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