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Head position while sleeping


Posted by Thomas in Alabama on July 06, 1999 at 06:42:58:

I have a couple of questions about head position while sleeping and its affect on OSA, as well as a couple of other questions. I will ask the head position questions first, and then give some background and ask additional questions:

My questions have to do with whether the chin is tilted "up" (away from the chest; toward the ceiling if you are on your back), or "down" (chin against the chest).

1) While on your back, could keeping your chin tilted up alleviate OSA? This puts your head and neck in the position recommended to ensure an open airway for rescue breathing, as all of the Red Cross books show. I have found it possible to maintain this position with one of those inflatable 99 cent "travel pillows" which are horseshoe shaped and go behind the neck and curve around to the front of the shoulders as a head rest to keep your head from flopping to the side. I have severe OSA while on my back, and this head position does not seem to help me, but I thought that I would mention it as an introduction to the next question, and also in case it might help others.

2) While on my side, it seems that keeping my head in the above position does relieve my restricted breathing. I have tucked my regular pillow under my neck in such a way that it kept me in this position while I fell asleep. However, I didn't stay in the proper position for long after falling asleep.

a) Has anyone experienced this "head position" effect, and/or made use of it to alleviate apnea?
b) Does anyone have any suggestions for keeping ones head in the required position while sleeping on ones side?
c) Would sleeping in such a position be bad for ones neck? Particularly for me, since I seem to get my neck "stuck" in this upward looking position, with it making a painful "pop" when I look down again.
Some type of "head positioner" or pillow would certainly be preferable to a CPAP. I would hate to think that it would work but that my neck problems would keep me from using it. I have not seen this issue addressed before. any comments?

Now for some background:

I have just been diagnosed with OSA, and am awaiting a second polysomnography for the purpose of CPAP titration. Before my first polysomnography, I was certain that I had apnea because I am quite aware when each apnea episode occurs. I am a VERY light sleeper, and when I am on my back, I stop breathing completely the instant that I fall asleep, and often before I am completely asleep (this was confirmed by my polysomnography), and then awake gasping. I don't believe that I sleep on my back often, so this is probably not a problem except when I need to sleep as a passenger in a motor vehicle or an airplane.

When I am on my side, however, the apnea is not completely obstructive, but breathing takes more effort. I am quite aware of this effect as I begin to fall asleep, and it seems as if while I can exert the required effort if I am conscious, I don't exert it while asleep or starting to fall asleep. The result is that I don't feel like I am trying to breathe against an obstruction, but I feel more like I have just stopped trying to breathe. The effect is such that I even suspected central apnea for a while. The polysomnography confirmed that these episodes were associated with increased respiratory effort, and htat they DISTURBED MY SLEEP, though my oxygen saturation stayed as high as while awake.

I have occasional periods of insomnia, and am ALWAYS kept awake or awaken by the slightest sound or discomfort; white noise sources (fans, etc.)also keep me awake and awaken me. As a result, as I feared, I could not sleep the night of my sleep study. I slept a total of 3 hours, and that sleep was very light and fragmented. This was my observation as well as that of the technician/instrumentation. I felt that my apnea was not nearly as bad this night as it is most nights. My pulmonoligist said, however, that the number of apnea and hypopnea episodes were just above the cutoff for my insurance provider to pay for treatment, so I guess that it doesn't matter whether or not my doctor believes that my condition is a serious as I believe it to be. He classified my apnea as "mild" (when on my side), but confirmed that because it disturbed my sleep, it could be having more than a mild effect on the quality of my sleep.

My pulmonoligist said that since my apnea was "mild", and appeared to be mainly due to a very large uvula, that my ENT might have a very minor "office surgical procedure" that might be helpful to me. I have an appointment with my ENT to see what he has to say, but I am very skeptical about the success rate of surgical procedures, even major surgery. Of course, if the proposed procedure is truly "minor", it might be worth a try. We will see what the ENT proposes.

My apnea is greatly affecting my alertness during the day, as well as my ability to get up in the morning.

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