How Your Face Can Predict Your Sleep Position

August 7, 2014

Sleep position is a perennial topic that you’ll see often talked about in the media. In most cases, your sleep position is thought to predict your personality type. However, there’s a simpler explanation for why you may prefer to sleep on your side or on your tummy. This has to do with the shape of your face, and in particular, the size of your upper airway. 

About once every few months, I’ll see a woman who complains of 4 weeks of frequent sinus infections, facial pain and misery. She was given multiple courses of antibiotics and allergy medications, all with only temporary relief. When I examine her upper airway, it’s usually very narrow, especially when she’s lying flat on her back. I ask her about her sleep position, and she’ll state that she likes to sleep on her back. I don’t believe her. Then I ask her what her favorite sleep position was 3 years ago. She replies that she used to sleep on her stomach. When did she change? About 4 to 5 weeks ago. Why did she change? Her dermatologist told her that she’ll get wrinkles on her face if she sleeps on her stomach. 

Not unexpectedly, after switching back to her tummy during sleep, her sinus problems get better.  In addition, I make sure that she stop eating close to bedtime and that her nasal breathing is optimized. What’s happening is that on her back, her tongue falls back more due to gravity, and during deep sleep, with total muscle relaxation, she stops breathing and keeps waking up. Poor sleep quality over time will cause sinus migraines, and even more facial wrinkles.

In the video below, I talk about how your facial shape can predict your sleep position. 

If you’ve had to change your sleep position for whatever reason, why did you do so, and did it affect your sleep quality?

5 Effective OTC Anti-Snoring Products

March 27, 2013

Guest post by Jimmy Keillor 

When it comes to snoring, there are plenty of solutions out there for people to try, from sleep-retainers, to specialty pillows, to nasal strips and beyond. Besides solutions that require a prescription, these are some of the most effective snoring solutions that I’ve seen out there. Let me say, first and foremost, that neither I nor the site-owner are receiving any kind of compensation for these reviews. We do not necessarily endorse these products, and I write about them from a completely objective standpoint. That said, here are 5 of my favorite OTC anti-snoring products.

Good Morning Snore Solution

The ZQuiet is different from other mouthpieces in that it isn’t a jaw-retaining mouthpiece, but a tongue-retaining mouthpiece. This is one gets a lot of good reviews because it will remedy snoring that is caused by multiple problems, including blockage of the airway by tongue, uvula, jaw, etc., while many others are simply concerned with the jaw. This mouthpiece offers a level of comfort that many others don’t, and also has been backed up by studies done in controlled settings, published in the Journal of Sleep and Medicine.

Zicac Stop Snoring Wrist Watch

This is one of the more interesting snoring solutions out there—it’s not actually a watch, but a device that shocks you if you snore. So it’s like a shock-collar that you put on mischievous pups to keep them from barking, except that it’s not supposed to hurt you, or even wake you up, but just cause a sort of stimulus that will get you to change your sleeping position, roll over, etc. Unfortunately, the problem with this device is that it does hurt some people, while others don’t feel it at all. It’s all over the place in terms of who it works for and who it doesn’t, so I usually recommend staying away from this one.

Rematee Bumper Belt

The bumper belt is a very simple idea. Like anti-snoring pillows, the bumper belt is designed to keep snorers on their sides, though these belts do so by strapping inflatable bumpers to your back that makes it extremely hard to roll over. Like the Zizac Stop Snoring Wrist Watch, everybody reacts differently to this product because it is a one-size-fits-all belt. Those that this belt fits (and that snore because they sleep on their back, and for no other reason) generally review the product favorably. If you fit those criteria, you probably will too. If, however, you snore for reasons related to your weight, dry membranes, or anything other than the fact that you sleep on your back, this product is not for you.

Breathe Right Nasal Strips

Any type of nasal strip is going to be, most likely, your most inexpensive snoring remedy. Unfortunately, nasal strips don’t generally constitute a complete solution when it comes to snoring, but they do work pretty well as a supplementary device at the low price of about $10. Some people can’t seem to get these strips to stick, while on the other hand some people complain that they hurt to take off because they stick so much, so they are not perfect, but as newer iterations of the device come out these problems seem to be fast disappearing.


The SnoreEzzz is an interesting device. It is different from other anti-snoring pillows because of its two-piece design. Unfortunately, people I know (including myself) have given this pillow more bad reviews than good ones, because the pillow seems to go flat fast—which means that is not only uncomfortable, but also that it stops being effective. There are better solutions out there, but if you are looking for an anti-snoring pillow, this one is right there for $65.

There are, of course, plenty of other solutions out there, and a large majority of them don’t cost a thing. If you are interested in learning more about those tips, check out this page over at the Top Anti-Snoring Devices blog. Last, but definitely not least, feel free to leave a comment in the comments section below.


About the Author: Jimmy Keillor is a retired medical researcher and freelance writer who has studied the causes and effects of sleep deprivation his entire career.  Many of his colleagues consider him a valuable reference when it comes to disruptive sleep patterns. When he’s not studying or writing, Jimmy enjoys parasailing and taking his two boys to the rodeo.


A New Trend in Fighting Seizures: Anti-Inflammatory Medications

June 10, 2012

Experts estimate that about 2.7 million people in the US suffer from seizures. About 1/3 do not respond or respond poorly to anti-seizure medications. A new trend is to prescribe steroids as an anti-inflammatory medication based on the finding that people with seizures have more inflammation in the brain. 

A New York Times article details the current research in the link between inflammation and seizures. As I was reading the article, I couldn’t help but think how may of these people with seizures have untreated obstructive sleep apnea. Numerous studies have shown a link between obstructive sleep apnea and seizures. In fact, sleep deprivation is known to lower your seizure threshold, meaning that you’re more likely to suffer epilepsy given your various risk factors. Other studies have shown significantly improved seizures after treating for obstructive sleep apnea.

We know from countless studies that obstructive sleep apnea causes major inflammation in the brain. This can be from hypoxia, micro strokes, small vessel clotting, and thickened blood viscosity. Yes, blocking inflammation (the end result) can seem to help, but you’re not really getting to the root cause of the problem. I’m not saying that all forms of seizures are caused by sleep-breathing disorders, but even if 25% have undiagnosed sleep apnea, that’s a very large number of people with epilepsy that can be treated.

I’ve written here before about seizures and sleep apnea. One thing that I notice is that the upper airway in patients with a seizure diagnosis is much more narrow than normal. Most of these patients prefer to sleep on their sides or stomach. This supports my theory that they are prone to breathing problems at night.

If you know anyone who has epilepsy, do they snore, or have parents that snore? Do they sleep on their back, side or stomach?

Major Life Changes That Can Trigger Sleep Apnea

July 9, 2011

Recurrent sinus infections, throat pain, ear fullness and chronic cough are some of the most common conditions that I see every day. You may think that I typically diagnose and treat for routine bacterial infections in these situations, but in most cases, they’re not really infections at all. What I do find, however, is that if you probe and look back at the patients’ history, there’s always some major life change or recent event that acted as a trigger for their symptoms, especially if their upper airway anatomy is already narrowed or predisposed. Here are 5 common examples:

 Sleepless nights from a newborn child

 The birth of a child is always a joyous event, but everyone knows that your life will change drastically all of a sudden. Your normal routines, eating habits, exercise regimens, and especially the timing for all these events will change. The sleep deprivation, lack of exercise, and bad eating habits can promote weight gain, which can narrow your throat even further. This leads to more problems breathing at night, leading to less efficient sleep, leading to more weight gain. This applies to both the mother and the father.

 It’s also a common phenomenon where a woman is never able to lose her pregnancy weight, despite extreme dieting or exercise. This leads to less effective sleep, increased fatigue, and various other health-related conditions. 

 Newfound independence, more depression

 The freshman 15 is more than just an observation—there’s a good reason why college students gain weight all of a sudden during their freshman year. Dorm meals and cafeteria food tends to be starchy and very high in calories, and because of the buffet-style format, there can be problems with portion control. Home-cooked meals by parents, eaten at relatively normal times (5 to 7 PM), turns into eating later in the night: more episodes of pizza, take out food, and late night snacks while pulling all-nighters for exams. 

 Having stomach juices when you go to sleep will allow more acid and other stomach materials to regurgitate into your throat, leading to more frequent arousals and less efficient sleep. This leads to a cascade of metabolic, hormonal, and cardiovascular consequences that promotes weight gain. Drinking alcohol at night relaxes the throat even further, leading to more frequent breathing pauses.

 This relative sudden change in your eating and sleep routines can definitely affect your mood and mental health. It’s not surprising that depression and anxiety peaks during the college years. This is also the time when the larynx (voice box) descends in the neck to its’ lowest position during maturation into adulthood. The lower your voice-box, the more the tongue can fall back, leading to more frequent breathing problems.

 A new job or a promotion

 It’s great to start a new job, or get that promotion that you’ve wanted. But just like any other major change in your life, your routines will change. You’ll stay later to impress your boss, skip meals, come home later and go to bed later. As a result, you’ll gain a few pounds. Some people can eventually adjust their schedules to accommodate a healthy sleep schedule, diet and exercise regimen, but others can’t. This is when things begin to go downhill.

 Injury or surgery

 Most people with sleep-breathing problems prefer to sleep on their sides or stomach. Any kind of injury or undergoing surgery can force you to sleep on your back, which causes more tongue collapse (due to gravity) and more obstructions and arousals (due to muscle relaxation in deep sleep). In fact, many patients have told me that their lack of sleep, physical activity and subsequent weight gain is what triggered a vicious cycle. 


 This applies mainly to women, but hormonal changes can affect men too. Loss of estrogen and progesterone can diminish their protective effects on the upper airway. In particular, progesterone is an upper airway muscle stimulant/dilator. As it begins to diminish in the early 40s, the tongue begins to relax more and more over the years, leading to less efficient sleep, and the typical vasomotor symptoms begin which includes hot flashes, night sweats, weight gain, mood swings, and irritability. Believe it or not, these symptoms can happen in young men, too. These are your body’s nervous system reaction to the changes with your sleep-breathing status.


As you can see, all of us will go through some or all of these events at some point in our lives. It’s natural as modern humans to be susceptible to these sleep-breathing related conditions. It may sound a bit depressing, but the good news is that now you’re aware of it, you can take preventive measures once it starts. 

How Sleep Position Can Affect Stillbirth Risk

June 19, 2011

Researchers from New Zealand discovered that women who did not sleep on their left side the last night before delivering their babies had twice the rate of stillbirth compared with those that slept on their left side. It’s commonly recommended for pregnant women to sleep on their left side, especially later in pregnancy. There are various explanations for why this is preferred, from placing less pressure on the mother’s major blood vessels to worsening the mother’s snoring.

I’ve mentioned before that a woman’s risk of developing obstructive sleep apnea increases as she gains weight during pregnancy, but progesterone counteracts this effect neuromuscularly, by tensing the throat muscles and increasing the drive to breathe. However, back sleeping is a known aggravator of breathing pauses during sleep due to gravity’s effects on the tongue. Whether or not this leads to apneas (10 seconds or longer pauses), the mother will still stop breathing and wake up more often during the night. This can place a major stress not only on the mother’s body, but on the baby as well.

This study was an observational study, so more prospective studies are needed. But it only goes to show that any additional situation that can aggravate sleep-breathing problems during pregnancy can raise your risk of complications, which also includes gestational diabetes and preeclampsia.

I wonder if the researchers asked the women what their preferred pre-pregnancy sleep position was. I suspect that women who can’t sleep on their backs may have more complications during pregnancy due to narrowed upper airway anatomy.

The Connection Between MS And Fatigue

June 8, 2011

It’s a given that if you have multiple sclerosis (MS), you’ll be tired all the time. It’s thought to be a normal part of having this condition, just like many other chronic medical conditions. But here’s an interesting study that suggests that fatigue can precede MS by up to 3 years. The researchers found that many MS patients complained of fatigue to their doctors months or even years before the first clinical signs of MS.

Here’s my take on this: I’ve written in the past about how the vast majority of people with MS that I see in my office have small jaws and narrowed upper airway anatomy. In an informal poll I conducted on’s MS forum, a very high number of people had an excessive number of dental extractions, couldn’t sleep on their backs, and many of their parents snored heavily. Having excessive dental extractions causes the oral cavity to become much smaller, making the tongue take up too much space.

I’m not discounting current thinking about the origins of MS, but it’s extremely interesting that most patients with MS have very narrowed upper airway breathing anatomy which prevents achieving deep sleep. Lack of quality deep sleep can lead to various neurologic, hormonal, metabolic and digestive problems. Many patients with MS also have obstructive sleep apnea, but most will most likely have upper airway resistance syndrome, which I’ve described extensively here and in my book.

For those of you who happen to have MS:

  1. What’s your favorite sleep position (back, side or stomach)?
  2. Did you have any teeth removed besides your wisdom teeth, and if so, which ones and how many?
  3. Do either of your parents snore heavily?

SIDS & Sleep Apnea, Revisited

May 4, 2011

Here’s the response I wrote on KevinMD to blog on the dangers of sleep positioners and SIDS. The author of that blog probably won’t like what I have to say. You’ll see that what I suggest may have huge implications with our children’s health.

The Fountain of Youth, Revealed

March 22, 2011

Ponce de Leon is well known as the Spanish explorer that searched for the fountain of youth in the early 1500s. Even today, that search continues through the multi-billion dollar cosmetics industry, plastic surgery procedures, and nutritional products. Anti-aging medicine even has a certifying organization for doctors. Some experts are even claiming that they can reverse the aging process.

Knowing what we know about the importance of sleep and the havoc it can cause on your body, I can confidently say that the best way to slow down aging is to optimize your sleep quality. Sleep is known to be vital in tissue healing and regeneration, hormone regulation, as well as in helping to consolidate memories and thought processes. For example, non-REM deep sleep is important for tissue repair, growth hormone release, and other regenerative processes. REM sleep is needed for memory consolidation and creativity.

When most people read or hear about better sleep, they think about going to bed earlier or sleeping longer. People with insomnia are also inundated with “warm milk” recommendations, such as valerian, green tea, turkey, melatonin, meditation, and probably dozens of other vitamins, supplements, or relaxation techniques that help to calm or numb the mind to allow for faster sleep onset. Many of these options can work to various degrees, but won’t be helpful at all if you stop breathing at night. Once your breathing passageways obstruct while sleeping, you have to wake up. You can either wake up violently in a state of panic with sweating and your heart racing, or just get taken out of deep sleep into a lighter stage of sleep.

About 1-2 times per month, I see women who complain of various ear, nose or throat symptoms, let’s say for about 6 weeks. They also usually complains of increased fatigue, headaches, and poor sleep. They usually see their medical doctors and have tried multiple courses of antibiotics or allergy medications. They will typically say that they sleep on their backs when questioned about their preferred sleep position. Looking at their oral cavity exam, I don’t believe them. When questioned further, they all admit that they used to be stomach sleepers, but changed to back sleeping after reading an articles on various magazines, usually by a dermatologist (or sometimes a chiropractor) that recommends avoiding stomach sleeping since it can cause facial wrinkles. Almost every time, their health problems began just after they made the switch in their sleep position. Once they go back to their normal sleep position, their health problems usually resolve.

The cosmetics industry’s fight against facial wrinkles is a classic example our quest to delay aging. In the above example, the reason why some people have to sleep on their stomachs is so that they can breathe properly. Being on their backs causes the tongue to fall back due to gravity, and when in deep sleep, it relaxes completely, leading to obstruction and arousal. Having smaller jaws and dental crowding can aggravate this problem even more. Not getting sufficient amounts of deep sleep causes a generalized state of physiologic stress and adrenaline production, which tends to constrict blood vessels that supply certain parts of the body that are considered “unessential” when you’re under stress. This includes your digestive system, your reproductive organs, as well as your skin. Not receiving proper circulation deprives the tissues of oxygen, preventing proper nutrition and not allowing for healing, regeneration, and waste removal. Hypoxia also creates an environment that’s toxic to the local tissues, leading to further damage and accelerated aging. The bottom line is that not getting good sleep accelerates your aging process.

Another important concept that has profound implications is the fact that underdevelopment of the bony midface and jaw structures leads to wrinkles earlier in life. Having smaller facial bony structures does not stretch the facial skin over the bones as much compared to larger facial structures. Since elastic properties of facial skin tend to degrade over time, having smaller facial bones allows wrinkles to show up earlier, with the same degree of environmental, dietary, or genetic factors.

Two common habits that are thought to accelerate aging and even wrinkles are sun tanning and smoking. Sun tanning may make you look “healthy” temporarily, but sun damage takes a toll on your skin, especially if you’re susceptible to the sleep-breathing problems that I describe. Imagine if you already have diminished circulation to the skin,  with diminished levels of oxygen. By definition, you’ll have more levels of oxidative stress, where free-radical oxygen molecules are formed, which can damage DNA. Add ionizing radiation, and it’s a double whammy.

Nicotine is a known stimulant which also has been proven to constrict blood vessels, especially in the skin. It also has a calming effect the way Ritalin helps to calm children with ADHD: Stimulants help to counteract the effects of sleep deprivation from not breathing well at night. It’s also been shown that it takes nicotine about 45 seconds to reach the brain once you inhale smoke into your lungs. This doesn’t make any sense, since most smokers will tell you that they feel more relaxed after the first one or two breaths. What’s making smokes relaxed is the relaxing properties of deep breathing, along with the stimulating effects of nicotine. But by relaxing more using deep breathing techniques to inhale a stimulant, you’re cutting off blood flow to your skin, which if already sun damaged, is more likely to suffer from wrinkles.

The basic thesis of my sleep-breathing paradigm states that all modern humans stop breathing once is a while. But as we get older, not only do we sag on the outside, but also on the inside. If you think about it, the rate at which we age is directly proportional to how narrow your upper airway gets. Add to this additional gravity and the typical weight gain that tends to occur during middle age, it’s no wonder so many people have sleep-breathing problems as we all get older. We’ll never run out of more pills, gadgets, devices and diets that tout their anti-aging properties, but without addressing how well you breathe while sleeping, you’ll continue to suffer from accelerated aging.


Struggling with an addiction? Check into a Long term drug rehab facility and get the help you deserve!


Treatment Resistant Depression: Could It Be Sleep Apnea?

March 9, 2011

Here’s a blog on KevinMD that talks about why there’s no such thing as treatment resistant depression. This is my response to the article:

Depression is assumed to be a biochemical or neurologic problem of the brain. It’s also a given that people with depression will have sleep problems, which is thought to be due to the depression. What this also assumes is that you’re able to breathe properly at night when you’re able to sleep, which is absolutely not true. Everyone stops breathing to various degrees, but only the end extreme is called obstructive sleep apnea. Modern humans, due to our unique upper airway anatomy, are all susceptible to breathing pauses at night.

You can stop breathing 20 to 30 times per hour and not officially have sleep apnea on a sleep study. Even if you had obstructive sleep apnea, 90% is estimated to be undiagnosed.

Not being able to achieve quality deep sleep can wreak havoc on your brain function. Even worse, not getting enough oxygen to your brain can cause major biochemical changes and even structural damage.

If someone has “treatment resistant” depression, it’s important to consider an underlying sleep-breathing problem. Medications or even ECT won’t help you recover if you’re not breathing properly at night. You can even make an argument to screen for a sleep-breathing problem at the first sign of depression.

I may sound like a hammer looking at depression as a nail, but if you accept the basic premise that everyone stops breathing at night to various degrees, and in light of the fact that most people with sleep-breathing problems are not diagnosed, it’s a simple condition that can be treated with gratifying results.

If you’re still not convinced, why is it that the vast majority of people with depression can’t (or prefer not to) sleep on their backs? It’s due to smaller jaw anatomy, where the tongue takes up relatively too much space, and can obstruct breathing easier when supine, especially when in deep sleep due to muscle relaxation. Parents of people with severe depression will snore heavily, and will have various degrees of cardiovascular disease (from untreated obstructive sleep apnea).

High-Tech Elbow To Prevent Snoring

January 14, 2011

Here’s an interesting device that reportedly helps prevent snoring. It’s called the    and it works by analyzing your snoring levels and through wireless technology, helps to increase your throat’s muscle tone, lessening the chances that you’ll snore. It’s made of two components: There’s a device under your mattress, and there’s a wrist band. Presumably, whenever it detects that you’re snoring, it sends a signal to your wrist device, causing some sort of mild stimulation, which will wake you just enough to lighten your sleep stage, but not enough to wake you up completely. It’s known that lighter stages of sleep can promote throat muscle tension.

In theory, it sounds great. But there’s a downside to this: it prevents you from staying in deep sleep. It’s just a high-tech version of getting your bedpartner’s elbow shoved in your ribs every time you snore.

Like most-anti-snoring gadgets out there, all it does is to cover up the snoring, with various degrees of success. In most cases, it ends up only delaying the diagnosis and treatment of obstructive sleep apnea.

Do you suffer from the “bruised rib syndrome”?

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