity, mainly for people who cannot sleep comfortably on their side.

• Elevation improves upper airway stability and may reduce the likelihood of soft tissue collapse.
• Studies in OSA have shown that head-of-bed elevation can reduce the apnea-hypopnea index (AHI), a measure of breathing disruptions per hour.
• It’s also useful for reducing snoring and acid reflux, two common coexisting conditions in sleep apnea patients.

How to do it:

• Use a wedge pillow or adjustable bed frame to raise the upper body, not just the head.
• Avoid stacking traditional pillows. This can kink the neck and worsen apnea.

Elevation is not a substitute for CPAP, but it can offer noticeable improvements for people with mild OSA or as a complementary approach.

How CPAP and Sleep Position Work Together

Continuous Positive Airway Pressure (CPAP) is the gold standard for treating obstructive sleep apnea (OSA). But how well it works can depend heavily on how you sleep.

Sleep position directly impacts CPAP effectiveness.

• When you sleep on your back, your airway is more likely to collapse, even with CPAP. The pressurized air must work harder to keep the passage open.
• Side sleeping reduces the gravitational pull on the soft tissues in your throat, which means CPAP doesn’t have to compensate as much.

Air leaks are another concern.

• People who sleep on their stomachs or toss and turn during the night may dislodge the mask. This leads to poor seal, dry eyes, mouth leaks, and less-effective therapy.
• Proper mask fitting and stable positioning matter. A nasal pillow mask might work better for side sleepers, while a full-face mask may be harder to manage in non-back positions.

Sleeping on your side while using CPAP can reduce apneic events, lower required pressure settings, and improve comfort and adherence. Your sleep position can make or break your CPAP results.

The Role of Sleep Hygiene

Good sleep hygiene strengthens all sleep apnea treatments by promoting deeper, uninterrupted rest through better habits and environment.

Poor sleep habits can worsen sleep apnea symptoms.

• Alcohol, particularly in the evening, relaxes throat muscles and increases the chances of airway collapse.
• Sedatives do the same, making apneas more frequent and more severe.

Caffeine and screen exposure delay sleep onset.

This leads to fragmented sleep, which adds to daytime fatigue, even if apnea events are managed.

What good sleep hygiene looks like:

• Consistent sleep and wake times, even on weekends
• No caffeine after noon
• A dark, cool, and quiet sleep environment
• No screens 30–60 minutes before bed
• Avoiding large meals or alcohol in the evening

Exercise helps, too.

Regular exercise improves sleep quality and can reduce apnea severity. The benefits are even greater when paired with weight loss and done earlier in the day.

Sleep hygiene won’t “cure” sleep apnea. But without it, even the best devices or medications can fall short. 

When Changing Position Isn’t Enough

Sleep position matters, but for many, it’s not the whole answer. If your apnea is moderate to severe, positional therapy alone won’t control it.

Red flags that indicate you need more than side sleeping:

• AHI (apnea-hypopnea index) remains high despite side sleeping
• CPAP use shows frequent events even with good mask seal
• You wake up gasping, with headaches, or feeling unrested
• You have underlying conditions like obesity, GERD, or CSA

In those cases, more advanced treatments are essential:

• CPAP or BiPAP: Often needed long-term if positional therapy isn’t enough
• Oral appliance therapy: Custom dental devices that reposition the jaw to prevent airway collapse
• Inspire therapy: A surgically implanted device that stimulates airway muscles
• Remede system: For central sleep apnea, this device stimulates breathing through the phrenic nerve

Positional therapy helps, but it’s rarely enough alone. It should be seen as a support tool, not a replacement for proven medical treatments when the severity of apnea demands more intervention.

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References

1. Timo Leppänen, Juha Töyräs, Anu Muraja-Murro, Salla Kupari, Pekka Tiihonen, Esa Mervaala, & Antti Kulkas. (2016). Length of Individual Apnea Events Is Increased by Supine Position and Modulated by Severity of Obstructive Sleep Apnea. Sleep Disorders, 2016, 1–13. https://doi.org/10.1155/2016/9645347

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