For some people suffering from severe sleep apnea, the introduction of the CPAP machine has been a life saver.
But as with any ground-breaking invention, it’s only great if it is used properly. Because CPAP equipment can be uncomfortable to use, difficult to clean, and just plain annoying, sleep apnea sufferers – especially those with mild cases of apnea – tend to not use them as religiously as they should. That’s where our ultimate guide to positional therapy for sleep apnea enters the picture.
If you’ve found CPAP device just isn’t for you, using positional therapy can greatly reduce or even eliminate your apnea episodes. And even if CPAP works well for you, positional therapy techniques and devices can work in combination with the CPAP to give you the best overall results, meaning you can use your CPAP at a lower setting or less frequently.
At Apnea Treatment Center we’ve had the chance to test nearly every idea that’s in the market for positional therapy. Some of the ideas are really smart, some are a little strange, and some are in between. As you might imagine, not all of them work.So allow us to help you avoid the ideas that don’t work.
We’ve compiled a list of the best positional therapy for sleep apnea options available today in the following categories:
Best Overall Positional Therapy Sleep Apnea Belt
Also called bumper belts, these belts make it uncomfortable for you to sleep on your back. Sleeping on the back can lead to increases in obstructive sleep apnea (OSA) episodes. Our favorite positional sleep apnea belt is the SlumberBUMP Positional Sleep Belt, which acts as a wedge to help you stay on your side, while also making it uncomfortable should you roll onto your back in the night.
Best Positional Sleep Apnea Pillow
These pillows will work to keep your airway open through proper positioning of the neck and jaw.
They also can force you to sleep on your side or stomach. The best positional sleep apnea pillow we found in our tests is the Therapeutica Sleeping Pillow. It doesn’t work well with CPAP, but it does hold your head and neck in proper alignment all night, helping to maintain an open airway.
Best Positional Sleep Apnea Shirt
These sleeping t-shirts have objects sewn into the back of them, so the wearer is forced to sleep on their side or stomach.
Our testing shows the Rematee Anti-Snore T-Shirt is the best positional sleep apnea shirt, as it is fully adjustable. This allows you to adjust the shirt in the most comfortable manner for sleeping on the side or stomach, while also preventing you from rolling onto your back.
Best Positional Sleep Apnea Mouthpiece
Intelliguard Pro Mouthpiece Adjustable Night Guard
Mouthpieces play a role in positional therapy by forcing proper alignment of the jaw and neck, resulting in fewer and milder OSA episodes.
We have found the Intelliguard Pro Mouthpiece Adjustable Night Guard is the best positional sleep apnea mouthpiece, because you can make slight adjustments to the guard to ensure a no-slip fit.
Best Positional Sleep Apnea Vibration Device
Some of these clever devices may look a little odd, but the alarms they use will work to reduce sleep apnea episodes, especially for those with mild- to moderate obstructive sleep apnea.
The best positional sleep apnea vibration device is the NightBalance Sleep Position Trainer. It is thin, meaning the sensor is comfortable to wear. And it collects quite a bit of helpful data about your sleep patterns throughout the night.
Continue reading to learn more about positional therapy for sleep apnea and which products are worth your time to try!
What Is Positional Therapy for Sleep Apnea?
Simply put, positional therapy uses devices such as belts, pillows, and other products to force people to sleep on their sides.
This treatment might seem like it’s so simple that it couldn’t work, but the power of positional therapy lies in the major causes of obstructive sleep apnea.
Let’s break down the key aspects of positional therapy for sleep apnea:
WHAT IS OBSTRUCTIVE SLEEP APNEA (OSA)?
The most common cause of OSA is when the muscles that support the upper airway relax too much during sleep. This can cause various parts of the mouth (such as the tongue, soft palate, etc.) to shift position, possibly causing an obstruction and blocking off the airway.
RAMIFICATIONS OF OSA
When the airway is obstructed, the body’s oxygen levels can drop and breathing may stop for up to 60 seconds (yes, 60!). The brain reacts to this by attempting to wake the sleeper, causing breathing to start again with a gasp. If this occurs multiple times each night – and night after night – it can cause permanent damage to the brain and other organs over time.
Unfortunately, some people don’t wake up fully enough to even realize the OSA problem is occurring, meaning they never seek treatment. Often times, a significant other sleeping next to the person suffering from OSA is the first to notice the symptoms, which also can include loud snoring.
SLEEPING POSITION IMPORTANCE
The soft tissues in the mouth have a greater chance of falling back into the throat and obstructing the airway when someone is sleeping on his or her back, versus sleeping on the side or stomach. Sleeping on the side or stomach allows the airway to remain open more fully, resulting in fewer OSA episodes. This means people often use positional therapy for sleep apnea as a means of avoiding sleeping on the back.
Now, some people may use a simple method of positional therapy, such as placing a pillow between their knees while sleeping on the side, hoping the pillow prevents them from rolling onto the back.
Or some may rely on a more direct simple method: A partner elbowing them to force them to switch sleeping positions once they start snoring! Ultimately, these simple methods usually end up causing a pillow to be thrown onto the floor and/or sore ribs, all while doing little to ensure a full night’s sleep on the side or stomach.
Fortunately, many companies have developed more extensive and scientifically based products that offer more success with positional therapy for sleep apnea. Such devices will use alarms, belts, wedges, mouthpieces, pillows, and bumpers to attempt to keep the body, head, neck, and jaw in the proper position throughout the night, while also causing the sleeper to avoid sleeping on his or her back.
Is Positional Therapy for Sleep Apnea Truly Effective?
Although positional therapy may seem like it’s too simple to help with a problem as serious as sleep apnea, many studies have been performed to measure the effectiveness of different positional therapy methods. Here are a few studies that show the effectiveness of positional therapy.
A study published on PubMed (from the National Institute of Health) highlights the effectiveness of alarm-based positional therapy. These devices use an audible alarm or a vibration of a device worn on the body during sleep to alert the person when he or she is sleeping on the back. The study showed these devices work well, and they also accurately measure the sleep position of the wearer.
AT HOME POSITIONAL THERAPY TREATMENTS
Another study published on PubMed measured the success rate of using positional therapy treatments at home for OSA sufferers. Because many patients have success with positional therapy at sleep clinics, the study’s creators wanted to see if such successes continued at home. The study showed 73% of OSA sufferers reported success with their positional therapy devices used at home over a three-month period.
BUMPER BELT TREATMENTS
The National Institute of Health published a study that discussed the ability of bumper belts to prevent people from sleeping on their backs. The study said such devices were effective.
MOUTH GUARDS FOR OSA TREATMENTS
A study from the Journal of Dental Sleep Medicine shows that mouth guards have a high level of effectiveness in limiting snoring and a moderate level of effectiveness against OSA symptoms.
OBJECT SEWN INTO A SHIRT
A study from the Journal of Clinical Sleep Medicine showed that 68% of participants had success with positional therapy in reducing the number of OSA events that occurred. The positional therapy method tested in this study involved sewing objects into a pocket on the back of a shirt, such as tennis balls or foam bumpers. Once the wearer rolled onto his or her back, having an uncomfortable object jammed against the back would cause them to shift onto the side or stomach.
SLEEP APNEA POSITIONAL PILLOWS
A study published on the National Institute of Health web site studied positional pillows and whether they could reduce episodes of snoring and OSA. The results showed these pillows produced a significant positive response for sleepers.
(Summary Table) Best Positional Therapy Products for Sleep Apnea
TYPE OF THERAPY
REQUIRES DOCTOR APPROVAL?
MULTIPLE SIZES AVAILABLE?
ADJUSTABLE FIT TO AVOID SLIPPING?
EASY TO USE?
Best Inflatable Sleep Apnea Belt
Best Foam Sleep Apnea Bumper Belt
Best Versatile Sleep Apnea Belt
Sleep Apnea Pillow
Best Sleep Apnea Pillow for Neck Support
Sleep Apnea Pillow
Best Contoured Sleep Apnea Pillow
Sleep Apnea Pillow
Best Sleep Apnea Pillow With Cooling Gel
Sleep Apnea Shirt
Most Versatile Sleep Apnea Shirt
Sleep Apnea Shirt
Most Comfortable Sleep Apnea Shirt
Sleep Apnea Shirt
Best Inexpensive Sleep Apnea Shirt
Intelliguard Pro Mouthpiece Adjustable Night Guard
Best No-Slip Sleep Apnea Mouthpiece
Yes (upper or lower)
Best Thin Sleep Apnea Mouthpiece
Best Inexpensive Sleep Apnea Mouthpiece
Best Easy to Use Sleep Apnea Vibrating Device
Best Data Driven Sleep Apnea Vibrating Device
Best Anti-Snoring Sleep Apnea Vibrating Device
Reviews of Best Products for Positional Therapy for Sleep Apnea
If you’re ready to try some positional therapy devices, our ultimate guide to position therapy for sleep apnea includes more than a dozen products that can help you.
These products are available in many different configurations, and they provide several different methods of achieving the same result: reducing or eliminating occurrences of OSA throughout the night.
You may find that one type of device is easier to tolerate than another, so look through our list to find a category that sounds like it would be comfortable for you to use while sleeping.
POSITIONAL SLEEP APNEA BELT REVIEWS
A positional sleep apnea belt makes use of a bumper or wedge to cause the wearer to avoid sleeping on his or her back, thereby hoping to alleviate OSA occurrences.
Some of the bumpers are aimed at making it difficult for the wearer to roll onto the back, encouraging side sleeping. Others will make it very uncomfortable to sleep on the back, as the wedge or bumper digs into the back, making it difficult to lie flat. The bumpers or wedges are held in place by a belt that fits around the torso.
1. Best Inflatable Sleep Apnea Belt – SlumberBUMP Positional Sleep Belt
The best sleep apnea bumper belt we’ve found is the SlumberBUMP Positional Sleep Belt. This design looks simple, but it’s also clever. It acts as a wedge, forcing you to remain sleeping on your side, which is preferable to sleeping on the back, as we discussed earlier. This bumper belt wraps around the chest with the wedge aligned against the back.
The SlumberBUMP makes use of an inflatable air pocket to create the wedge. This means the device doesn’t weigh much, which makes it easier to sleep comfortably. Additionally, the SlumberBUMP will collapse flat if you ever need to transport it for a trip.
If you’re someone who thrashes around a lot during the night, you may find that the SlumberBUMP can rotate out of position if you aren’t wearing it tightly enough. However, make sure you pick the right size of bumper belt (of the three sizes that are offered), and it’ll stay in place more effectively all night.
2. Best Foam Sleep Apnea Bumper Belt – Zzoma Positional Device
The Zzoma Positional Device uses wedges to force the wearer to sleep on his or her side during the night. You’ll wear the Zzoma around your upper torso, with the bumpers against the back. The device clasps along your chest, using Velcro straps to ensure a proper fit. This means the device is one size fits all up to a 55-inch chest.
By forcing you to sleep on your side, the Zzoma Positional Device can reduce or eliminate OSA episodes during the night, while also reducing snoring. The bumpers are made of foam, so the Zzoma Positional Device doesn’t weigh much.
The Zzoma device does require a Class II prescription, as it has been approved by the FDA. The company will work with you and your insurance plan, which is a nice feature.
3. Best Versatile Sleep Apnea Belt – Back Off Anti-Snoring Belt
Our favorite aspect of the Back Off Anti-Snoring Belt isn’t its simple design, but rather its versatility in how you can wear it. Some people will enjoy better success with this device when it’s worn in a vertical position, aligned with the direction of the spine. Others will prefer wearing the Back Off belt in a horizontal position, perpendicular to the spine for the best results.
Either way, the Back Off Anti-Snoring Belt is uncomfortable enough that when you roll over onto your back while sleeping, you’re going to know it.
The Back Off belt uses tennis balls inside a pouch that is worn on the back. The idea of the device is that when you roll onto your back, you’ll wake up because of the uncomfortable feeling of the tennis balls, forcing you to readjust your position to your side or stomach. So it’s a bit different than the other best bumper belts on our list in that it doesn’t use a wedge to keep you on your side. It does seem to work better when using a firm mattress, otherwise the tennis balls can sink into a soft mattress, and you may not feel them.
POSITIONAL SLEEP APNEA PILLOW REVIEWS
The best positional therapy sleep apnea pillows work well as standalone devices for reducing instances of obstructional sleep apnea. Some sleep apnea pillows are specifically designed to work with CPAP devices too, holding the hose in position to ensure it doesn’t disturb your sleep.
1. Best Sleep Apnea Pillow for Neck Support – Therapeutica Sleeping Pillow
The contours on the Therapeutica Sleeping Pillow may look odd and uncomfortable, but they perform the job you’re asking them to do. (And they really aren’t as uncomfortable as they look.) The Therapeutica pillow is available in a few different sizes, which is helpful for finding just the right fit.
With its rounded indention in the middle of the pillow, you’ll keep your head in place throughout the night. The pillow’s contour works to keep the head and neck properly aligned as well.
If you’re someone who simply cannot sleep unless you’re on your back, the Therapeutica Sleeping Pillow provides the right head and neck support for back sleepers. It’s still better to sleep on your side with this pillow, but it does provide support against OSA symptoms for back sleepers too.
2. Best Contoured Sleep Apnea Pillow – Sensorpedic sensorGEL Contour Pillow
The contours of the Sensorpedic sensorGEL Contour Pillow are perfectly designed to keep your head and neck aligned during the night. However, to set itself apart from other contoured pillows, the Sensorpedic model offers two levels of contours, using a different height on either side of the pillow. You’ll have better success finding the most comfortable level of contour when you have two options from which to pick.
The contours are a little uncomfortable to use for stomach sleepers, but they work great for those who sleep on their sides or backs.
We also appreciated the fact that Sensorpedic infused the sensorGEL Contour Pillow with cooling gel, making it more comfortable to use. Some memory foam pillows can feel warm on the skin after a few hours of contact, but this pillow will feel like it’s at a comfortable temperature throughout the night.
3. Best Sleep Apnea Pillow with Cooling Gel – Hermell Products Cooling Gel Memory Foam CPAP Pillow
Cooling gel is an effective method of maintaining a cool feeling on the skin when using a memory foam pillow, as memory foam can feel warm on the skin after sleeping on it for a few hours. However, a memory foam pillow is the best option for a positional therapy sleep apnea pillow because of the way it holds its form and supports your head and neck.
So the Hermell Products Cooling Gel Memory Foam CPAP Pillow is a great option for solving this problem. The cooling gel layer sits atop the memory foam pillow, giving you the support of memory foam with the comfort of cooling gel.
For those who want to use a positional therapy pillow in conjunction with a CPAP machine, this Hermell Products pillow is a good choice, It contains notches that will guide the CPAP mask hose and hold it in position while you sleep. This should keep your mask properly aligned throughout the night.
POSITIONAL SLEEP APNEA SHIRTS REVIEWS
The best positional sleep apnea shirts work in a manner similar to the bumper belts we discussed earlier. They use wedges to try to force the wearer away from sleeping on his or her back. The wedge will help you maintain a side sleeping position. Or it could wake you up when you roll onto your back because the object is so uncomfortable. With these t-shirts, the objects are sewn into the shirt, which means you don’t have to worry about straps that are difficult to adjust.
1. Most Versatile Sleep Apnea Shirt – Rematee Anti-Snore T-Shirt
We really appreciate the versatility that the Rematee Anti-Store T-Shirt offers. It provides three sewn-in pockets on the back of the shirt that you can use to hold three inflatable bumpers. The versatility enters the picture with this Rematee product in that you can select how fully to inflate the bumpers and whether to use all three of them.
With the bumpers in place, you will have an uncomfortable feeling if you ever roll onto your back while sleeping. By forcing you to sleep on your side or stomach, the Rematee Anti-Snore T-Shirt should help you eliminate or reduce the number of obstructive sleep apnea episodes you experience.
The Rematee t-shirt is available in three different sizes, and it’s made of cotton. It’s easy to pack this anti-snore shirt when traveling because you can deflate the bumpers and fold them flat with the t-shirt.
2. Most Comfortable Sleep Apnea Shirt – SleepTZ Sleep Shirt
The SleepTZ Sleep Shirt has an insert that’ll rest against the upper part of your back, making it uncomfortable when you sleep on your back. By forcing you onto your side or stomach, you should reduce or stop episodes of OSAs. The foam used to create the insert fits into a pocket sewn into the shirt itself.
The shirt contains a strap that ensures you’ll keep the insert in the proper position in the shirt’s back pocket. This strap does its job, but if you have tried bumper belts and don’t like the strap used with them, the SleepTZ shirt may not be comfortable for you either.
To keep you from feeling hot because of the foam, the shirt contains a polyester and cotton mix, allowing the fabric to maintain breathability. Additionally, the foam used in the pocket has a contour that ensures it won’t make contact with your back and spine directly, allowing for air flow.
3. Best Inexpensive Sleep Apnea Shirt – Tennis Ball T-Shirt
This sleep apnea shirt design is so simple, you may be wondering why you didn’t think of it first. Fortunately, the Tennis Ball T-Shirt has such a low price that you won’t feel bad ordering it to help with any OSA episodes you may experience.
The Tennis Ball T-Shirt has a zipper pocket in the middle of the back of the shirt, into which you’ll insert a tennis ball. That’s it. The design may be simple, but it’s relatively effective. The biggest problem is that a single tennis ball might not bother you enough to wake you up if you end up sleeping on your back. You can fit two tennis balls into the pocket, so we’d recommend trying this if one tennis ball doesn’t force you onto your side or stomach.
The t-shirt is available in multiple sizes and is made of a lightweight 100% cotton to help you stay cool while sleeping. Additionally, as we mentioned, the price point of the Tennis Ball T-Shirt is terrific. In fact, the price is so good we don’t mind that you have to provide your own tennis balls for the shirt’s zipper pocket.
POSITIONAL SLEEP APNEA MOUTHPIECE REVIEWS
Although a sleep apnea mouthpiece isn’t going to force you to sleep in a certain position, using the mouthpiece in combination with some of the positional sleep apnea options we’ve discussed above should ensure the best protection against obstructive sleep apnea episodes.
The positional sleep apnea mouthpieces we’ve reviewed below gently force your jaw into a forward position, helping to keep your airway open.
So if you do end up sleeping on your back at some point in the night, these mouthpieces can still help you avoid snoring and OSA episodes. And the mouthpieces on our list are quite a bit cheaper than what you’ll receive from your dentist’s office.
We love the Intelliguard Pro Mouthpiece Adjustable Night Guard because it’s so easy to set up and use. You’ll create the snug fit of this sleep apnea mouthpiece at home by boiling the night guard and then biting into the device to mold it tightly to your teeth and mouth.
Because you can make adjustments in 1 millimeter increments to the way the Intelliguard Pro Mouthpiece fits, you’ll ensure a tight fit. You won’t have to worry about the Intelliguard mouthpiece slipping out of place as you sleep.
This is a bulky mouth guard, so those with small mouths may find it uncomfortable to wear. It may even cause pain in some cases. But it does its job of forcing the jaw forward very effectively, which will reduce snoring episodes and OSA episodes throughout the night.
2. Best Thin Sleep Apnea Mouthpiece – Teeth Armor Professional Dental Lab Custom Teeth Night Guard
For those concerned about finding a thin sleep apnea mouthpiece, the Professional Dental Lab Custom Teeth Night Guard from Teeth Armor is a great solution. It measures less than one-eighth of an inch in thickness, meaning it’s comfortable to wear, even for those with small mouths.
Teeth Armor custom makes each night guard to fit the mouth of the person ordering the product, and yet it only takes a few days to receive it. Teeth Armor uses a medical grade material that’s similar to what dentists use to create mouthpieces. It fits extremely well, ensuring the guard won’t slip out of place while you sleep.
You can pick whether to receive an upper teeth guard or a lower teeth guard. However, Teeth Armor does not offer a tongue guard with this product, which means it may not work for some OSA sufferers.
3. Best Inexpensive Sleep Apnea Mouthpiece – Serenity Sleep Aid Custom Night Mouth Guard
Mouth guards to use for sleep apnea can be very expensive pieces of equipment. If you obtain this type of mouthpiece from your dentist’s office, it can cost several hundred dollars. However, the best sleep apnea mouthpieces we’ve listed already will cost quite a bit less than that.
And if you want to save even more, the Serenity Sleep Aid Custom Night Mouth Guard is an option well worth considering. You’ll use the boil and bite method of creating a tight fit with the Serenity mouthpiece, which is pretty easy. Additionally, it only requires several minutes to create the proper fit with this model, which is quite a bit faster than some other options.
With a combination upper and lower teeth guard, this product provides a high level of support. Serenity includes a breathing hole in the device, but those who are mouth breathers as they sleep may find this hole isn’t large enough to allow for comfortable breathing while sleeping.
POSITIONAL SLEEP APNEA VIBRATION DEVICE REVIEWS
Some positional sleep apnea devices use vibrations and buzzers in combination with positional sensors to alert the wearer as to when they’re sleeping on their backs. These alarms are designed at first to wake you up so you can readjust your sleeping position.
The hope is that after several days of using the alarms that you will eventually involuntarily train yourself to sleep on the side or stomach to avoid the alarms. Such devices often require a doctor’s prescription or a trip to a sleep apnea clinic for diagnosis of OSA, however.
1. Best Easy to Use Sleep Apnea Vibrating Device – NightBalance Sleep Position Trainer
If you have a difficult time sleeping anywhere but on your back, the NightBalance Sleep Position Trainer is a great option to try. The Sleep Position Trainer uses a sensor connected to a belt that you’ll wear around the waist. The sensor measures your sleep position constantly, and once it determines you’re sleeping on your back, it will deliver a mild vibration, so you can shift your sleep position. By avoiding sleeping on the back, you’ll reduce instances of snoring or OSA during the night.
It’s extremely easy to use. The NightBalance device is about the side of an iPod and is very flat, so most people can tolerate wearing it. However, you cannot purchase this device without a prescription.
Additionally, the Sleep Position Trainer measures your sleep positioning throughout the night, storing the data so you can view how well you slept during the night.
2. Best Data Driven Sleep Apnea Vibrating Device – BuzzPOD
One of the best aspects of the BuzzPOD vibrating positional sleep apnea device is that you’ll undergo a seven-night trial to determine whether this device can help with your sleep position before you purchase it. The testing is performed with and without the BuzzPOD’s buzzer alarm in effect. By studying the resulting data the device collects, it’s possible to determine whether the device is helping you.
During use, you are able to select a particular amount of time that you’re lying on your back before the device generates a buzzer, which is another nice feature. If you’re simply adjusting your sleeping position from side to side, for example, you can set the delay to five seconds, so the BuzzPOD doesn’t sound the buzzer as you are rolling over.
The BuzzPOD includes a sensor that you’ll wear around the upper chest that measures your sleep position. The BuzzPOD runs from two AAA batteries, so it’s a little thicker than some other sleep apnea vibrating devices, which some people will find uncomfortable.
3. Best Anti-Snoring Sleep Apnea Vibrating Device – Night Shift Sleep Positioner
If you have difficultly wearing belts around your chest or waist, you may want to consider the Night Shift Sleep Positioner.
Like the other devices we’ve discussed, when you are sleeping on your back, the Sleep Positioner uses a sensor to alert you with a vibration. Unlike the other devices, this device is worn around the neck. Some people may find this location doesn’t work well, because the skin on the neck is too sensitive, but it is nice to have an alternative for those who cannot tolerate wearing a belt around the chest.
If you don’t respond to the vibration within a few seconds, the Sleep Positioner will increase the intensity of the vibration until you do respond.
Additionally, the Night Shift Sleep Positioner measures data about your sleep position throughout the night, giving you helpful feedback. As part of that measurement data, the device also measures frequency of loud snoring, which is information some doctors appreciate having. You will need a prescription to obtain the Sleep Positioner.
CPAP devices work great in theory, and some people use them successfully. However, they simply aren’t the perfect sleep apnea therapy for everyone. They’re uncomfortable to wear, they make noise, the air pressure they use can startle you and interrupt your sleep, and they just look weird.
Our collection of the best positional therapy for sleep apnea products listed here can give you the relief you need from OSA symptoms without wrestling with a CPAP device every night.
Certainly, some forms of severe sleep apnea require wearing a CPAP; there’s no way around it. In those cases, our positional therapy for sleep apnea options can be used in combination with your CPAP device, reducing the number of episodes you have and reducing the frequency with which the CPAP device interrupts your sleep.