Alternatives to CPAP
Positional Therapy for Sleep Apnea: Sleeping Off Your Back
Some people have most of their breathing events while sleeping on their back, called positional obstructive sleep apnea. Positional therapy uses devices that keep you off your back, and a 2025 review found it helps selected people with milder disease, though it lowers AHI less than CPAP and long-term use often drops off.
What positional sleep apnea is
A common definition, from Cartwright, is an AHI at least 50% lower when you are not on your back. Other definitions also require a minimum time in each position. A 2025 narrative review reports positional sleep apnea in roughly 20% to 75% of people with obstructive sleep apnea, depending on the definition and population.
Your sleep study report may list AHI by position. That is the first place to look.
Types of positional therapy
The old tennis ball technique sews a ball into the back of a shirt. The review calls it largely outdated and notes it failed in about a third of patients in one study, and many people stop using it.
Newer vibrating position trainers worn on the chest, neck or forehead sense when you roll onto your back and vibrate until you turn. Positional pillows and wedges are also used.
How well it works
The review found CPAP generally lowers overall AHI more than positional therapy, but positional therapy can perform reasonably once you account for how many hours people actually use each treatment. It may suit people with significant oxygen drops less well.
Short-term adherence was good in studies, but long-term data are limited, and one study found only about 42% still used it regularly at six months.
Using it with CPAP
Side sleeping can also help on CPAP, reducing pressure needs on auto machines and mask leak against the pillow for some people. A CPAP pillow can make side sleeping with a mask easier.
Do not stop CPAP for positional therapy without your clinician's agreement and, ideally, a sleep test showing it works for you.
Supplies that can help
A pillow with cutouts or a contoured edge so a mask and hose are not pushed out of place when you sleep on your side.
Retailer links are affiliate links. We may earn a commission at no cost to you.
Frequently asked questions
Does sleeping on your side help sleep apnea?
For people with positional sleep apnea it can reduce events substantially. Your sleep study can show whether your events are concentrated on your back.
Is positional therapy as good as CPAP?
Generally it lowers AHI less than CPAP. It can be an option for selected people with mild to moderate positional sleep apnea, after discussion with a clinician.
Does the tennis ball trick work?
It can keep some people off their back, but a 2025 review calls it largely outdated, with poor comfort and long-term use. Newer vibrating trainers are better tolerated.
How do I know if I have positional sleep apnea?
Look at the positional breakdown on your sleep study report or ask your clinician. It is often defined as an AHI at least 50% lower off your back.
Sources
Last reviewed October 11, 2026. How we research · Report an error