Breathe properly at night and learn to sleep better

Every time you see a depiction of someone sleeping on TV or in the movies, you’ll see the person sleeping on his or her back, and oftentimes, snoring.

The lay public, doctors, and even alternative and complementary practitioners naturally assume that you’re able to breathe properly at night. This couldn’t be further from the truth.

Evolutionary biologists and comparative anatomists have stated that speech and language development was ultimately detrimental to humans. The voice box, by descending underneath the tongue, unprotected the airway. The human upper airway serves three functions: breathing, speech, and swallowing. Overdevelopment of speech can be detrimental to breathing and swallowing.

There are clearly significant benefits to complex speech and language development, but the downside is that humans have so many breathing and swallowing problems that most other animals don’t have. In fact, only humans regularly choke and die.

We compensated for this situation until about a century ago when we began to eat more processed, soft foods. Dr. Weston Price, in his nutritional classic, Nutrition and Physical Degeneration, described significant dental crowding and narrowed jaws when indigenous cultures moved away from eating naturally off the land, mountains or oceans, to highly processed foods and refined sugars. This phenomenon occurred across all cultures in all continents.

As a result of dental crowding, the tongue takes up relatively too much space. Many modern humans literally can’t sleep on their backs, since due to gravity, the tongue and voice box can obstruct breathing, especially when in deeper levels of sleep when muscle relaxation occurs. Most people with this anatomy naturally prefer to sleep on their sides or stomachs. The problem is that even if you sleep on your side, obstructions and arousals can still occur.

Because of our upper airway anatomy, by definition, all humans stop breathing once in a while. For example, if you’re completely “normal” and you suffer from a head cold with a stuffy nose, you’ll probably toss and turn at night. One major reason for poor sleep is because you’ll stop breathing more often. A congested nose creates vacuum forces downstream in the throat that causes your tongue to fall back more often. This process is confirmed by the fact that in a study, sleep apnea was documented though sleep studies when healthy college students had their noses plugged.

If you stop breathing at night, even for a few seconds, a vacuum effect is created, which suctions up your normal stomach juices into your throat. This can cause the all-too-common symptoms of laryngopharyngeal reflux disease, with associated throat pain, throat clearing, post-nasal drip, chronic cough, hoarseness, difficulty swallowing, tightness, lump sensation, or burning. In most cases you won’t feel any stomach discomfort whatsoever.

It’s also been shown that H. pylori and even pepsin can be found in middle ear, sinus and lung fluid washings. Notice that many “colds” usually begin with a scratchy, sore throat and then it travels up into the nose, or down into the lungs. This can aggravate or cause the classic bronchitis, ear and sinus “infections” that’s too commonly treated with oral antibiotics.

All humans have some degree of partial to total obstruction and arousals while sleeping. Only the the end extreme of this spectrum is called obstructive sleep apnea. Even if you don’t officially have obstructive sleep apnea, you can still have breathing problems during sleep that can be exacerbated by any form of temporary inflammation (colds, allergies, reflux), or weight gain due to anatomic narrowing.

Chronic upper respiratory symptoms that linger after a simple cold can be explained by this sleep-breathing paradigm. If you suffer from recurrent or lingering colds, can’t sleep on your back, and feel tired, no matter how long you sleep, perhaps it’s your inability to breathe properly at night that could be contributing to your problem.

Steven Y. Park is Clinical Assistant Professor of Otolaryngology at the New York Eye & Ear Infirmary, and author of the book, Sleep, Interrupted: A Physician Reveals The #1 Reason Why So Many Of Us Are Sick And Tired.

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  • Vernon Rowe

    This is a fine article.

    As neurologists and sleep medicine doctors, we’ve also found that sleep disorders are strongly associated with cervical radiculopathy, or pinched nerve roots as they exit from the cervical spine. This can lead to headaches, neck pain, and weakness or numbness of an arm or leg. We presented some of this research at the APSS sleep meetings in San Antonio.

    While side or prone sleeping, as Dr. Park says, is the only way some of us can sleep, these positions do not appear to be good for the musculoskeletal system.

    • Steven Park, MD

      You’re right—it’s a catch-22. Sleeping laterally or prone, wile better for breathing, is not ideal for the musculoskeletal system. While many people seem to do well sleeping in these positions, others go on to develop the various conditions that you mentioned.

  • ninguem

    What do you think of the devices that provide some forward advancement of the mandible. Either a custom-made device from a dentist, or some of the devices sold over commercials, “Pure Sleep”, etc.?

    • Steven Park, MD

      Mandibular advancement devices are a good way of addressing these issues in many cases. By advancing the lower jaw forward, the tongue gets pulled forward, thereby opening up the posterior airway space. Ideally, custom-made devices by dentists are most effective, but even the simple over-the-counter boil-and bite devices can be effective sometimes. There are various issues with these devices and that’s why it’s important to have an experienced, qualified dentist that fabricate and titrate the oral appliance.

      Rather than arguing over which is better (CPAP vs. oral appliances), when possible, go ahead and try both to see which one you like better. People respond differently to these devices, no matter how ideal the patient (as with CPAP). This is also why a good upper airway exam is important to see if you’re a candidate.

  • MMMD

    So…. how exactly are we supposed to “Breathe properly at night and learn to sleep better”? Problem described; solution… not so much.

  • JEB Johnson, MD

    Help us to sleep better! What do you suggest?

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