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July 13, 2018

Why side sleeping boosts your sleep health

It’s estimated that up to 90 million people in the United States struggle with some form of sleep-disordered breathing. Sleep-disordered breathing refers to a broad spectrum of breathing-related issues that prevent a restful night’s sleep, and in some cases, can impair health in the long-term.

However, promising research shows that side sleeping can help improve overall sleep health and aid in the treatment of sleep-disordered breathing. That same study showed a 68% success rate among patients who slept on their sides, defined by significantly better breathing patterns during sleep.

Common examples of sleep-disordered breathing range from snoring at a loud volume to central sleep apnea (when your brain sometimes doesn’t send the signal to take a breath) and obstructive sleep apnea, where your respiratory path becomes so relaxed that the airway is obstructed. In this last instance, your body is unable to take full breaths, despite its best efforts.

What is sleep apnea?

Obstructive sleep apnea is a condition that affects approximately 45 million people in the United States. It’s fairly common, but how and why does it happen? In order to best treat obstructive sleep apnea, it’s important to know what causes it.

The upper airway has evolved into a somewhat complex architecture, performing multiple key functions daily. The airway not only needs to allow air to get to the lungs, but also to allow food to get to the stomach. This special pathway, bordered by the tongue and soft palate, is also near where speech occurs.

When we’re awake, we’re typically upright, and this may help to support the muscles around our throat to help keep our airway open. But when we go to bed, the air sometimes doesn’t travel so easily. When we lie down, two things can make the passage of air more difficult. Gravity works against us, pulling the tongue and soft palate into the back of the throat when we are on our backs (also known as the supine position). This is even more likely if we have difficulty breathing through the nose and experience mouth breathing. The jaw, and tongue, can shift and block the throat.

When supine, gravity also pushes any belly weight down on our diaphragms, reducing the volume of our lungs and diminishing our breathing. Further, sleep is a relaxation process, and our muscles naturally relax, particularly during certain stages of sleep.

When gravity and relaxation combine, it can make airflow much more difficult. As a result, the flow of oxygen is sometimes obstructed or outright halted for short periods of time. When these interruptions—these obstructive sleep apnea events—occur frequently enough, a formal diagnosis of sleep apnea from a sleep health professional often follows.

How side sleeping can help with sleep apnea

Most people breathe better when sleeping on their side. According to one study, around 68% of people with sleep apnea breathe much better when not on their back. The reason is simple: gravity. Side-sleeping has long been known to protect the airway from collapse.  When sleeping near a snorer, a nudge to get them off their back usually quiets things down considerably.

There are a variety of different treatment options for sleep apnea. The practice of deliberately avoiding sleeping on your back is called positional therapy. Research on sleep positional therapy points to side sleeping being very effective for treating sleep apnea. A recent study of 105 people with sleep apnea showed that 67% of them reduced their incidents of sleep apnea to less than five per hour (within the normal range).

Most people cannot simply command their bodies to sleep on their sides throughout the duration of the night. Thankfully, there are a lot of products on the market, both over the counter and through a prescription, that assist with maintaining a side sleeping position. These generally range from specially shaped wedge pillows to wearable feedback devices that discourage the sleeper from rolling onto their back.

Further benefits of side sleeping

Alleviate neck pain

Some people who sleep in the supine position report neck pain, as a result of their pillow holding their neck up too high, causing the neck to slump forward at an uncomfortable angle. A misaligned airway can also increase blockages during sleep. Those who sleep on their stomachs also sometimes report neck pain from having to sleep with their head twisted for the duration of the night. With the right kind of pillow, side sleeping can relieve the sleeper from the pain associated with the prone and supine sleep positions.

Be more well-rested and alert

When sleep apnea causes breathing to stop, the brain springs into action, causing an arousal (or awakening) which kickstarts the act of breathing once again. This natural instinct interrupts deep restorative sleep, causing people to wake up or enter lighter sleep. Usually this happens without the sleeper realizing it. This can happen dozens or even hundreds of times per night. As a result, the quality of sleep can really suffer, although most of the time the sleeper is unaware of the cause.

Sometimes, people realize that they are tired all the time, or notice that they fall asleep during the day without meaning to, such as during an afternoon meeting or when stopped at a traffic light. Not only are these problematic situations, with potentially hazardous consequences, they are classic symptoms of sleep apnea.

Sweeter dreams for everyone

Making the commitment to improving your sleep won’t just do wonders for your own personal health. Consider the quality of sleep of your bed partner who may have been dealing with loud snoring, gasping for breath, and other symptoms of sleep apnea, for months or even years. The gift of good sleep health doesn’t just begin and end with you; your loved ones can benefit as well.

Side sleeping is sometimes used as a tactic to achieve more restful, healthy sleep in conjunction with other sleep apnea treatments, such as a CPAP machine or oral appliance. A sleep health professional will be able to best assess your specific needs and create a program that will set you on a path to better quality sleep experience and improved overall health. With a little bit of time, you could soon see better nights and brighter mornings.

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.

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