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Positional therapy

Obstructive sleep apnea is described as “positional” when breathing events occur mostly, if not exclusively, when persons sleep on their back. In this position, the tongue tends to fall backward, which intensifies the obstruction of the upper airway. Therefore, positional therapy trains people to sleep without lying on their back.

But willpower is not always enough to correct the problem. Some devices discourage sleeping in the supine position, enabling a patient to maintain a lateral position during the night.

Who benefits from this therapy?

This treatment is obviously intended for people who suffer from positional obstructive sleep apnea (it is estimated that they represent more than half or all OSA cases). It is recommended primarily for cases of mild to moderate apnea. However, in patients with more severe apnea requiring continuous positive airway pressure therapy, maintaining a lateral position may help reduce the pressure needed to control the sleep apnea.

Who prescribes it?

After arriving at a diagnosis of sleep apnea, a doctor trained in sleep care may suggest this therapy if the sleep test (polysomnography or cardiorespiratory polygraphy) reveals positional OSA.

How does it work?

There are various devices available to help people sleep on their side. Although they may need to be used indefinitely, sometimes they are successful in changing behaviour and after a few months of training, are no longer needed.

Some are designed to make the supine position uncomfortable in order to prevent patients from sleeping on their back. One can even be made by sewing a pocket with a tennis ball into the back of a pyjama top. Unfortunately, this solution is often painful.

Another option is to purchase an anti-snore T-shirt, vest or belt with foam or plastic bumpers on the back to prevent sleeping in a supine position. Generally, these devices do not cause back pain, but they can be cumbersome.

Another device, more recent, is much more discreet and comfortable. This device is worn at the base of the neck or on the chest and vibrates when it detects a supine position, prompting the person to move to his or her side. The vibration has seven levels of intensity, starting very softly and increasing until a non-supine position is achieved. Reports on snoring, body position, vibration frequency and basic sleep parameters can be generated through an online portal.