Sleep Apnea, Sleep Position, SIDS, & Brain Development

October 8, 2010

I was talking with a mother about her young child, who just happened to be a natural stomach sleeper. The mother was very emotional as she described what she had to do a few months after her daughter was first born, to keep her from rolling onto her stomach. Her doctors chastised her for allowing her child to sleep on her stomach, despite the fact that she slept much more deeply and soundly in this position. There were even implied threats of calling children’s services.

What she ended up doing was to stay up all night, watching her sleep, just to make sure that she didn’t roll over or stop breathing. Often, she would end up crying due to her chronic sleep deprivation and seeing that her daughter wasn’t able to sleep comfortably at all on her back.

I wrote in the past about a proposed theory that the back to sleep campaign in the early 1990s, although it did lower the rate of sudden infant death syndrome (by about 50%), it may have aggravated the sudden rise in the rate of autism. The rationale is that by keeping infants on their backs, it keeps them in a lighter stage of sleep, so that they’re more likely to wake up if there’s any form of partial or total obstruction. If this is true, then you’re also preventing proper memory consolidation and brain development.

I’m not proposing that we all go against the back sleeping recommendation for infants. However, I just wanted to bring up a potentially important issue that deserves much more discussion and further study.

What do you think about this issue? Is it plausible, or just a ridiculous theory? I’d like to hear your opinions.

8 Responses to “Sleep Apnea, Sleep Position, SIDS, & Brain Development”

  1. Monica Betancur on October 9th, 2010 10:48 pm

    I agree and at the same time share my story. My son who is 3 yo, has severe sleep apnea. He can only sleep well for 2 hours and suddenly it looks like if somebody clips his nose. His nose sounds congested and stuffy, he starts complaining, tossing and turning for about 2-3 hrs before he can go back to sleep peacefully again. He has choanal atresia on his right side, so we try to place him over that side and with some pillows so that he is elevated. He is delayed and not being able to sleep well doesn’t help at all. My husband and I watch him every night taking shifts to try to help him. Sometimes using saline drops he breaths better but most of the time not much. His ENT removed his adenoids supposedly to help but we didn’t find improvement. He is suggesting jaw distraction! we want the atresia corrected!

  2. Terri on October 9th, 2010 11:53 pm

    This makes complete sense to me. As a life-long sleeper on my stomach now using CPAP, I have noticed that I wake up less rested and more functionally impaired during periods of sleeping only on my back. It’s something I do intentionally to support my neck when it flares up but I definitely notice a difference vs. stomach/side. If it can can have that impact on a fully developed adult, surely it can have serious impact on a still developing baby.

  3. Deborah Wardly on October 27th, 2010 3:44 pm

    very interesting Dr. Park, I have started to wonder about this also. I have UARS and realize it is due to the structure of my jaw which I inherited from my mother’s side, and all of us with the jaw have multiple medical problems including chronic fatigue and vertigo. my daughter inherited my husband’s facial structure and wide jaw, and despite her overbite from me she slept easily on her back as an infant. my son however inherited my jaw as well as the overbite. he was NEVER able to sleep on his back and it was a really big problem, especially as I am a pediatrician and have told countless mothers that they HAVE TO make their babies sleep on their backs, and never co-sleep. if I swaddled him tightly he could sleep for 2 hours supine but then would wake sweating and screaming. it seemed like his startle reflex was exaggerated and it was waking him up. he could sleep fine in my arms or prone on the couch during the day while I could watch him, but the sleep deprivation finally got to me, as my UARS unknown to me at the time was clearly worse as I had to start Sonata when he was 3 days old because I stopped sleeping entirely. so I ended up having him sleep in bed with me tucked under my arm so I could keep him on his side, and I propped myself so I could not roll over on him. now I know I could never have rolled on him because I don’t get any deep sleep anyway. at 3 1/2 months I bit the bullet and started putting him in his bassinet prone to sleep. he can sleep on his back now but he is almost 3. but he barely was able to nap in child care because they would not allow him to sleep prone. Dr. Park I completely agree with you on your sleep breathing paradigm and I think there is SO much we do not know about sleep breathing disorders and I think they have got to be rampant. I had one doc tell me my sleep study was completely normal. my arousals were considered within normal. but I have tongue collapse and I am finally getting better after over a year of awful crushing fatigue, with the use of a tongue retaining device. I think we have to come up with better ways of diagnosing UARS because clearly even a sleep study is limited for detecting it. so your theory about autism is compelling. I know that my brain has definitely taken a hit with the past year of my UARS getting so much worse. toss in critical periods of brain development and there you go.
    -Dr. Deborah Wardly

  4. Deborah Wardly on October 27th, 2010 3:50 pm

    one more thought; I saw the pictures in your book I think it was, and in the newborn the voicebox is somewhat behind the tongue initially, more like in animals, rather than below the tongue as in an older child or adult. I thought an infant would be less likely to have a sleep breathing disorder as a result. but is it far enough away from the animal anatomy that in the presence of a relative/mild micrognathia/overbite that the infant would still be at risk for SBD? I know in Pierre Robin it’s obviously a big problem but that is the end of the spectrum.
    -Dr. Wardly

  5. Deborah Wardly on October 27th, 2010 3:53 pm

    sorry I just keep having more thoughts about this. so, if your theory is correct, wouldn’t there be a higher incidence of autism in children with Pierre Robin? maybe not if they all get trached. can we design a study to investigate this?
    -Dr. Wardly

  6. Steven Park on November 11th, 2010 6:49 am

    Dr, Deb,

    In infants, the voice box drops very slowly on a gradual basis, but at 4-6 months, it’s sufficiently dropped low enough to create a significant oropharynx, allowing the tongue to fall back easier. Yes, if your jaws are not developing to it’s full potential, it only adds to the problem. Thanks for sharing your history.

    In a recent grand rounds presentation, I saw a lecture of ENTs doing distraction osteogenesis of the jaws with some incredible results. Many toddlers and children were able to reverse their tracheotomies. Using different techniques, from aggressive orthodontics, oral appliances to various degrees of jaw surgery, we have the technology and ability to open up the jaws.

  7. Brittany on December 29th, 2010 5:25 pm

    I am very passionate about this issue. I am mother to a 5 month old son and my husband and I decided when were expecting to follow the advice of a 114 year old pediatrician, Dr. Leila Denmark. We live in the Atlanta area and she’s pretty famous here having practiced pediatrics for 70 years. She doesn’t practice anymore but she is still alive at 114 (so she must be doing something right). Anyways, we were counseled by our Pastor and his wife on her “methods” and infant care philosophy. Her ways are the “old” ways, “ancient” in fact. We sleep our son on his tummy and have since arriving home from the hospital. We feed him on a schedule and never allow him to sleep with us, always in the crib. He is about to crawl, any day now. He is ahead of the game in all motor-functioning, holds his head up, sits up on his own, etc. And he’s very happy. The only time he spends on his back is for diaper changes. And his head is shaped so nice!

    I am also a 2nd grade teacher and have witnessed the rise in autism, ADHD, and other behavior disorsers. While I think a lot of these have to do with environment and the change in family/parent style in the last decades, I definitely think the AAP should research this more.

    Our pediatrician knows we sleep our son on his back and she’s never said anything except “keep doing what you’re doing because he’s doing great.” I think she agrees with us and Dr. Denmark but can’t say because of the guidelines. Anyways, I slept on my tummy, my husband on his, and all these doctors on theirs too probably. We all turned out fine.

    Dr. Denmark addresses SIDS in her book “Every Child Should Have a Chance.”

    God Bless!

  8. Steven Park on December 29th, 2010 9:17 pm

    Brittany,

    Thanks for your comments. It’s funny that you mention that your son is undergoing all his developmental milestones normally, if not earlier. A recent Time article reported on health care professionals reporting a significant rise in developmental delays (especially motor skills) since implementation of the back to sleep campaign. I’m definitely going to check out Dr. Denmark’s book.

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