What Is the Pillow Trick for Sleep Apnea?

Published October 20, 2026 by NightWells. General information, not medical advice.

This page is general information. It is not medical advice. Only your doctor and a sleep study can tell you what kind of sleep apnea you have and what will treat it. Do not stop or change CPAP or any other treatment on your own. If you have chest pain, signs of a stroke or severe trouble breathing, call 911.

The pillow trick means using pillows to keep you off your back, or to raise your upper body, while you sleep. Lying flat on your back lets gravity pull your tongue back into your airway, and the trick fights that (AASM Sleep Education). It works best for people whose sleep apnea is mostly a back sleeping problem. In a 2019 Cochrane review of eight trials, keeping people off their back cut about 7 breathing events an hour compared with no help, but CPAP cut about 6 more an hour than position therapy did (Srijithesh and others, 2019).

The short version.

The pillow trick is really three tricks. A pillow that stops you rolling onto your back, a wedge or raised bed that lifts your chest and head, and the old tennis ball on the back of your shirt.
About 75 percent of people with sleep apnea in a large study of 1,719 adults had more than twice as many events on their back as off it.
Raising the head of the bed just 7.5 degrees took the AHI from 15.7 to 10.7 in a 2017 study of 52 adults.
The tennis ball works in theory, but only 6 percent of people still used it about two and a half years later.
It is a helper, not a cure. Do not drop CPAP or a mouth guard for it unless a sleep study and your doctor say so.

The Three Things People Mean by the Pillow Trick

Search this question and you get a mix of pillow ads, short videos and dentist pages. On October 19, 2026, the top results on Google were a UK dental sleep clinic, an ear nose and throat practice page from 2022, a CPAP maker, CPAP and pillow sellers and a short video. Most of them describe the trick. Few of them show numbers. So here are the three versions, and then what the studies found for each.

Version	What you do	What it is meant to fix
Side pillow	Hug a long body pillow, or wedge a firm pillow behind your back so you cannot roll flat	Back sleeping, when the tongue and soft palate fall back
Wedge or raised bed	Lift your chest and head with a foam wedge, or raise the head end of the bed	Airway collapse that gravity makes worse when you lie flat
Tennis ball	Sew a tennis ball into a pocket on the back of a shirt so lying on your back feels bad	Back sleeping, the same as the side pillow

All three lean on the same idea. NHLBI says your provider may suggest sleeping on your side, not your back, to help keep your airway open (NHLBI). MedlinePlus lists sleeping on your back as one thing that can block or narrow the airway, and lists avoiding it as a self care step (MedlinePlus).

One thing to get right with a wedge. Lift your chest, not just your chin. A stack of soft pillows under your head can bend your neck forward, and that does not lift the airway the way a slope from the waist up does.

What the Studies Actually Found

We read the study abstracts ourselves. Here is each pillow or position trick that has been put through a sleep study, with the number the authors reported. AHI means apnea hypopnea index, the count of breathing pauses and shallow breaths per hour. Lower is better.

Study	What was tried	Result
Souza and others, 2017	Head of the bed raised 7.5 degrees, 52 adults	AHI fell from 15.7 to 10.7. Lowest oxygen rose from 83.5 to 87 percent. Sleep stages did not change
Skinner and others, 2004	Shoulder and head elevation pillow vs CPAP, 14 adults	AHI fell from 27 to 21 on the pillow. CPAP got it to 5. The pillow fully worked for 4 of 14 people
Zuberi and others, 2004	A triangle pillow for side sleeping, 22 adults	AHI fell from about 17 to under 5 on average in mild and moderate cases. Snoring dropped
Benoist and others, 2017	A small sensor worn on the chest that buzzes when you roll onto your back, vs a mouth guard, 99 adults	Median AHI fell from 13.0 to 7.0, about the same as the mouth guard group
Cochrane review, 2019	Eight trials, 323 people, pillows, backpacks and buzzers	About 7.4 fewer events an hour than no therapy. CPAP did about 6.4 better than position therapy. Evidence rated low certainty

Three takeaways. First, the trick helps on average. Every row moved the right way. Second, it rarely gets a moderate case all the way to normal. In the shoulder pillow study, 7 of the 14 people were treatment failures, while CPAP failed for 1 (Skinner and others). Third, the studies are small. The pillow study with the best result had 22 people and has not been repeated at scale.

Here is our take on the angle. Many guides, including the CPAP maker ResMed, say to raise your upper body 30 to 45 degrees (ResMed). That may be fine. But the head of bed study above got its drop at just 7.5 degrees, and people slept as well as before (Souza and others). A steep wedge that makes you slide down all night is not a better trick. A gentle slope you can keep is.

An adjustable hospital bed with two pillows and a slightly raised head section beside a gray sofa — An adjustable bed. The head of bed study raised the whole top end of the bed a little, which lifts the chest and head together. Photo by JesusisGreat7, CC0.

Who the Pillow Trick Can Help. Check Your Sleep Study

The trick is built for one kind of sleep apnea, called positional sleep apnea. That means most of your breathing events happen when you are on your back. AASM calls positional therapy a behavior strategy to treat positional sleep apnea, and says it can be used alone or with another treatment (AASM).

It is common. In the HypnoLaus study, 1,719 adults aged 40 to 85 had a full sleep study at home. The study counted an AHI of 5 or more as sleep apnea. Positional sleep apnea, defined as at least twice as many events per hour on the back as off it, showed up in 75 percent of the people who had sleep apnea. In 36 percent, the AHI dropped to normal whenever they were off their back (Heinzer and others, 2018).

You cannot tell which group you are in by how you feel. Your sleep study report can. Look for two numbers, often called supine AHI and non supine AHI. Supine means on your back.

Worked examples using the HypnoLaus rule. Not a diagnosis. Ask your doctor to read your report.
Back AHI	Off back AHI	Ratio	What it suggests
30	4	7.5 times	Positional, and normal off the back. The best fit for the trick
30	12	2.5 times	Positional, but still sleep apnea on the side. The trick may help, not fix it
30	25	1.2 times	Not positional. Position will not change much

Bring the report to your visit and ask three things. Is my sleep apnea positional? What was my AHI off my back? Would a position device be worth a trial with a repeat test? One warning from the shoulder pillow study. Even a positional result did not predict who would do well with a raised pillow (Skinner and others). Only a test with the pillow shows that.

Why People Quit, and How to Make It Stick

The hard part is not the idea. It is keeping it up for months. A sleep clinic in Adelaide mailed a follow up survey to 108 people it had told to use the tennis ball. Of the 67 who answered, about two and a half years later, only 4 (6 percent) still used it. Nine had learned to stay off their back without it. The other 54 (80.6 percent) had stopped and were back on their backs. The top reason, given by 34 of them, was that it was too uncomfortable (Bignold and others, 2009).

Newer devices do better. The chest sensor that buzzes when you roll over scored an average adherence of 89.3 percent over three months, counted as at least 4 hours a night on 5 or more nights a week (Benoist and others, 2017). In the 12 month follow up, all 29 people who finished in that group met that bar, and their median AHI was 7.1, down from 13.2 (de Ruiter and others, 2018). The Cochrane review notes back and chest pain and broken sleep as the most common complaints with position devices (Cochrane).

If you try the pillow version, these steps make it easier to live with.

Use a long body pillow in front and a firm pillow behind your back. Hugging one and leaning on the other keeps you on your side without a hard lump.
Put a pillow between your knees. It keeps your hips level so side sleeping does not hurt your back.
Pick a gentle wedge that starts at your waist, or raise the whole head of the bed, so you do not slide down.
Give it time. Most of the trouble in the studies was comfort, not whether the idea works.
Ask about a test with the device on. A home sleep test or a lab night shows whether it is working for you.

A close view of a yellow tennis ball on a court seen through a chain link fence — A tennis ball sewn into the back of a shirt is the oldest version of the trick. Most people in one follow up stopped using it because it was too uncomfortable. Photo by Miscellaneous contributor, CC0.

Using the Pillow Trick With CPAP

You do not have to choose. AASM says positional therapy can be used together with another sleep apnea treatment (AASM). Position matters on CPAP too. ResMed notes that side sleeping can cause mask leaks if the mask shifts against the pillow, and that nasal pillow masks may suit side sleepers better (ResMed). Any change to your pressure is a call for your sleep doctor, because the setting is a prescription.

Do not swap CPAP for a pillow on your own. If your insurer is checking your CPAP use, nights without it count against you. Our post on the 4 hour rule for CPAP explains what most plans want to see. If the mask is the reason you want to quit, our guide to CPAP side effects covers the common fixes first.

Pillows sold as CPAP pillows do a different job. They are shaped to leave room for the mask, which is about comfort and fit. They are not the same as the position trick above.

When the Pillow Trick Is Not Enough

Move on to a full treatment plan if any of these fit you.

Your sleep study shows sleep apnea even when you were off your back.
Your sleep apnea is severe. The pillow studies above were mostly mild and moderate cases.
You still feel sleepy in the day, or doze off when driving, after a few weeks on your side.
Your partner still hears you stop breathing, gasp or choke.

If you have never had a sleep study, start there. The pillow trick works on one kind of sleep apnea, and only a test tells you whether that is your kind. Our page on signs you should be tested and our post on snoring or sleep apnea help you decide. When you are ready, our directory lists sleep apnea providers by state in Ohio, Michigan, Indiana and Kentucky. A listing is not a referral, and we do not give medical advice.

Common Questions

Do sleep apnea pillows really work?

They can help some people. In small sleep studies, a side sleeping pillow and a raised head both lowered the number of breathing events per hour. They work best for positional sleep apnea, where most events happen on your back. They work less well than CPAP, and few people get to normal with a pillow alone.

What is the worst sleeping position for sleep apnea?

Flat on your back is usually the worst. Gravity lets the tongue and soft palate fall back into the airway. In the HypnoLaus study of 1,719 adults, 75 percent of people with sleep apnea had at least twice as many events on their back as off it.

How to lie down with sleep apnea?

Lie on your side if you can, with a pillow behind your back so you do not roll over. If you must be on your back, raise your upper body from the waist with a wedge or by raising the head of the bed. Keep using any treatment your doctor prescribed.

Is it better to sleep elevated with sleep apnea?

For many people a slight incline helps. In a 2017 study, raising the head of the bed 7.5 degrees lowered the AHI from 15.7 to 10.7 without hurting sleep quality. Lift your chest, not just your head, so your neck does not bend forward.

Does the tennis ball trick work for sleep apnea?

It can keep you off your back, but most people stop. In one follow up of 67 patients, only 6 percent still used it about two and a half years later, and most said it was too uncomfortable.

Can the pillow trick replace CPAP?

Usually not. For some people with mild positional sleep apnea, a doctor may suggest position therapy as the main treatment after a sleep study shows it works. For most people it is a helper alongside CPAP or a mouth guard.

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Sources

NightWells publishes information, not medical advice. Nothing here replaces being seen by a clinician who can examine you.