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Brilliant Minds, Better Sleep  
Newsletter of Sleep Medicine Associates of Texas, P.A.
July 15, 2009 Edition V
In This Issue
Body Position and Sleep Apnea
Solutions You Shouldn't Turn Your Back On
Snoring is a Nuisance
 
 
Car accident
 
 Snoring is the most common complaint we hear.  Assess your bed partner's snoring and we can recommend a solution.   
 
Car accident
 
If you suffer with daytime sleepiness, you could be at risk for a motor vehicle accident while driving long distances.   Before you travel this summer, 
Sleeping Pills 
If chronic insomnia is causing you to turn to over-the-counter sleeping pills, our experts can find an effective long-term treatment.  For more information, 
 
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Body Position and Sleep Apnea

Man Sleeping on Back

Why do sleep doctors ask you whether you sleep on the back? When a person sleeps on the back, they are more likely to snore loudly and have more frequent episodes of closure of their throat. Untreated obstructive sleep apnea (OSA) is associated with poor sleep, possible changes in heart function (higher high blood pressure, strokes and the abnormal heart rhythm of atrial fibrillation), and excessive sleepiness. In addition, the loudness of snoring is likely disturbing your partner's sleep quality. If you (or a loved one) had a sleep study, it is likely that your doctor advised you to avoid sleeping on your back. 

Our research team brings into question a person's perception of position during sleep. The results of our recent research study shows that over half of the participants had no particular preference for supine sleep and yet spent potentially significant periods of their sleep on their back.

Most people are able to identify a preferred body position for sleep. The study found that 43% of people with a complaint of loud snoring favor sleeping on their back (1). The others favored the side position (46%) and the stomach position (11%). Actual recording of body posture during sleep at home found a high correlation between favored body position and the monitored body position. However, even those people who do not favor sleeping on their back spend at least part of the night on their back. These findings show that most people spend at least part of the night on their back even when they report that "I never sleep on my back."

People who sleep next to a person who snores know that snoring becomes louder with a shift to their back. The loud snorer will be told to "roll over" and may receive the prompt of an elbow or fist to the ribs to move back to his/her side. In addition, sleep studies show that OSA is worse when the person sleeps on the back. Snoring and OSA are caused by narrowing behind the tongue, which become more significant when sleeping on the back due to the gravitational pull on the jaw and the backward shift of the tongue that reduces the opening behind the tongue.

In our recent study, we found that people who favor their back for sleep end up spending most of their sleep time in this position (51% of the time). Surprisingly, even people who do not favor the back position for sleep spend part of the night in this position. People who preferred the side position spent 28% of their sleep time on their backs and those who favor their stomach spent 17% of sleep time on their backs.

Temporary Strategies versus Long-Term Solutions

Over the years, a number of strategies have been used to help people avoid the back position during sleep.  The "Tennis Ball Technique" is the most commonly prescribed method to discourage sleeping on the back. It consists of a pocket sown into the back of the pajamas (or a t-shirt that is available from your sleep doctor) that is worn while sleeping. Usually, a tennis ball is placed in this pocket. The idea is to make it uncomfortable to sleep on the back. Unfortunately, this strategy often results in a back ache and might worsen a back condition for those people with a history of back problems. At times, a person finds a way to accommodate to the tennis ball and resumes sleeping on the back despite the ball.
 
Recently, specialty pillows have become available to avoid the back sleep position. However, people frequently report discomfort with having to remain in one position through the night. Thus, relying on positional training to avoid sleeping on the back is frequently uncomfortable and unlikely to represent an adequate treatment for snoring and OSA.

There are a variety of effective treatments that can adequately address problems with snoring and OSA while allowing people to sleep in their preferred position. If you, or a loved one, are actively trying to avoid sleeping in the supine position, do not assume that this approach is effective. Discuss with your physician the best strategy for you to follow; remember that untreated OSA has potentially negative effects on your health. Besides CPAP and oral appliances, Sleep Medicine is researching a variety of new treatment options for snoring and OSA.   
 

1. Rosenthal L and Dolan DC; Comparison of Subjective Sleep Position preference Vs. Objective Ambulatory Data. Sleep: 32: A387; 2009  
Sincerely,
 
 
Duane Day
Practice Administrator 
Sleep Medicine Associates of Texas, P.A.