The Tennis Ball Trick for Snoring: Does It Actually Work?

The Physiological Rationale for the Tennis Ball Technique

The tennis ball trick — sewing or strapping a tennis ball to the back of a sleep shirt to make lying supine uncomfortable — is a form of positional therapy targeting a well-documented phenomenon: supine-dependent snoring. When a person sleeps on their back, gravity acts on the soft palate, uvula, and tongue base, pulling them posteriorly toward the pharyngeal wall. This gravitational displacement narrows the retroglossal and retropalatal spaces, both of which are critical dimensions for maintaining a patent airway during sleep.

The physiological logic is sound. Research published in the Sleep Foundation's clinical literature consistently shows that lateral (side) sleeping increases pharyngeal cross-sectional area by 25 to 40 percent compared to the supine position in snore-prone individuals. For people whose snoring is exclusively or predominantly positional — meaning it occurs only on the back — maintaining a lateral sleep position addresses the primary anatomical cause directly. The tennis ball creates an aversive stimulus that conditions the sleeper to avoid rolling supine, at least in theory.

What the Clinical Evidence Actually Shows

The research on the tennis ball technique is more nuanced than its popularity would suggest. Several small controlled trials have confirmed that it does reduce supine sleep time and, in strictly positional snorers, produces meaningful reductions in snoring frequency and severity. A 2015 randomized trial in the Journal of Clinical Sleep Medicine found that a tennis ball device reduced supine sleep time from 42 percent to 7 percent in participants who completed the trial — and those participants showed significant improvements in snoring and apnea-hypopnea index scores.

However, the effect size is specifically limited to positional snorers, who are defined as individuals whose sleep apnea or snoring severity is at least twice as bad in the supine position as in the lateral position. The NIH's sleep apnea research estimates that positional OSA accounts for approximately 50 to 60 percent of moderate sleep apnea cases, but positional-only primary snoring (without apnea) is less clearly defined. For those whose snoring originates from tongue base collapse, palatal redundancy, or obesity-related generalized pharyngeal narrowing, lateral positioning alone is insufficient regardless of how well it is maintained.

Compliance Rates and Why People Abandon It

The tennis ball technique's most significant clinical limitation is not its efficacy in ideal candidates — it is adherence. Long-term compliance data are consistently poor. The same 2015 trial that showed strong short-term results reported that only 36 percent of participants were still using the device at 6 months, with the majority citing discomfort, fragmented sleep caused by the device itself, and the inconvenience of sewing or rigging a ball into clothing every night.

The discomfort problem is genuine: a firm object in the mid-back disrupts sleep position comfort, causes lower back pain in some users, and can dig into the spine during the semi-conscious positional adjustments that occur naturally throughout the night. Commercial positional therapy devices — purpose-built back-avoidance vests, vibrotactile monitors that alert the wearer when they roll supine, and positional pillows — address the comfort problem more effectively than a tennis ball and have demonstrated superior long-term adherence in head-to-head comparisons, though still not matching the compliance rates of well-fitted oral appliances.

When It Works: Purely Positional Snorers Only

The tennis ball technique and positional therapy in general should be considered a first-line option specifically for individuals who meet the following criteria: their snoring is clearly worse on their back and significantly reduced or absent when sleeping on their side; they do not have a diagnosis of moderate or severe obstructive sleep apnea requiring CPAP; and they are willing to commit to the nightly ritual of a positional device. The simplest clinical screen is self-observation or partner report: if snoring disappears on the side, positional therapy is worth trying systematically.

For individuals who fit this profile, positional therapy is evidence-based and can be highly effective without requiring a device worn inside the mouth. It is particularly useful as a first step for people with mild snoring who are hesitant about oral appliances, or as an adjunct to other therapies in people with moderate positional OSA. The American Academy of Dental Sleep Medicine includes positional therapy in its clinical practice guidelines as a recognized component of conservative snoring management, typically in combination with other interventions.

Better Alternatives for Consistent Results

For most people who try the tennis ball approach and either find it uncomfortable, ineffective, or unsustainable, several superior alternatives exist. Wedge pillows that elevate the torso at a 30-degree angle reduce both supine positioning and gravitational effects on the soft palate without requiring anything strapped to the body. Purpose-built positional sleep shirts with foam back inserts are more comfortable than tennis balls and purpose-designed for this use.

However, the most broadly effective intervention for snoring that is not purely positional — and for people who want a single, reliable solution regardless of sleep position — is a well-fitted mandibular advancement device. Unlike positional therapy, which is passive and only effective when the correct position is maintained, a MAD like the Snorple mouthpiece actively repositions the jaw and stabilizes the tongue throughout the night, regardless of whether the sleeper ends up on their back, side, or stomach. For snorers whose problem extends beyond one position, this is not just a more convenient solution — it is a more physiologically complete one.