Sleep Position and Obstructive Sleep Apnea
How you lie down makes a huge difference in how well you sleep when you have sleep apnea. And the need to spend the night in a different sleep position can even trigger sleep apnea. A man we will call Raymond knew this fact all too well.
Ever since he was a little boy, Raymond had slept on his stomach. On a ski trip to celebrate his sixtieth birthday, however, he skied into a tree. The impact shattered his ankle and bruised several tendons in his leg. The doctors at the ski slope took one look and had him loaded into an ambulance that sent him to a hospital 200 miles away for surgery to have pins put in.
Raymond was in great shape and came through the surgery with no complications. He was wheeled up to his room and put into bed. The broken bones, bruised tendons, and surgical procedure produced intense pain, so he was given morphine. And because of the surgery, he had to sleep lying on his back.
Thanks to the morphine drip, Raymond felt no particular discomfort in his ankle, but he just couldn’t get to sleep. Finally about 5 o’clock in the morning, he dozed off. Only a few minutes later, however, he woke up to excruciating pain in his left arm. He had a heart attack.
If you have to have a heart attack, it is usually best already to be in a hospital. The attack was so mild that Raymond didn’t have to have either angioplasty or a bypass. But for the next ten days he continued to have trouble sleeping. As he was being discharged, the doctor noted he had gained 20 pounds. That had to be it. Raymond’s heart attack caused by overweight and he would need to go on a special diet and take a combination of over a dozen drugs daily for the rest of his life, they said.
These medical measures did not address the underlying problem. In fact, Raymond’s heart attack was induced by a combination of obstructive sleep apnea and central sleep apnea. Prior to his stay in the hospital, Raymond never slept on his back. He often slept without a pillow. He had never experienced the collapse of his windpipe that occurred when he could not sleep on his stomach. The morphine that stopped the severe pain of broken bones reduced his breathing even further, and his heart could not keep up with the stress of trying to circulate oxygen to his brain.
People who have undiagnosed sleep apnea are at major peril to health when they are forced to sleep on their backs. Many people sleep on their stomachs or their sides because their tongues would roll back into the throat if they did not. But since they always sleep on their sides or their backs, they never display the symptoms of sleep apnea until they are placed in a hospital bed on their backs hooked up to intravenous lines and monitoring equipment. Painkillers, sedatives, and muscle relaxants aggravate breathing problems and being constantly woken up during the night causes them go into rapid eye movement (REM) sleep over and over again.
Muscles relax during REM “dream” sleep. During this time when the windpipe is most likely to collapse. For 10 to 30 seconds at a time, up to 100 times an hour, the windpipe collapses, the person with sleep apnea comes out of REM sleep for just 1 to 3 seconds, and the cycle starts all again. The heart beats harder and harder to keep poorly oxygenated blood flowing and heart attacks can occur, even when there is no atherosclerosis.
Clearly, it’s a good thing to know you have sleep apnea before you wind up having emergency surgery. It’s also a good thing to know the importance of sleep positions at every age and stage of life.
Sleep Position and Sudden Infant Death Syndrome (SIDS)
Sudden infant death syndrome, also known as SIDS, is a heartbreaking condition that most commonly strikes healthy babies within the first year after birth. About 20% of babies who are stricken with SIDS are born premature, but their deaths only occur after they have made substantial progress in their development. A baby is put to bed on his or her back and found lifeless a few minutes to a few hours later. The condition was and is still is considered largely inexplicable, but in the 1990’s, American public health agencies started asking parents to make sure that infants slept on their backs, not on their sides or their stomachs and not at their mother’s breast.
In the 1980’s, about 0.14% of all infants in the United States died of SIDS. By the late 1990’s, only about 0.04% of all infants died of SIDS. In the 1980’s, 72% of parents put their babies to sleep in ways that allowed them to roll over on their stomachs. By 1999, due to an intensive public outreach program, only 13% of parents put their babies to bed in ways that allowed them to roll over on their stomachs. The traditional “swaddling clothes” for babies that kept them in an upright starfish position turned to be a very good idea.
Why should the position that helps adults resist sleep apnea cause sudden death in an infant? Babies have throats that are configured for suckling. Their throat muscles are rapidly growing and strong, but the epiglottis that protects children and adults from gagging is not yet in place in infants. The sleeping position that may save life in adults who have sleep apnea may endanger life in babies.
Sleeping Positions in Children
Many times the kid who acts out is also the kid who is always coming down with sore throat and tonsillitis. Inflamed tonsils and adenoids are a common contributor to sleep apnea in children aged two to ten. Research at the Mayo Clinic also confirmed that restless legs syndrome, which may occur along with sleep apnea or chronic throat infections, is a genetic condition rather than a psychological quirk of children seeking attention. Restless legs make it impossible to fall asleep.
By the time a child has reached the age of two years, sleeping on the back may trigger obstructive sleep apnea, often without snoring. Children should not be encouraged to sleep on the stomach or chest, but sleeping on their sides (either leg may be curled up or not) in the fetal pose may help keep the tongue in place so obstructive sleep apnea does not occur.
Sleeping Positions in Teenagers
Medical researchers at the University of Arizona School of Medicine’s Tucson Children’s Assessment of Sleep Apnea project found two interesting correlations between teen lifestyle and sleep apnea. Teens who consume energy drinks made with caffeine are more likely to suffer obstructive sleep apnea. Teens who spend more time in front of video screens (TV, computers, or games) are also more likely to suffer obstructive sleep apnea.
Many adolescents simply don’t go to bed before they absolutely must. They quickly go into REM sleep, which weakens the muscles around the windpipe. When these soft drink guzzling gaming teenagers are also obese, the risk of sleep apnea is particularly high. Any teen sleeper who has sleep apnea needs to avoid sleeping on the back, as any adult with obstructive sleep apnea or similar sleep disorders.
The Surprising Relevance of Sleeping Positions in Adults Who Have Apnea
Most people who have obstructive sleep apnea know that they need to avoid sleeping on their backs. Most people who have obstructive sleep apnea don’t know that it is best to support their weight on their right side.
When the weight of the body rests on the right side of the body rather than being evenly distributed across the back, the right vagus nerve is stimulated. This nerve helps regulate heartbeat. Not only do people who have obstructive sleep apnea have fewer episodes of apnea or hypopnea (low oxygen levels) when they rest of their right sides, they also have lower blood pressure and fewer episodes of racing heartbeat. The right vagus nerve also regulates the motion of digested food downward through the digestive tract, stimulating contraction at the bottom of the esophagus so food can’t come back up. This keeps stomach acid down during the night reducing acid reflux and heartburn. Even during a nap on the couch, it is helpful to choose the orientation that allows putting more pressure on the right side of the body and less pressure on the left.
If you can’t sleep on your back because you have apnea and you can’t sleep on your stomach because you have heartburn, sleeping on your right side is the best compromise. Even better, of course, is getting effective treatment for your sleep apnea.
