Struggling to sleep?
What if your neck keeps you awake at night?
Sleep Apnoea & Your Neck
Most people think obstructive sleep apnoea is just about snoring. Research has found links between neck posture, neck pain and sleep apnoea, though it hasn’t shown that one causes the other.
Book Your AssessmentMost people think obstructive sleep apnoea (OSA) is just about snoring or a blocked airway. Research has found that people with OSA more often have certain neck posture features and neck pain, which raises questions about how the two are connected [1].
If you wake up tired with a stiff neck, it’s worth knowing what the research does and doesn’t say about that connection [1].
What Sleep Apnoea Really Is
Obstructive sleep apnoea happens when the airway becomes too narrow or collapses during sleep. Common symptoms include loud snoring, gasping, waking suddenly, restless nights, morning headaches, and a heavy, foggy feeling the next day [1].
What the Research Tells Us
A recent systematic review explored the link between the cervical spine, posture, neck pain, and sleep apnoea [1]. Its findings are mostly associations from small studies, so they show links rather than cause and effect:
Postural Changes
In some studies, people with OSA were more likely to show forward head posture, a flattened natural neck curve, and joint stiffness in the upper cervical spine [1].
Forward Head Drift
Forward head posture changes the angle of the head on the neck, and some studies link this with a narrower airway. Whether screen or desk habits contribute to OSA hasn’t been shown [1].
The Neck Pain Cycle
Poor sleep increases pain sensitivity, while neck pain disrupts sleep quality—creating a cycle that requires addressing both sides [1].
Cervical Motion & Breathing
Head and neck position affects airway shape, which is one reason sleep position can change snoring. Whether restricted neck movement worsens OSA is not yet known [1].
What This Means for You
If you suffer from snoring, pauses in nighttime breathing, poor sleep quality, morning headaches, or persistent forward head posture, see your GP first. These can be signs of sleep apnoea, which needs a proper sleep assessment. If you also have neck pain or stiffness, that can be assessed and managed alongside your medical care.
- Neck pain and stiffness: can be assessed and treated in their own right.
- Sleep and pain: poor sleep and pain tend to feed each other, so easing neck pain may help you sleep more comfortably.
- Sleep apnoea itself: needs medical diagnosis and treatment, such as CPAP or an oral appliance.
Where Chiropractic and Exercises Fit In
Chiropractic care doesn’t treat sleep apnoea, and there’s no good evidence that it improves it. What we can help with is neck pain and stiffness, which often sit alongside poor sleep [1].
Targeted Exercise Evidence
A second study evaluated modified cervical and shoulder retraction exercises in patients with a flattened neck curve and neck pain [2]. After the exercise program, participants had less neck pain, better neck movement and a measurable increase in neck curve [2]. This was a small study in people with neck pain, not sleep apnoea, so it doesn’t show any effect on breathing during sleep.
Putting It All Together
Chiropractic care and specific rehabilitation exercises do not replace CPAP or primary medical treatments for sleep apnoea. If you also have neck pain, care for your neck can sit alongside your medical treatment to help you move and rest more comfortably [1,2].
Frequently Asked Questions
Can a chiropractor help with sleep apnoea?
No. Sleep apnoea needs medical diagnosis and treatment, such as CPAP or an oral appliance. We can help with neck pain that may sit alongside poor sleep.
What is the best sleeping position for sleep apnoea?
Side sleeping can reduce apnoea for people whose symptoms are worse on their back. Talk to your sleep doctor about what suits you.
Can a different pillow help neck pain and snoring?
A pillow that keeps your neck comfortable may ease neck pain. It won't treat sleep apnoea, so loud snoring with pauses in breathing should be checked by your GP.
Can forward head posture cause sleep apnoea?
Studies show an association, but it hasn't been shown that posture causes sleep apnoea. Airway anatomy, weight, age and jaw structure are the main factors.
What is the 4% rule for sleep apnoea?
In a sleep study, a reduced breath counts as a hypopnoea if airflow drops and blood oxygen falls by at least 4%. Some labs use 3%, which changes how severe sleep apnoea is scored.
Is there a pillow trick for sleep apnoea?
Pillows that keep you on your side or raise your head can reduce apnoea for some people whose symptoms are worse on their back. They don't replace treatment, so talk to your sleep doctor.
References
Sutherland K, Cistulli PA. Obstructive sleep apnea’s association with cervical spine abnormalities, posture, and pain: A systematic review. Sleep Med. 2020;75:231‑240. doi:10.1016/j.sleep.2020.08.041
Lee MY, Jeon H, Choi JS, Park Y, Ryu JS. Efficacy of modified cervical and shoulder retraction exercise in patients with loss of cervical lordosis and neck pain. Ann Rehabil Med. 2020;44(3):210‑217. doi:10.5535/arm.19117
