A good night’s sleep is crucial to your overall health and wellness, and comfort is key. But anyone with sleep apnea (OSA) knows a comfortable and easy night’s sleep can be difficult to achieve thanks to difficulty breathing and CPAP or BIPAP masks. Your preferred sleeping position plays a key role in the frequency of your OSA episodes, and ultimately, the key to sleeping well with sleep apnea (in addition to getting treatment) is to know the best sleep positions for sleep apnea.
How Sleep Apnea Affects Sleep
Obstructive sleep apnea (OSA) is a common sleep disorder where sleepers experience a partial (hypopnea) or complete (apnea) collapse of their airway while they sleep. Essentially, the muscles at the back of the throat relax enough to impair the person’s breathing. Typically, those with OSA will stop and start breathing repeatedly throughout the night.
Apneas can last anywhere from 10 to 20 seconds at a time, and it can happen hundreds of times per night depending on the severity of the condition. Loud snoring, gasping during sleep, fragmented sleep, and excessive daytime sleepiness are hallmarks of the condition.
The severity of sleep apnea is typically measured against an apnea/hypopnea index (AHI), which measures the average number of apnea or hypopnea events in one hour.
- Mild sleep apnea is an AHI between 5 and 15. This means the person has between 5 and 15 apnea or hypopnea events per hour. (In the absence of other symptoms, mild sleep apnea may not warrant treatment.)
- Moderate sleep apnea in an AHI between 15 and 29 events per hour.
- Severe sleep apnea is AHIs that occur 30 or more times in an hour.
While the AHI might seem like abstract numbers, it’s pretty startling when you do the math. Someone on the low side of moderate sleep apnea could be waking up about 120 times per night, while someone with severe sleep apnea could be waking as much as 240 times per night.
Continuous positive airflow pressure (CPAP) therapy has long been the gold standard for
treating sleep apnea. Dr. June Seliber-Klein, MD DABPN, sleep board certified and chief medical officer of Ognomy Inc., tells Sleepopolis, “A CPAP machine is essentially a fan (blowing air which is usually heated and humidified for comfort), and a mask. [The mask] creates a seal, which directs all the pressure into your airway to hold it open so you do not snore and do not stop breathing.”
Why Is It So Hard To Sleep With CPAP?
While the benefits of CPAP therapy are well-documented, it’s only beneficial when you are using it. That said, it’s a mask worn over your face while you sleep and it can take some time to find the right fit, so it almost comes as no surprise that CPAP has a high non-compliance rate. However, Seliber-Klein notes that looks can be deceiving, and compliance is often closely tied to the support the user gets and their dedication to getting a good night’s sleep.
“Looking at [the device], it looks like it would be very hard to sleep with; however, surprisingly, the majority of patients with the proper motivation and support get used to sleeping with it,” she says. “There are many, many different kinds of masks; some cover just the nose, some cover the mouth and the nose. Their straps are in different places, and they have different features, so we can usually find a mask that is very comfortable.”
Seliber-Klein adds, “many of my patients end up with a small wardrobe of masks that I suggest they select based on changing criteria. If you have a cold, you might feel better with a mask that covers your nose and your mouth. If it’s hot, you might feel more comfortable with that very small mask that just goes into the nose.”
She points out that support makes a huge difference, too. “Having the appropriate support from the family and from the CPAP provider as well as your physician is important for success. I try to concentrate on this assistance within the first few weeks so patients don’t get frustrated or develop any negative associations.”
The Best Sleep Positions for Sleep Apnea
Back Sleepers
Unfortunately for back sleepers, this is the worst sleep position if you have sleep apnea.
According to Dr. Chester Wu, double board-certified doctor in Psychiatry and Sleep Medicine, “sleeping on your back can worsen sleep apnea symptoms by causing your tongue and soft palate to collapse into the airway, obstructing breathing.” Wu also notes that some people may find that their symptoms are significantly improved with positional therapy — an intervention used to keep sleepers off their back — for sleep apnea that excludes back sleeping.
Positional therapy to keep sleepers off their backs may include a variety of different strategies, including strategically placed and shaped pillows to keep them from rolling over or alarms that vibrate whenever the sleeper rolls onto his or her back.
Left and Right Side Sleepers
“Sleeping on your side can help keep the airway open and reduce symptoms of sleep apnea,” says Wu. He also notes that side sleeping may allow some people to lower the level of air pressure on their CPAP machine compared to back sleeping since this position allows for easier breathing.
It may be worth noting that sleep apnea has been linked with gastroesophageal reflux disease (GERD). Those dealing with both issues may find it more comfortable to sleep on their left side as GERD symptoms are often minimized in that position.
Sleeping on Your Stomach
While you might think that gravity would work in your favor to mitigate the symptoms of sleep apnea when sleeping on your stomach, that’s not quite the case. Yes, sleeping on your stomach will pull your tongue forward, ultimately reducing an airway obstruction, but stomach sleeping also covers your face and mouth, still exacerbating symptoms of severe sleep apnea.
Overall, Wu says finding the best sleep positions for sleep apnea may be a matter of trial and error. “For optimal sleep [in any position] with sleep apnea and/or CPAP, people can use pillows to support their neck and prevent the mask from shifting during the night,” he adds.
Other Tips for Sleeping Comfortably with Sleep Apnea
Sleep apnea and comfortable, restful sleep don’t always go hand in hand, so Wu offers a few more tips to help sleep apnea sufferers get through the night, such as:
- Experimenting with body pillows to make side sleeping more comfortable
- Buying a mattress that keeps your spine aligned when sleeping on your side
- Using a thicker pillow to keep your spine aligned
- Maintaining a cool, dark, and quiet sleeping environment
- Practicing relaxation techniques, such as deep breathing or progressive muscle relaxation, both of which can help reduce stress and decrease the time it takes to fall asleep
How to Make CPAP and BIPAP Devices More Comfortable
There are several things you can do to make CPAP devices more comfortable. A heated humidifier will prevent dryness in the nose and throat, a properly fitting mask won’t let air escape or create uncomfortable pinch points, and using a machine with adjustable pressure settings are all great thought starters. Read on for additional tips.
Use a Properly Fitting Mask
One of the best tips for making your CPAP more comfortable is to ensure you have the right fit. CPAP masks come in a wide variety of sizes to accommodate all types of wearers. For the best results, make sure your mask fits your face and suctions properly, and there should be no pinching or discomfort. Moreover, sometimes CPAP devices need to be broken in. If you’re still feeling uncomfortable after a reasonable breaking-in period, you may need to get a different mask.
If you’re a mouth-breather at night, which can cause air leakage, you may want to consider a chinstrap to keep your mouth closed and avoid air escaping through your mouth.
Manage a Dry Mouth and Stuffy Nose
CPAP therapy is notorious for drying out your airways, so users should consider adding a humidifier or, better yet, a heated humidifier to their CPAP machine to increase comfort levels and give their overall experience a boost. For stuffy noses, try a saline nasal spray at night to keep things moist.
Hose Management
A hose attached to your face that extends over to your nightstand could understandably stymie anyone’s plans for sweet dreams. Good news: CPAP pillows with hose tethers and CPAP hose stands can help support the weight of the hose so you can get some shut-eye.
Manage Claustrophobia
CPAP masks have the tendency to amplify claustrophobia — as a matter of fact, claustrophobia is often cited as one of the reasons for poor CPAP compliance. If that’s an issue for you, try a smaller mask that doesn’t cover a large area of your face, or think about speaking with a therapist to learn some breathing exercises to help you manage the stress.
Why It’s Important to Wear Your CPAP
“It is important to wear your CPAP while sleeping with sleep apnea because it helps deliver pressurized air into the airways in order to keep them open,” says Isabella Gordon, Sleep Science Coach and Co-Founder of Sleep Society. “Not only does this help reduce breathing pauses and snoring while you sleep, but it also improves oxygen levels in the blood.”
But Gordon adds that wearing your CPAP goes far beyond the short-term benefits of improving your sleep. “Wearing your CPAP also helps prevent long-term complications associated with sleep apnea, such as high blood pressure, stroke, heart attack, and diabetes. It’s essential that people who have been diagnosed with sleep apnea use their CPAP every night for optimal health and well-being.”
How to Sleep with Sleep Apnea Without CPAP
“There are many other treatments for sleep apnea, and more are being developed daily, it seems,” says Seliber-Klein. “There are dental appliances that advance the mandible to open your airway, there are devices that stimulate muscles to stay open or to increase their tone, and surgical procedures using a laser or radio frequency.”
Beyond the devices and surgical interventions, Seliber-Klein suggests a few key lifestyle changes or positional therapy. “If a sleep apnea patient has a large neck due to weight gain, losing that weight can often be helpful.” And while she notes that sleeping in a semi-upright position may be okay for the short term, it’s not an advisable long-term solution as it interferes with full muscle relaxation during sleep.”
The Last Word from Sleepopolis
When collapsing airways cause you to stop breathing as much as 100 times per night, only to wake up gasping for air, that doesn’t exactly make for a restful night. Luckily, there are different sleep positions you can try to mitigate the effects — and guidance for loyal CPAP users for how to sleep more comfortably. To ensure some shuteye with a CPAP machine, ensure your mask is fitted correctly and comfortable for the best results.