Positional sleep apnea and how it impacts your health
Most of the time, we don’t even think about breathing—it just happens on its own. But approximately 90 million people in the United States live with some form of sleep-disordered breathing. This means that the quality of their breathing is compromised in one way or another when they sleep, which can have long-lasting effects on overall health.
Of those 90 million, it is estimated that about half suffer from sleep apnea. In order to understand the effects of sleep apnea, it is important to first know what sleep apnea is, and what causes it.
Sleep apneas are lapses in optimal respiratory function during sleep, where a person has a partial or complete stoppage of breathing. Short lapses in breathing are fairly normal and happen to almost everyone, but when the lapses are both prolonged (lasting more than ten seconds) and numerous (more than five in a one-hour period) is when sleep apnea is often diagnosed.
Obstructive sleep apnea
The most common form of sleep apnea is called obstructive sleep apnea, or OSA. When lying down, the muscles in the throat relax, causing the tongue, tonsils (if present), and soft palate to gently move downward, which causes the airway to narrow. Sometimes, it narrows so much that it briefly closes off completely, interrupting breathing and reducing the level of oxygen in the blood.
With obstructive sleep apnea, drops in oxygen levels alert the brain that something isn’t working as it should. As a result, the brain wakes the sleeping person up so the airway can be reopened once again. Typically, the person falls back asleep almost immediately and has no memory of being awake.
This becomes a problem when the sleeping person is awakened repeatedly, sometimes dozens of times an hour. Repeated awakenings resulting from sleep apnea can lead to different kinds of health problems, including:
- Irregular heartbeat
- High blood pressure
- Chronic headaches
- Heart attack
Additionally, a lack of deep, restorative sleep can also impair cognitive functioning during the day, not to mention the commonly reported problem of being tired all the time.
For obstructive sleep apnea, position is key
Many times obstructive sleep apnea is actually positional sleep apnea. Positional sleep apnea is a subset within sleep apnea, and is defined as when a person has at least two times as many breathing events when on their back versus on their side. Most people find that the number of stopping breathing events increases or decreases depending on what position they sleep in.
The good news is there are immediate steps you can take to reduce the impact of position on your sleep apnea. Research shows that your sleep position, or sleep posture, is a factor in the occurrences of sleep apnea. Many studies have shown that side sleeping reduces the number of times a person partially or completely stops breathing, especially when compared to sleeping on the back.
Sleeping on your back, especially with the head in a position facing up, is generally associated with a worsening of obstructive sleep apnea due to increased pressure on the throat to collapse. In addition, there are a number of other factors that can contribute to sleep apnea.
As mentioned above, the posture, or position, that someone sleeps in can both help and hinder the likelihood of keeping a more open airway during sleep. The good news is that several positional therapy products are on the market that can help manage a sleeping person’s position by coaxing them onto their side and preventing them from lying on their back.
Certain characteristics of the neck are hereditary, and not much can be done by way of changing them. For example, some people naturally have a more narrow airway, or tonsils or adenoids of a certain size, that obstructs breathing when lying in a supine position. Men with necks that measure more than 17” in circumference have greater risk, and women with neck circumferences greater than 15” also see a spike in incidences of sleep apnea. An elongated neck may also contribute to an airway that may be more prone to collapse during sleep.
People who are obese have four times the risk of sleep apnea when compared to people of normal weight. Women who are menopausal and overweight also increase their risk. It should be noted, however, that not everyone who is overweight has sleep apnea, and apnea affects many normal-weighted individuals.
The impact of positional therapy on obstructive sleep apnea
Recent data have identified that sleep position plays a more important role in people with mild and moderate obstructive sleep apnea. The same study found that 50% of people with mild obstructive sleep apnea and 19% of patients with moderate obstructive sleep apnea have a strong positional component.
In the above-mentioned study, all participants underwent a home sleep apnea test after undergoing positional therapy for three continuous months. The results showed a significant reduction in sleep apnea, and a higher oxygen count in the blood.
In some cases, simply avoiding the supine position can be enough to successfully treat sleep apnea. This is often achieved with positional therapy. Positional therapy attempts to treat positional sleep apnea by managing, and in some cases, correcting, what position someone sleeps in.
Different kinds of sleep positioners
- This is one anyone can make themselves. Fill a tube sock with tennis balls, then sew the sock down the back of a tight fitting t-shirt. When the shirt is worn while sleeping, it can prevent the wearer from rolling on to their back.
Pillows and Pads - make sleeping on your side more comfortable.
- The home remedy of strategically placing pillows in bed to support side sleeping is easy to try. Body pillows, with their longer shapes, are specially designed to support comfortable side sleeping.
- Sleep Yoga Side Sleeper Arm Rest Pillow: A line of contoured pillows that promote and support side sleeping. Widely available and well reviewed.
Wearable belts - discourage back sleeping by making it uncomfortable.
- Rematee: These bumper belts and shirts are purchased over the counter. The smooth, bumpy pads, worn on the back, keep the sleeper from rolling into anything other than a side or stomach sleeping position.
- Slumberbump: An air bladder in the rear compartment creates a wedge that prevents the user from rolling into the supine sleep position.
- Zzoma: An angled wedge made of soft foam, Zzoma was one of the first products to be specifically marketed for the treatment of sleep apnea. Available by prescription only, Zzoma works by ensuring the user sleeps only on their stomach or side.
Position Trainers - have alarms or buzzers meant to train the sleeper to avoid back sleeping.
- NightShift Sleep Positioner: A sleep position therapy device that aims to discourage the sleeper from rolling on to their back using gentle vibrations when it senses your body is becoming supine. The vibrations’ intensity increases until you roll over to your side or stomach.
- NightBalance: This device is about the size of a cell phone and is worn on the front of the body in an adjustable chest band. When the person wearing it rolls over to an undesired sleeping position, the device sends out gentle vibrations to coax you back into sleeping on your side.
Positional therapy can be used by itself or in conjunction with other sleep apnea treatments.
Thankfully, there are many effective, non-invasive treatment options available to help manage positional sleep apnea and assist in achieving greater sleep health.
Brandon R. Peters, M.D., is board-certified in both neurology and sleep medicine and currently practices at Virginia Mason Medical Center in Seattle. He is also a clinical faculty affiliate at Stanford University's School of Medicine in the Department of Psychiatry and Behavioral Sciences. His latest book, Insomnia Solved, is available on Amazon.