YOUR HEALTH

Snoring and Sleep Apnea – the Holy Grail

Snoring and its extreme form, sleep apnea, are again hot button items as Time magazine  has another article on the dangers of sleep apnea (June 15, 2015, p.20). Time’s illustration shows the head of a man lying on his back with his mouth wide open and his neck curved upward.  The drawing also shows the man’s windpipe contracted or narrowed due to the position of his head - resulting in snoring and sleep apnea.

Time's information is nothing new and has been well known for at least the 15 years I have been studying the subject. The illustration shows the worst-case position possible for head and neck, and one for which simple repositioning and various devices on the market address -- more or less.

The basics are well known:

• snoring is the rhythmic and repetitive production of a single sound -- like a  musical note -- or pairing sounds when breathing during sleep

• air in the  lungs/breathing system gets distorted  and emerges like a note from a wind instrument such as a flute, trumpet, saxophone or tuba

• 60% of men and 40% of women eventually become snorers as they age

• most snoring  occurs while sleeping  on one's back though snoring on one's side also occurs.

• snorers are NOT aware they are snoring and making repeated, loud noise. In fact they will vigorously deny snoring and accuse the person making the claim of lying, and only video footage or multiple witnesses will be believed (as per my own case).

• As snorers are not deaf, I conclude that the brain has somehow learned to ignore the  person's own ‘signature’  snore and treats it like regular background noise.

• nudging a snorer or telling him/her to turn over works temporarily as it breaks the subconscious snoring cycle.

• people can snore when asleep sitting up but are far more likely  to snore when lying down.

• people do NOT snore when walking, running or are otherwise involved in conscious activity.  It is limited to the semi-conscious state of sleep -- when mental control of body functions is reduced.

Using the wind instrument analogy, medical scientists have long identified three factors: 

1. sagging upper mouth palate.  This is rarer, but over time, the muscles of the upper mouth can   weaken and sag and allow for reed-like sound vibration. Biteplates and even surgery -- like a facelift -- are available.

2. Poor Head position.

    This is the major cause of snoring and is the result of the Law of Gravity.

     a. tongue windpipe constriction. The air passage behind the tongue gets narrowed when lying down -- especially on one's back – due to the Law of Gravity.  Our tongues fall forward when we sit or stand -- due to gravity --  or are  kept forward by throat muscles when we are conscious and working under a car or sink. But our tongues fall back when sleeping on our backs or droop downward if we are on our side: causing the windpipe to narrow and/or twist.  

Simple Solutions: 1. when on one’s back, keep the entire head elevated above the                                          shoulders.                         

                                2. when sleeping on one’s side, keep the head horizontal.  (Yes,  side-                                             sleeping with the face turned down would work but it leads to a                                                             stiff neck in the morning from being twisted.)

     b. sleeping with mouth open.  Dropping the jaw alters the air flow pattern and helps constrict the windpipe behind the tongue. It creates a distinctive snore just as a tuba produces a much different note than a flute or trumpet. Mouth pieces and chin straps have been invented to address this factor. But keeping the head elevated when on one’s back or having the cheek and jaw properly cushioned when on one’s side also work – just as they do for tongue issues!

****  For sleep apnea -- which usually involves both open mouth and tongue related constriction -- proper elevated head position is essential, and there are a variety of breathing devices and extra oxygen pump-machines on the market.  

So,  if poor head position is the real and common cause, then using the ‘wrong pillow’ is the central problem.

Put simply, the pillow one uses determines and locks in place the position of the head, tongue and jaw.

Normal pillows, whether firm (foam), soft (foam) or super soft (i.e. feathered) do not usually work for snorers and sleep apnea.

And neither do many of the specialty pillows on the market which promise a ‘better’, ‘more restful’  night’s sleep and ‘reduced neck and back pain’ in the morning, but rarely claim to help with snoring.

 Moreover, to date, no single pillow design fits both proper side and proper back sleeping as they require radically different head support positions (see more below), and people's body frames and weight/bulk also affect how the head angles against a pillow.

The Holy Grail: better and best pillow designs:

• P shaped pillows currently being sold are often fine for side-only sleeping: so long as the pillow is raised or lowered as-a-whole so that the head is not forced to angle up or drop down below the horizontal.   Some have two raised ends to accommodate different heights – which is fine.
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Unfortunately, most people have faces that narrow from the ear forward so the pillow needs e3xtra support for the cheek.  P and Double-P pillows have no such special raised sides.   Thin and small frames people can get away with this but not larger headed individuals.

• Back sleepers only need two ordinary pillows angled to form a hill slope and adjusted to the individual’s shoulder frame and spine comfort. 

 

BUT, for those of us who roll at night and sleep both ways, no pillow on the market does both jobs.

Over 15 years ago, I started on the mission of creating a dual-function pillow – the Holy Grail of snorere pillows - and have a prototype I use today. I call it the Silent Sleeper.

The dynamics of the ideal -- yet to be marketed – dual-function pillow is actually quite simple:

1. the neck must be gently cushioned if contacted at all. Only the jaw and cranium – i.e., solid bone,  when on the side, and cranium alone when sleeping on one's back are to make solid contact and bear the pressure.

 2. the head and neck and spine -- which form one continuous, interlinked chain --  must be allowed  to stay in a relaxed and natural line without any sideways stress on the vertebrae.

When sleeping on one’s side, all three parts must line up horizontally, i.e., the spine and neck bones are to line up with an imaginary line running dead centre through the skull   (as correctly displayed in tempura mattress ads.)   Legs strait or fetal position makes no difference though fetal does help relax vertebrae lengthwise as well.  

For back sleeping, the head must be fully elevated and neck and full spine -- including the small of the back - aligned into one continuous gentle C curve.   (This is where all specialty pillows falter as they recreate the undesirable head position of the Time magazine warning.)

A raised slope of 4 OVER 10 (or 40 degrees) works well for me with my bulky, curved, football lineman's shoulders.

The secrets of building such a dual-function pillow --  which I share with you gratis --  are as follows:

1. top surface (at least 3 cm)  must be soft and allow the head to cradle cozily. Quilted fabric works well as does polyester batting.  I use both.

2. under this top use a standard pillow-size piece of sofa chair foam 4 inches thick (which comes  in different levels from  firm to soft if you get the material  from an upholsterer). It needs to be cut out to have a  (sideways) oblong, sunken mid-section so when sleeping on one’s side the head rests in the dead middle -- like a baseball in an old fashioned catcher’s mitt.

 

The side curves (right and left) should be relatively low and designed to support a cheek (right or left) while keeping the head horizontal.  

            Note: these raised sides are needed because most people’s faces get narrower                         and narrower in front of the ear to the nose and are far wider behind the ear.      So this sloping side curve is needed to support  the cheek and jaw and keeps the             head in a horizontal plane. 

The top and bottom should be rounded edges with one side bulkier and the other less so like the Double P pillows. The two different heights allow a larger framed person -- such as me -- to sleep on the higher curve supporting my jaw or - when sleeping on my back - my upper cranium.  The lower side does the same for people with less bulky shoulders. 

             

3. The bottom of the foam is also curved so the pillow can rock somewhat back and forth - but not side to side: to allow for automatic fine-tuning adjustments.

Silent Sleeper head location

When sleeping on one’s side, the oblong, dead centre of the pillow is used. 

When switching to one’s back, there is a need to slightly slide down: so the bottom curved edge fully elevates the cranium (as illustrated above with the RED slope.)

Bottom Line

• Never, ever sleep on your back without your cranium raised high. 
• When lying on your side, whether you use a regular or specialty pillow, check that your spine-neck-head axis is horizontal by using a mirror, camera or a friend. 
• As your pillow only comes in contact with some 15% of your body, the mattress also needs to be considered.  All mattresses are designed to adjust to your body’s curves and weight distribution; but any given mattress may be ‘overly soft’ or ‘overly firm’ for your individual body. Also, wear over time may mean the mattress does not ‘fit’ you properly.
• Finally, try your own hand, as I did with my Silent Sleeper.

My snoring has been greatly reduced if not fully eliminated – as I do fidget and twist around at times when sleeping.  I also feel more rested in the morning and no longer wake up to a stiff neck and/or painful back.

So think about the facts and options mentioned above.

Remember, people spend close to 1/3 of their lifetime sleeping, so do it right:  for your own sake and for that of your bedmate or roommate.