Respiratory patients can often play an important role in alleviating their symptoms through a few simple steps. Encouraging patients to make worthwhile changes in small steps is an effective way to achieve overall success. Since the average person spends about one third of the day sleeping, the bedroom is a good place to start implementing healthy solutions for better respiratory health.

The Ergonomics of Sleep

Improving posture during sleep not only helps respiratory patients feel more well rested, but also has beneficial effects that last throughout the day. While recommendations might vary, depending on the respiratory issue, the desired outcome of maximizing the time spent resting is the same across a spectrum of diagnoses.

Sleeping with the head elevated. Use a wedge pillow to promote restful sleep. Keeping the head elevated can make breathing easier and encourages a person's tongue and jaw to move forward to help reduce snoring. Head elevation can also alleviate sinus problems at night, by allowing gravity to promote drainage and by situating a person's nasal passages above the heart. When lying down flat with a thin pillow, a person's head is close to level with the heart. This can affect the sleeper's blood pressure and subsequently allow nasal blood vessels to become engorged and affect breathing through the nose.

Lying in the prone position. The prone position, or lying face down, is a challenging sleep position, although research suggests that in a hospital setting, this position can benefit patients with acute respiratory issues.¹ A person's decision to sleep at home on their stomach is more often an issue of personal preference, rather than a decision based on how sleeping face down might benefit a respiratory problem.

Sleeping in the prone position can be especially difficult for people who use continuous positive airway pressure (CPAP) therapy to treat sleep apnea. This is because in this position, a person's face is pressed directly against the pillow or sleeping surface, which can interfere with a CPAP mask and cause mask leaks. CPAP patients who sleep on their stomachs should consider using a specialized pillow to help cradle the face and mask to reduce leaks and improve comfort. All respiratory patients who sleep in this position should also consider placing a flat pillow underneath their hips to help maintain natural alignment of the spine while they rest, often resulting in fewer aches both night and day.

Lying in the supine position. Research shows that by avoiding the supine position, which is sleeping on the back, sleep apnea patients experience a decrease in the number and severity of obstructive sleep apnea episodes.² Even people who snore lightly are urged to sleep on their sides, rather than their backs. Although research indicates sleep apnea patients should avoid back sleeping, for patients prescribed a CPAP or oxygen mask, this can be a comfortable position that minimizes interference with the effectiveness of the mask.

Patients who wear a mask, or even those who just sleep on their backs as a personal preference, should consider sleeping with a pillow under their knees to take pressure off the lower back. They should also use a supportive head pillow, such as a memory foam or CPAP aid pillow, which will not sag after the initial few hours of sleep and will help keep the neck and shoulders in alignment throughout the night. Sleeping on one's back with a pillow that begins to sag after an extended length of time can cause one's jaw to begin to thrust forward, pushing the tongue and soft palate to rest against the back of the throat and block the airway. A supportive pillow can help curb this issue for back sleepers.

Lying laterally. As mentioned earlier, sleeping laterally, or on the side, is a common recommendation for people with snoring or sleep apnea issues. Maintaining proper body alignment in this position is critical for achieving a comfortable, relaxed position during sleep. Stress and discomfort often result from the upper leg and knee being unsupported during side sleeping. The sleeper instinctively shifts the upper knee forward, causing the hips and spine to rotate, putting a twisting force on the lower back. This often leads to low back pain at night and can aggravate an existing condition. The solution is to place a contoured leg pillow between the upper and lower thighs. This keeps the upper leg even, eliminating pressure on the knee and drastically reducing the tendency to twist the hips. Maintaining a comfortable open side posture helps keep the spine in a natural, relaxed position.

Even if patients begin sleeping in this side position, they can unknowingly roll onto their backs once they fall asleep. To prevent this, there are "anti-snore" pillows that help to discourage back sleeping. Another common suggestion is to sew a tennis ball in the back of the pajama top so that it becomes slightly uncomfortable to roll backwards, prompting patients to stay on their sides.

Bedding and Sleeping Surfaces

Beyond body positioning, other factors that respiratory patients can easily control in the bedroom are the materials and condition of their bedding and pillows. The Asthma and Allergy Foundation of America³ identifies dust mite allergies as one of the most common triggers for respiratory problems. The foundation also cites studies showing that more dust mites live in the bedroom than anywhere else in the home. Another staggering statistic the foundation cites is that 20% of a pillow's weight can come from dust mites and their waste.

Using memory foam pillows, mattresses, or mattress toppers is one solution for controlling dust mites, since foam is more resistant to dust mites than natural or synthetic fiber-filled pillows. Other preventive measures include washing bedding weekly in hot water at least 130° Fahrenheit and using plastic or dustproof casings for mattresses and pillows.

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Scott Davis is founder and president of Contour Products, Charlotte, NC.

References

1. Messerole E, Peine P, Wittkopp S, Marini J, Albert R. The pragmatics of prone positioning. Am J Respir Crit Care Med. 2002;165:1359-1363.
2. Oksenberg A, Silverberg D, Arons E, Radwan H. The sleep supine position has a major effect on optimal nasal continuous positive airway pressure: relationship with rapid eye movements and non-rapid eye movements sleep, body mass index, respiratory disturbance index, and age. Chest. 1999;116:1000-1006.
3. Allergy and Asthma Foundation of America. Available at: www.aafa.org. Accessed January 17, 2008.