Positional Therapy

If you have sleep related breathing disorder that is worse when sleeping on your back, positional therapy can help. Positional Therapy uses a device to help you sleep on your side. Below are common options, listed from most effective to least effective, based on medical research 1–9.

Vibrotactile Devices

Examples: NightBalance, NightShift

Most Effective High Comfort & Adherence
  • How it works: Worn around the chest or neck; gently vibrates when you roll onto your back to prompt side sleeping.
  • Effectiveness: Strong reduction in apnea events & supine time; comparable to CPAP in selected positional OSA patients 2, 3, 5, 6, 7, 8.
  • Comfort & adherence: Better long‑term use than older methods; generally preferred by patients 3, 5, 6.

Tennis Ball Technique (TBT)

Effective (Short‑Term) Lower Comfort

  • How it works: A tennis ball is sewn or strapped to the back of pajamas to make supine sleep uncomfortable.
  • Effectiveness: Works for many initially, but less effective than vibrotactile devices 1, 3.
  • Comfort & adherence: Many discontinue due to discomfort or sleep disruption 1, 3.

Positioning Pillows (e.g., Posiform®)

Special shapes encourage side‑sleeping

Moderate Effect Generally Comfortable
  • How it works: Contoured pillows reduce rolling onto the back.
  • Effectiveness: Can reduce supine time and improve sleep quality but less effective than electronic devices 9.
  • Comfort & adherence: Comfortable for many; may not work for everyone 9.

Positional Backpacks (Zzoma, Rematee)

Block rolling onto your back

Least Effective Bulky / Uncomfortable
  • How it works: A small backpack or foam block is worn to physically prevent rolling onto the back.
  • Effectiveness: May reduce supine time; generally less effective than other options 1, 3.
  • Comfort & adherence: Many find these bulky or uncomfortable and stop using them 1.

Quick Comparison

Device How It Works Effectiveness Comfort & Adherence
Vibrotactile (NightBalance, SPT) Vibrates when supine to prompt side‑sleeping Highest — often large reduction in apnea & supine time 2,7 High comfort; best long‑term adherence 5,6
Tennis Ball Technique Uncomfortable object on back discourages supine sleep Good (short‑term) 1,3 Low comfort; many discontinue 1,3
Positioning Pillows (Posiform®) Contoured support to keep you lateral Moderate 9 Generally comfortable; mixed results 9
Backpacks / Semi‑Rigid Physical block to prevent rolling onto back Low 1,3 Often bulky; poor adherence 1

 

Key Points

  • Vibrotactile devices are the most effective and comfortable for most people with positional OSA 2, 3, 5, 6, 7, 8.
  • Simpler methods like the tennis ball technique or special pillows can help but are less effective and often less comfortable 1, 3, 9.
  • All devices work best if your apnea/snoring is clearly worse when supine.
  • Discuss the best option for you with your healthcare provider.

 

References

  1. Srijithesh PR, Aghoram R, Goel A, Dhanya J. Positional Therapy for Obstructive Sleep Apnoea. Cochrane Database Syst Rev. 2019;5:CD010990.
  2. ALQarni AS, Turnbull CD, Morrell MJ, Kelly JL. Vibrotactile devices meta‑analysis. Thorax. 2023;78(11):1126‑1134.
  3. Eijsvogel MM, et al. Sleep Position Trainer vs Tennis Ball. J Clin Sleep Med. 2015;11(2):139‑147.
  4. Hidalgo Armas L, et al. New Forehead Device RCT. Thorax. 2021;76(9):930‑938.
  5. van Maanen JP, de Vries N. Long‑term SPT effectiveness. Sleep. 2014;37(7):1209‑1215.
  6. Laub RR, et al. RCT of Sleep Position Trainer. J Sleep Res. 2017;26(5):641‑650.
  7. Berry RB, et al. NightBalance vs Auto‑APAP. J Clin Sleep Med. 2019;15(7):947‑956.
  8. Ravesloot MJL, et al. New‑generation positional therapy meta‑analysis. J Clin Sleep Med. 2017;13(6):813‑824.
  9. Newell J, et al. Positioning Pillow study. Sleep Breath. 2018;22(4):1143‑1151