Sleep Hygiene September || Take 2 Tips: Position yourself.

AUG 2 || POSITIVE MED
Fix Your Health Issues With Proper Sleeping Positions“Certain sleeping positions can treat or even resolve harmful health conditions."

AUG 21 || HER
This is best position to sleep in when you have your period
"I think all women will agree that getting to sleep when you have your period can be a lot more difficult than normal nights."

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||  TAKE 2 TIPS & FEEL BETTER IN THE MORNING  ||

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SLEEP HYGIENE TIP OF THE WEEK: Using CPAP with a head cold

When the cold and flu season hits, the inconvenience of dealing with viral symptoms can be magnified if you're also using a PAP device (CPAP, BiPAP, APAP). Some people think it is better not to use your PAP therapy at this time, but the truth is, you still need it, even if you experience more discomfort while asleep. Your body will get through a respiratory illness more quickly if you continue your therapy because it will have more sleep (even if it doesn't consciously feel like it).

Here are some tips to stay the course through those nights when sore throats, runny noses, congested sinuses and coughs crop up this winter.

1. Adjust your sleeping position. A runny nose or congestion can make breathing very comfortable while you sleep. Try sleeping on your side, which will use gravity to drain your sinuses (one side at a time). If you have a reclining chair, that might also be helpful for the same reason. You don't want phlegm collecting in the back of your throat, which will just worsen matters. Avoid sleeping on your back or completely flat; even elevating the head of your bed by 3 inches can make a big difference.
   
2. Make sure you use your humidifier. The warm moist air will really help your passages remain pliable and comfortable through the course of a virus.
   
   If you don't know how to use your humidifier, ask the CPAP specialist who initially set you up with your current machine. Some people normally don't use the humidifier, but may turn it on just for head colds or allergies.
   
   If you have an older machine, it may not have a humidifier, or if it has a humidifier, it may not have a heated setting. If you get a lot of respiratory illnesses during the winter, you should ask your doctor about updating your machine to one with a heated humidifier.
   
3. Try using nasal sprays. These can be a quick, easy and affordable solution. Look for sprays which are designed for decongestion. Even a simple saline nasal spray (or gel) can help relieve stuffiness. If you have allergies, opt for a spray with an antihistamine in it, if you don't already have one.
   
   Avoid any over-the-counter spray which causes sedation; this can worsen your apnea. Unsure which spray is best for you? Ask your pharmacist.
   
4. Similarly, consider menthol. Menthol can help to clear blocked nasal passages pretty swiftly.
   
   You won't want to suck on menthol drops while trying to sleep, as that is an obvious choking hazard, but you could have a drop right before bed to help open up your airways.
   
   Also, 15 minutes before bed, try rubbing a little menthol ointment on your chest and let the vapors rise and help decongest your airways before applying your mask.
   
   Sometimes the challenge is just getting to sleep; once asleep, the humidity from PAP therapy can often take over and keep everything clear.
   
   Please do not add menthol products to your PAP humidity reservoir without first checking with your mask and PAP machine user's manuals to ensure you can safely do so; if so, they will also advise on which kinds of menthol products and how much to use.
   
5. Try cleansing your sinuses with a neti pot. These are little bulb- or teapot-shaped vessels that help you to flush your nasal passages out. They can be found in most drugstores and are often an effective pre-sleep solution for anyone with a problem with congestion.
   
6. Switch to a different style mask. There are many patients who have more than one mask. They use their nasal or pillow mask for normal use but switch to a full-face mask if they find they are breathing through the mouth, as full-face masks cover both mouth and nose and allow for oral breathing. Pillow masks are sometimes difficult to wear if the nose it sore and swollen; a nasal mask might be a good alternative if you aren't mouth breathing. However, having a head cold leads to mouth breathing even in those who don't normally do so; it might be worth it to look into having a spare full-face mask on hand for this reason.
   
7. If you use CPAP, consider APAP. This is a more expensive solution but if you suffer from seasonal allergies or viruses on a regular basis, the "smart technology" in an AutoPAP (or APAP) might help you breathe better when congestion is a regular problem. The APAP delivery system senses your need for more or less pressure and automatically adjusts, unlike the CPAP which, as its names suggests, only delivers one continuous pressure. Discuss this option with your physician; you will need a prescription in order to acquire one of these.

Here's what a simple neti pot looks like; there are also
more extravagant ones, but a simple over-the-counter
product can be just as effective.

Finally, keep everything clean! You should be vigilant about cleaning your PAP tubing and mask anyway, but if not, NOW is the time to change that bad habit to make it a regular part of your daily routine. Learn some basics here.
Keeping your tubing, masks and accessories clean and sterile is necessary to prevent the growth of bacteria inside your equipment, which can actually make you even sicker (or cause illness when you aren't sick).

Follow manufacturer's instructions for cleaning your PAP-related items or, if you know you are just not going to follow through on a daily regimen, look into one of the new PAP cleaning kits now available which sanitize all of your items with the push of a button.

ABCs of Sleep || Gastroesophageal Reflux Disease (GERD)

Gastroesophageal Reflux Disease (GERD) is a condition in which acid rises from the stomach and breaches the valve separating the bottom of the esophagus from the top of the stomach. This valve, also known as a sphincter, is meant to keep stomach acid out. If it comes into contact with the stomach acid on a regular basis, it can become damaged and no longer prevent the "reflux" of stomach acid from rising back into the esophagus and even into the trachea and other parts of the upper airway. 

The highly corrosive nature of stomach acid means it will wreak havoc on other parts of the body outside the stomach as they are not lined with the heavy mucosal barrier like the stomach. If allowed to enter the airways, stomach acid reflux can lead to, trigger or aggravate respiratory disorders like chronic cough, wheezing and asthma. 

Other common complaints of GERD include chest pain; problems with the ears, nose and throat, such as postnasal drip, vocal cord damage, upper airway resistance and congestion; and inflammatory diseases like bronchitis and pneumonia, in which particles of stomach acid are accidentally aspirated (inhaled) into the lungs. 

Researchers are also looking into relationships between GERD and obesity as well as obstructive sleep apnea (OSA) as each of these conditions relates to physiologically challenged upper airways.

GERD can happen at any time of day and to nearly anyone at any age and of any size. But at nighttime, it can be especially troublesome. People laying completely flat (and especially while supine) are most susceptible to the creeping up of stomach acid. 

This can make bedtime frustrating because GERD leads to frequent awakening, requiring its sufferers to rise out of bed, take an antacid, and even sit in a chair in order to fall asleep again, as the gravity of a vertical position can help pull the acid back into the stomach where it belongs. 

However, sleeping is hardly easy or comfortable to achieve in an upright position. GERD may be a key reason why many older people sleep in reclining chairs, as they have the flexibility of raising and lowering the back of the chair to suit their issues with GERD. 

There are several things a person with GERD can do to help prevent their condition from interrupting with their nightly sleep. 


Elevate the head of the bed by 3 inches. This increases the angle of the bed enough to help use gravity to one's advantage without being too noticeable for people sleeping in bed. Individuals might consider sleeping in a reclining chair or using a wedge pillow that helps them sleep more upright. 

Quit smoking. Smoking exacerbates any issues with asthma or other pulmonary conditions that could develop as a result of GERD.

Dietary changes. Eating a low-fat diet, avoiding high acid foods, eating lighter meals at dinner and eating at least two hours before bedtime can help alleviate GERD and improve sleep quality.

Avoid alcohol. Alcohol relaxes the body's muscles, which increases the chance that the sphincter which serves to keep stomach acid out of the esophagus will lose its ability to seal. 

Sleep on your left side. This sleeping position is most likely to support the closure of the sphincter between the esophagus and the stomach; sleeping on the right side is more likely to break that important seal.

Treat GERD. There are a number of approaches to managing reflux disease; some are over-the-counter, while others are more aggressive prescription approaches that should be monitored by a healthcare professional.

JUST BREATHE: What happens if I don't want or like PAP therapy? You have options

It's no secret that some people don't like PAP therapy (nor is it a secret that some people swear by it). Therapies that require the use of devices can be challenging for some people and even with their best efforts, they may not  be able to use them effectively.

Below is a list of options for those who have tried and failed at PAP therapy for whatever reason. It is not the purpose of this website to favor one therapy or another, or to compare and contrast, but rather to illustrate the variety of options that patients with sleep-disordered breathing may have.As always, your diagnoses and treatments are best discussed with your sleep physician, as this website cannot diagnose your problem or prescribe or advise as to which options are best for you. Whether you qualify for any of these treatments is going to be a decision you make with your physician. 

• Oral devices. Read here for a more detailed discussion about sleep dentistry and how it might help you. 
• Expiratory positive airway pressure. This is a kind of nostril patch device that works by blowing against the patches during exhale, which may improve the "patency" or rigidity of the upper airway tissue and provide, for some, a kind of "tracheal traction" to create greater ease in inhalation. 
• Oral pressure therapy. This works by using a small oral suction tube to draw the soft palate forward, which may stabilize the tongue and keep it from blocking the airway during sleep.
• Pillar procedure. This is a minimally invasive surgical procedure in which tiny implants are inserted into the soft palate. Their presence may reduce tissue vibration which can lead to snoring, sleep apnea and upper airway resistance syndrome. 
• Somnoplasty. This is a minimally invasive surgical procedure using radio frequency (RF) energy to sculpt upper airway tissue under local anesthesia; this may effectively open the airway.
• Upper airway neurostimulation. The Inspire is a small device implanted into the chest to deliver to deliver carefully timed mild stimulation to the airway during sleep. This controlled neurostimulation may achieve "patency" or firmness of the tissues in order to prevent their collapse. 
• Uvulopalatopharyngoplasty (UPPP). This surgical procedure removes excess tissue in the throat, soft palate, uvula, tongue, tonsils, and/or parts of the pharynx to create more space in the upper airway; this may prevent collapse airway collapse during sleep.
• Adenoidectomy. Removal of the adenoids (tonsils) make help make space in an otherwise crowded airway.
• Numerous other surgeries used to correct obstructive sleep apnea have been outlined clearly at this page hosted by the American Sleep Apnea Association.

Certain lifestyle changes or habits may not "cure" your sleep apnea, but they can certainly give you some relief. These include: 

• Positional therapy. Read here for a more detailed discussion about how just changing your sleep position can help those who snore or have mild apnea.
• Weight loss. Losing a few pounds, even just ten, can help shrink fat cells. Smaller fat cells retain less water and place less pressure on the tissues of the upper airway during sleep. This may reduce, if not completely eliminate, obstructive breathing patterns. Remember, even if you don't have noticeable fat pads in your neck, you may carry extra water weight in your feet during the day; when you lie down, the fluid recirculates and plumps up fat throughout the body, including in the neck area. 
• Gastric bypass or other surgical weight loss procedures. For those who are morbidly obese, these options may also help prevent obstructions secondarily, but these patients may need to have a sleep study prior to surgery to identify any preexisting sleep apnea so that the pre-surgical team can prepare proper anesthesia and respiratory therapies prior to the operation. 
• Smoking cessation. Smoking (of tobacco or any other substance) may inflame the upper airway and, in the case of tobacco, create a "rebound effect" in the upper away during the night because of short-term nicotine withdrawal. Smoking may also lead to Chronic Obstructive Pulmonary Disease, a chronic and irreversible respiratory disorder which can severely impact one's ability to breathe, especially at night while asleep.
• Daily aerobic exercise. Daily aerobic exercise may help to improve the tone of the tissues in the upper airway and may lead to weight loss and the shrinkage of fat cells which are partly to blame for obstructions of breathing at night.
• Change pillows or reduce the number of pillows used. If your pillow seems to be pushing your chin forward, it may be contributing to the mechanical obstruction of the airway. Find a pillow that allows your head to lie flat while still supporting your neck. Also, propping one's head up with multiple pillows may do the same thing. If you struggle to sleep with your head flat, it could be that you have a severe obstructive respiratory condition, and you should discuss this with your physician. 
• Play the didgeridoo. Seriously. There's some evidence that playing some form of wind instrument may help improve airway tone and build a skill called "circular breathing" which allows for better gas exchange. 

For more information about alternative therapies for sleep apnea which don't involve using PAP, click here. 

JUST BREATHE: The easy, obvious way to deal with snoring and mild sleep apnea is to...

...sleep on your side.

Seems like common sense, right? People who sleep on their back and snore or have apneic episodes will quiet down immediately when they turn to their sides. 

In fact, people with the most severe sleep apnea rarely, if ever, sleep on their back (unless side sleeping gives them pain) because it's nearly impossible for them to get adequate oxygen while they sleep supine. Even when they aren't consciously thinking of it, their brains are taking over during bedtime, signaling the body to sleep laterally (right or left side) in order to open that airway just a wee bit more so the flow of oxygen in and CO2 out can continue unobstructed. 

Unfortunately, those with severe sleep apnea cannot get away with simply sleeping on their side; they will generally require a therapeutic device like a PAP machine to help them keep the upper airway open enough to allow for quality airflow. 

But for those who solely snore or who have mild sleep apnea (as determined by an overnight polysomnogram--mild, moderate and severe are terms that are assigned based on specific objective measurement protocols, not educated guesses), a simple, effective solution may, in fact, be to sleep on the side. 

According to the American Sleep Apnea Association, "Such people can eliminate or reduce airway blockage simply by learning to sleep on their side."

How can one achieve this when they are sleeping? After all, they aren't making conscious choices or decisions at this time. 

The simplest way to achieve this is to place a tennis ball in a sock, then pin the sock to the back of your sleep shirt. Who could sleep on their back with this annoyance in place? It works! 

If you want to get fancy, you can also buy a pajama top that is custom-built to "discourage supine sleeping," which is generally a sleep shirt with a tennis ball sewn into the back or tucked into a special pocket in the back. 

Alternatives: Therapies for Sleep Apnea that don't involve a mask

One of the concerns that some patients have when they consider that they might suffer from sleep apnea is whether they will have to use a CPAP machine and mask as therapy.

CPAP (Continuous Positive Airway Pressure) therapy is considered the gold standard for treatment of obstructive sleep apnea; until the 1980s, we didn't even have CPAP as an option, and the only way to treat sleep apnea was to perform a tracheostomy (by cutting a hole through the tissue in the throat to open up the airway). Therapy for obstructive sleep apnea, and especially CPAP, has come a long way for those who suffer from severe sleep breathing disorders. Machines are smaller and quiet and masks are smaller with more comfortable headgear and a better fit.

Still, some people may try CPAP treatment but find they cannot tolerate it. Others may have a milder form of sleep apnea and may possibly do just as well by undertaking an alternative treatment. There are other options, after all. Some of them are more invasive, or more controversial, or more useful to certain patients over others. They all have risks and costs to consider as well, and the rate of effectiveness for each alternative varies widely and depends upon a multitude of variables.

It is not the purpose of this website to favor one therapy or another, or to compare and contrast, but rather to illustrate the variety of options that patients with sleep-disordered breathing may have.

As always, your diagnoses and treatments are best discussed with your sleep physician, as this website cannot diagnose your problem or prescribe or advise as to which options are best for you. But if you are thinking you might qualify for a CPAP alternative or are willing to try other approaches, read on.

ALTERNATIVE DEVICES

• Oral devices.
  These are various kinds of dental devices which are molded to your unique jawline; they may help to realign the jaw overnight so that your airway can be opened while you sleep. These are not the over-the-counter mouthpieces; you must be fitted for one through a dentist with sleep dentistry credentials. Insurance is now starting to cover these devices and labs now have technologists who can help patients titrate them for optimal treatment.
• Expiratory positive airway pressure.
  This is a kind of nostril patch device that works by blowing against the patches during exhale, which may improve the "patency" or rigidity of the upper airway tissue and provide, for some, a kind of "tracheal traction" to create greater ease in inhalation.
• Oral pressure therapy.
  This works by using a small oral suction tube to draw the soft palate forward, which may stabilize the tongue and keep it from blocking the airway during sleep.

SURGICAL PROCEDURES

• Pillar procedure.
  This is a minimally invasive surgical procedure in which tiny implants are inserted into the soft palate. Their presence may reduce tissue vibration which can lead to snoring, sleep apnea and upper airway resistance syndrome.
• Somnoplasty.
  This is a minimally invasive surgical procedure using radio frequency (RF) energy to sculpt upper airway tissue under local anesthesia; this may effectively open the airway.
• Upper airway stimulation.

  

  © UMM/Inspire Medical Systems Inc

  This is a small device implanted into the chest to deliver to deliver carefully timed mild stimulation to the airway during sleep. This controlled neurostimulation may achieve "patency" or firmness of the tissues in order to prevent their collapse.
• Uvulopalatopharyngoplasty (UPPP).
  This surgical procedure removes excess tissue in the throat, soft palate, uvula, tongue, tonsils, and/or parts of the pharynx to create more space in the upper airway; this may prevent collapse airway collapse during sleep.
• Adenoidectomy.
  Removal of the adenoids (tonsils) make help make space in an otherwise crowded airway.
• Numerous other surgeries used to correct obstructive sleep apnea have been outlined clearly at this page hosted by the American Sleep Apnea Association.

Image courtesy NightBalance

LIFESTYLE CHANGES

• Positional therapy.
  This is admittedly "old school," but training yourself to sleep on your left or right side and avoiding sleep on the back or belly may help keep the airway open and reduce airway collapse leading to sleep apnea. Some patients sew tennis balls into the fronts or backs of their nightshirts to prevent them from rolling onto either of these sides.
• Weight loss.
  Losing a few pounds, even just ten, can help shrink fat cells. Smaller fat cells retain less water and place less pressure on the tissues of the upper airway during sleep. This may reduce, if not completely eliminate, obstructive breathing patterns. Remember, even if you don't have noticeable fat pads in your neck, you may carry extra water weight in your feet during the day; when you lie down, the fluid recirculates and plumps up fat throughout the body, including in the neck area.
  
  For those who are morbidly obese, gastric bypass and other surgical weight loss procedures may also help prevent obstructions secondarily, but these patients may need to have a sleep study prior to surgery to identify any preexisting sleep apnea so that the pre-surgical team can prepare proper anesthesia and respiratory therapies prior to the operation.
• Quit smoking.Smoking (of tobacco or any other substance) may inflame the upper airway and, in the case of tobacco, create a "rebound effect" in the upper away during the night because of short-term nicotine withdrawal. Smoking may also lead to Chronic Obstructive Pulmonary Disease, a chronic and irreversible respiratory disorder which can severely impact one's ability to breathe, especially at night while asleep.
• Daily aerobic exercise.
  Daily aerobic exercise may help to improve the tone of the tissues in the upper airway and may lead to weight loss and the shrinkage of fat cells which are partly to blame for obstructions of breathing at night.
• Change pillows or reduce the number of pillows used.
  If your pillow seems to be pushing your chin forward, it may be contributing to the mechanical obstruction of the airway. Find a pillow that allows your head to lie flat while still supporting your neck. Also, propping one's head up with multiple pillows may do the same thing. If you struggle to sleep with your head flat, it could be that you have a severe obstructive respiratory condition, and you should discuss this with your physician.
• Play the didgeridoo.

  

  "Didgeridoo - U. Dist Street Fair 1993 - 1"
  by Joe Mabel. CC BY-SA 3.0 

  
  Seriously. There's some evidence that playing some form of wind instrument may help improve airway tone and build a skill called "circular breathing" which allows for better gas exchange. Read more.

Things that likely don't work.

• Oxygen therapy.
  This definitely can't work for someone who's airway is collapsing as they sleep. An oxygen tank and cannula delivers oxygen, but it is not pressurized to the level necessary to open up the airway. PAP stands for "positive airway pressure," and it is this air pressure itself, not merely the presence O2, which makes the therapy useful.
• Nasal strips.
  Some people swear by these but theoretically they are only useful for nasal congestion. Problems with upper airway are not limited to the sinuses and nasal passages, but extend into the mouth, the larynx and parts of the upper pharynx, which is where obstruction takes place.
• Snore pillows.
  If these work, it is because they force you to practice positional therapy (see Lifestyle Changes, above), not because of the particular contour of the pillow. They are expensive and not largely proven to be any more effective than just choosing to sleep on your side.
• Sleep apps for your smartphone.
  There is no way you can treat sleep apnea, snoring or upper airway resistance using a phone app. All of these are mechanical issues of the airway that require some kind of physical application of external, manipulative or surgical therapy. It's not even clear whether any of the smartphone apps sold to help you identify sleep problems are even useful for predicting any kind of sleep quality. They do not tap your brainwaves like an electroencephalogram (EEG) does, so you can't be sure they are truly measuring any kind of sleep, much less specific stages; also, these apps cannot measure drops in nocturnal oxygen saturation or capture pertinent muscle movement. The one way you can use your phone is as a device for video and/or audio recording, of yourself or others while asleep, in order to demonstrate the potential presence of apnea or heavy snoring in action, but that is about it.
• Drugs.
  Nope, there's not a pill for sleep breathing disorders, which are mechanical issues of the upper airway and, therefore, not treatable by medication. In fact, many drugs (over the counter, prescription and illicit) can depress the upper airway or worsen underlying apnea, snoring or upper airway resistance. Right now there's research into medications for these issues, but that is about it.

Finally, here's a great article from Sleep Review that analyzes various alternatives to CPAP.



A friendly reminder that links to websites offering products does not imply endorsement by SleepyHeadCENTRAL.com.

SleepyHeadCENTRAL strongly encourages people with ongoing sleep health problems to approach a medical professional to determine appropriate differential diagnoses and treatment. This post, like all other posts on SHC, is not intended to substitute for medical advice.