One of the most common recommendations that doctors give for snoring is to sleep with a tennis ball attached to the back while sleeping. This is so that you’ll stay off your back. A simple way to do this is to place a tennis ball inside an old sock, roll it up and pin it to the back of your pajamas, between your shoulder blades.
For people who have positional sleep apnea (those that stop breathing much more on their backs versus other sleep positions), anything that keeps you off your back will help, to various degrees. In my experience, most people find it too uncomfortable to use regularly or just sleep on top of it.
Australian researchers reported in
this month’s issue of Journal of Clinical Sleep Medicine that while it can be effective initially in lowering the apnea hypopnea index (the number of times you stop breathing per hour), most people just stop using it after a few years. After about 30 months, only 6% were still using it, 13% trained themselves to stay off the back, and 81% stopped using it for various reasons (mainly discomfort and ineffectiveness).
There are now other options besides tennis balls to keep you off your including
Zzoma, and the
Antisnoreshirt. One patient misunderstood me and slept with a backpack filled with tennis balls. He slept much better.
My biggest criticism of these methods, while they do work to some degree in some people, will only delay the diagnosis of significant obstructive sleep apnea in most people who snore and try to treat this on their own.
Have you tried sleeping with a tennis ball? What have you tried to keep yourself off you back? Please enter your experiences below in the comments box.
As the obesity numbers keep climbing, everyone wants to eat less and to exercise more. This is great if you’re able to exercise moderation and common sense. But if you’re already sick and your frame of reference is unhealthy to begin with, it’s difficult to know when enough is enough.
Just as those with anorexia diet excessively to cover up their faulty body image, some people with sleep breathing problems like upper airway resistance syndrome (UARS), or obstructive sleep apnea (OSA), abuse exercise as a means to cope with the lethargy created by their chronic sleep deprivation.
Addicted to Exercise
A lot of patients I see with UARS and OSA become exercise junkies in the same way that people who don’t sleep enough become coffee addicts. Rather than consume substances to give them a "high", these exercise addicts crave the endorphin fix they get while working out to overcome the constant fatigue they feel from not getting the quality sleep they need. Many of them admit that If they miss even one day of working out, they’ll get agitated, moody, and sometimes downright catatonic.
For these people, exercise or any physical activity is a coping mechanism for the constant energy drain they feel. The problem is, like any drug, too much exercise, if it’s used to deter them from taking care of their underlying sleep breathing problem, will manifest later into health complications that no amount of exercise may be able to cure.
What’s Your Sleep Position?
Obviously, not everyone who exercise excessively do so to compensate for an underlying sleep breathing problem. One quick and simple way I use to discern who is and who is not susceptible to having a sleep breathing problem is to ask whether or not they can or like to sleep on their backs. You see, those with sleep breathing problems can only sleep on their sides or more commonly their stomachs. The reason being, that they’ll have difficulty breathing when they’re sleeping otherwise.
To summarize, my sleep-breathing paradigm proposes that all modern humans have difficulty breathing at night to various degrees due to our unique upper airway anatomy. The voice box is located underneath the tongue, as opposed to animals, where the voice box is located behind the tongue. This location of the voice box under the tongue is necessary for complex speech and language. But this is also what makes our airway vulnerable and unprotected, making us more prone to having the various breathing and swallowing problems that we, as modern humans have.
What’s worse, it’s thought that due to a radical change in our diets (highly processed foods and refined sugars) over the past century, our jaws are getting narrower and we have more dental crowding. Furthermore, dentists have stated that introduction of bottle-feeding to infants can aggravate dental crowding and malocclusion, which makes everything much worse. All these factors aren’t the only reason for everyone’s sleep problems, but they are problematic if your anatomy is already predisposed.
So what does breathing have to do with sleep quality? There are two components to this issue: When lying flat on your back, your tongue falls back partially, due to gravity. This narrows the breathing passageway behind your tongue to various degrees. As you fall asleep, the deeper level of sleep you enter, the more your muscles relax, and at a certain point, your tongue can fall back and obstruct your breathing. The more narrow your airway (due to smaller jaws or inflammation due to a cold or allergies), the more likely you’ll stop breathing and wake up to turn over. When you were young, you tossed and turned and eventually figured out that you can sleep much better when sleeping on your side or stomach. The problem is that even on your side or stomach, it’s never perfect, and you’re not able to get deep, efficient sleep, no matter how long you sleep.
Sleep Among Athletes
It’s also not too surprising that many personal trainers and fitness professionals have very similar features: Almost invariably they prefer to sleep only on their sides or stomachs. The same can be said about bodybuilders—a personal trainer/natural body builder friend of mine told me that almost every one in her gym snores. Snoring, incidentally, is a very common trait amongst those who have OSA or UARS.
Professional football players also have a much higher incidence of obstructive sleep apnea. About 1/3 of all linemen were found to have mild or moderate sleep apnea. Many people assume that this is due to the abnormally thick necks that many football players have. However, it’s not only the fat in the neck—it’s also the muscle mass that impinges on the soft tissues of the upper airway. So in theory, the more muscle bulk you have in your neck, the more breathing problems you’ll have while sleeping, and therefore more fatigue to cope with. This in turn, makes you work all that much harder than let’s say, someone else who may not be sleep deprived, to get the same level of intensity. It’s hard to say which came first, the sleep breathing problem, or the intense work outs, but once it’s started, it ends up being a self-perpetuating vicious cycle.
Sleeplessness Can Aggravate Injuries
As a long time track and field enthusiast, I know how important it is to eat right and exercise–especially as you get older. Running helped invigorate me after being cloistered for days studying for finals during medical school, and it still helps me maintain my health while balancing the demands of my work and family. Yet, there are times when I’ve let the running take control. This often happens when I’m outpaced by someone in my age group, or when I’m coping with a stressful event. During these times, I’d often train to the point of illness or injury—at which point, I’m temporarily unable to do the one thing that keeps me healthy and sane.
In this way, if you’re an exercise junky, you’re also more prone to having injuries. It’s like that saying: "The higher you climb, the harder you fall." Unfortunately, once injured, it becomes all that much harder to gain the momentum back. What often occurs is common trap for any athlete but much worse if you have UARS or OSA. The sudden lack of activity can cause you to eat more due to increased levels of stress from increased sleep deprivation. As you gain weight, your upper airway narrows even further, leading to worse deep sleep quality. Another scenario that can happen is if you injure your neck or shoulder. This will prevent you from being able to sleep on your side or stomach, which again, aggravates the vicious cycle.
What I just described may seem a little far fetched, but if you are prone to constant fatigue, snore, or have any other chronic health problems like chronic sinusitis, nasal congestion, throat problems, then the sleep breathing paradigm can potentially explain and help you avoid the various health complications you may experience down the road. One way to see where you’re headed is to look at your parents. More often than not, one or both your parents may snore heavily, and in many cases will have one or more of the complications of untreated obstructive sleep apnea: depression, anxiety, diabetes, hypertension, heart disease, heart attack or stroke.
The best way for you to stay healthy and fit is to eat well, exercise, and most importantly, to sleep better.
I participate on a medical forum called Medhelp.org, where I’m the sleep-breathing expert. I answer people’s questions on various topics related to sleep and breathing. Somehow, I stumbled onto the multiple sclerosis (MS) community and was surprised to see that many people have severe fatigue issues, cold hands and various sleep issues. Their symptoms sounded surprisingly like upper airway resistance syndrome, which I’ve described before. So I decided to take a poll: I asked three questions: 1. How many MS patients have cold hands or feet? 2. How many MS patients have one or both parents that snore heavily, and if so, what kind of medical problems do they have? And 3. What’s your favorite sleep position (back, side, or stomach)?
The answers to this informal and unscientific poll was surprisingly lopsided. Out of 36 responses, 31 people said that they had either cold hands or feet. Many had to wear socks before going to bed, but some had to kick them off later. Fifteen out of sixteen stated that a parent (usually their father) snored heavily, and many also had major heart disease. Lastly, 26/30 responded that they prefer to sleep on their sides or stomachs. Many complained of intense fatigue.
This is the exact pattern that I see in patients with upper airway resistance syndrome, where they also have cold hands or feet, has a parent that snores, and wears mittens and socks to bed. Typically one or both parents snore, and have various degrees of heart disease. As many people with UARS slowly gain weight over the years, their cold hands may get better, but they’ll slowly develop into obstructive sleep apnea.
It’s a given that both UARS and MS will have a physiologic stress response, for different reasons. This can lead to various autonomic nervous system dysfunctions, such as cold hands or feet. It’s also known that chronic low-grade physiologic stress can stimulate the immune as well as the nervous system, heightening both these systems, leading to various pain issues or autoimmune conditions. I can’t say if there’s a definite cause and effect relationship between UARS and MS, but one thing for sure is that both have problems staying in deep sleep. The only definitive way to find out is is examine these MS patients with a flexible fiberoptic camera to examine the airway.
Am I going too far with my sleep-breathing hypothesis, or could I be onto something big?
In many cases, taking a good history and asking some pointed questions can solve a medical problem without resorting to medications. For example, I saw a man in his late 30’s who came to see me with 3 days of left ear sound distortion and reverberation with mild fullness. He had no other problems, including hearing loss. His exam was completely normal. Most doctors at this point will give a diagnosis of Eustachian tube dysfunction, where due to mild nasal inflammation, the tube that connects to the ear is partially blocked, leading to pressure changes that can cause ear problems. Many patients will walk out the door with prescription allergy mediations or over-the-counter decongestants.
After going through my standard list of questions addressing what changes or lifestyle issues that he’s been going through, it turns out that his wife delivered their first child 2 weeks ago. Obviously, this can be detrimental to sleep. Upon further probing, he admitted to working later the last few days, coming home late, and eating just before going to bed. He also had some alcohol late at night as well. To top it off, he normally likes to sleep on his left side.
The history alone solved the puzzle: He normally likes to sleep on his side to partially compensate for his tongue falling back during deep sleep (due to muscle relaxation). When he ate late the last few days, every time he stops breathing even temporarily he sucks up small amounts of stomach juices into his throat, and since he’s lying on his left side, it can easily travel to his left Eustachian tube, causing mild swelling and partial blockage. He also noted afterwards that he has post-nasal drip and mild throat clearing, which is consistent with reflux in the throat.
He was advised to eat dinner much earlier and avoid alcohol close to bedtime. This should be a life-long habit. Another great example of using my sleep-breathing paradigm to solve a medical problem without the need to give to medications.
A: Although there are many studies in the psychology fields about personality types and sleep position, you may be surprised by how important sleep position may be for some of you. If you normally like to sleep on your back and are able to sleep well, waking up refreshed in the morning, then continue to do so. If you prefer to sleep on your side or stomach, then keep doing what you’re doing. But if you used to love sleeping on your stomach and now have to sleep on your back due to a neck, shoulder or back injury, then try to do everything possible to go back to your side or stomach again. If your grandmother told you that it’s healthy to sleep on your back, but you love to sleep on your stomach, ignore your grandmother. If your dermatologist tells you to sleep on your back to prevent facial wrinkles, then ignore your dermatologist as well. Sleeping better will be much more to prevent wrinkles and aging than keeping your face off your pillow.
The reason that sleep position is so important is that for many people, due to certain oral cavity features, the tongue falls back somewhat due to gravity. But if your jaw is on the small side, then the tongue falls back even more, and then when you go into deep sleep on your back, due to muscle relaxation, you obstruct and wake up. You can wake up subconsciously to light sleep or completely awake. People with these issues generally compensate well by not sleeping on their backs, but can never get deep refreshing sleep.
I just saw a young man who complains of many months history of right-sided throat pain and swollen glands. Past medical history is significant for anxiety issues. He noted that he usually sleeps on his back. He also mentioned that he’s had a nagging right chest, and shoulder discomfort, which started around the same time as his throat problems. When asked how he slept prior to his problems began, he stated that he normally slept on his sides. He also complains of chronic post-nasal drip, throat clearing, and coughing. He also has a relatively small lower jaw. He eats late and complains of being tired all the time, no matter how long he sleeps.
His exam reveals severe tongue collapse when on his back with swelling and inflammation of the back of his voice box, consistent with a sleep-breathing, throat acid reflux problem aggravated by suddenly sleeping on his back. I recommended sleeping on his left side, not eating late, and practicing relaxing breathing exercises.
About once per week, I see mostly female patients who come in for recurrent sinus or throat problems who also have severe and chronic fatigue. When asked if they sleep on their backs, they’ll say yes. But when I question them further, they’ll tell me that when they were younger, they always slept on their stomachs, with their face on one side of the other. Then I asked about when they began to sleep on their backs, and not too surprisingly, it’s about the same time that they began to feel more tired and started to have various illness such as sinus infections, throat pain, etc.
When asked why they began to sleep on their backs, the most common answer usually is, "my dermatologist said sleeping on my face could aggravate wrinkles" (read the article from the American Academy of Dermatology here). What the dermatologist does not appreciate, however, is that these people MUST sleep on their stomachs so they can breathe well when sleeping at night. The reason for this is that many people (to various degrees) have a tendency for their tongues to fall back slightly when lying on their backs due to gravity. When you add deep sleep, all the muscles begin to relax, and the tongue may collapse completely, which causes a temporary obstruction and arousal. This prevents people from getting deep sleep. This is what I talk about in my book, Sleep, Interrupted.
If you have this condition, you probably realized this subconsciously when much younger and slept on your side or stomach to compensate pretty well. But when you start to sleep on your back, then you can’t compensate very well anymore and you will have multiple micro-obstructions and arousals, preventing you from achieving restorative, deep sleep. So in a sense, this will age you more in the following manner: inefficient sleep causes a low grade stress response, constricting blood vessels to nonessential organs such as your gastrointestinal or reproductive organs, skin and hands or feet. If you don’t get enough blood flow. your skin cannot heal and repair itself properly, this "aging" faster. Plus you also feel tired and lousy.
This situation can also apply to people who are admitted to the hospital after operations or after an accident, but in these situations, the consequences can be much more severe. Others have to sleep on their backs due to an shoulder injury or neck pain, which prevents stomach sided sleeping. Some people ABSOLUTELY cannot sleep on their backs. Something to think about.
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