Posture Control Device

Do you snore worse or stop breathing more on your back?

Does your bed partner frequently prompt or push you to move to your side when you sleep?

If you answered ‘yes’ to either or both questions above, body position retraining may be a suitable way of treating your snoring or sleep apnoea.

A person with obstructive sleep apnoea (OSA) may stop breathing very frequently during sleep, sometimes hundreds of times each night. For people who are very obese, their sleep apnoea has a tendency to occur regardless of whether they sleep on their back, side or front (stomach). On the other hand, up to 50% of people with OSA including those very obese patients who have lost some weight, may experience more sleep apnoea or snoring when sleeping on their back compared to the side or front (stomach).

How does sleeping on your back worsen your sleep apnoea and snoring?

As pointed out in the section on weight loss, patients with OSA tend to have larger tongues as well as smaller and more floppy airways. Worse still, when sleeping on the back gravity pushes the tongue downward on the upper airway during sleep. Thus, it is not hard to imagine why it is easier and more likely for the upper airway of these patients to obstruct repeatedly during sleep in this posture.

What is a ‘posture control device?'

Our group has developed and tested a simple vibration alarm device to monitor and record sleep posture and discourage supine sleep, without discomfort and with minimal sleep disturbance to the bed partner. We have already shown the device accurately and reliably records body position, almost completely abolishes supine sleep and appears to be highly effective in treating supine OSA. However, long-term acceptance and use of this therapy and the effectiveness in snorers remains to be established. This project is investigating the effectiveness of the supine-avoidance device for treating snoring and reducing overnight cardiovascular disturbances associated with snoring and frequent awakening.

Does the ‘posture control device’ work?

If sleep apnoea could be worsened by a large tongue falling onto the upper airway, it makes sense that sleeping on the side or front could lessen this obstruction to some degree. In fact, reduction in the severity of sleep apnoea, or indeed the level of continuous positive airway pressure (CPAP) by sleeping on the side has been observed in studies and also our clinical experience. It is a self-reminding alternative to the age-old method of a bed partner pushing or prodding the snoring or apnoeic patient! Over time, the patient may become trained to sleep on the side or front without the need for a physical reminder.

Are there other methods of body position retraining for sleep apnoea?

You may have heard of techniques such as sleeping with the head elevated to 30-degrees from horizontal using a wedge or a specialised bed, or the use of triangular pillows to alter the angle of the neck. Compared to sleeping on the side, the head elevation technique may be more effective in keeping the airway open although surprisingly this does not result in any further reduction in the CPAP level achieved sleeping off the back. Sleeping on the side or front is by far the simplest, cheapest and most easily performed technique for body position retraining for sleep apnoea.

Is this a suitable treatment for you?

As with any medical treatment, your physician will assess and then guide you toward the most appropriate form of therapy. If your sleep study shows that your sleep apnoea improves substantially when you lie on your side or front your physician may recommend a trial of this form of therapy.

From studies and our own experience, body position retraining tends to work better in those who are not severely obese and those with less severe forms of sleep apnoea. It is not suitable for patients who can’t lie on their back because of a back disorder or those who simply can not sleep on their backs. Finally, it should be emphasised that CPAP is still the most effective method of controlling sleep apnoea whilst concurrent weight loss in obese patients has the advantage of also reducing the risk of developing cardiovascular disorders.

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