Positional therapy for obstructive sleep apnea

A subset of my patients with obstructive sleep apnea (OSA) have it only on their back. By this, I mean that I've documented with a sleep study that a patient has OSA when sleeping on their back, but no OSA when on their sides. In my experience, this type of OSA is rare and usually only in patients with normal weight. But these patients have a treatment option that does not work in a majority of OSA patients - positional therapy. This means that if the patient can sleep on their sides or stomach only, they greatly reduce their snoring and sleep apnea. The trick is to not sleep on their back - something hard to do if they are asleep! I usually advocate using pillows behind the back to keep the person from rolling onto their side.

The FDA has just cleared an interesting device for positional OSA. It's called Night Shift by Advanced Brain Monitoring. It's a small device worn around the neck at night. It detects position (probably by gyroscope) and causes mild vibrations when the wearer is on their back. The vibrations help the user roll over, but stay asleep. The device vibrates more vigorously if the person is not responding. Their have been some studies on this device and they report improvement in sleep quality, reduction of snoring volume, and reduction of OSA.

Stillbirths and Sleep

There was a study published in the British Medical Journal about sleep and stillbirth. One hundred and fifty five womean that were at least 28 weeks pregnant were asked questions about sleep position, sleep duration, time of day they sleep, snoring, daytime sleepiness, and urinating at night.

The results show that the risk of still birth is higher when pregnant women sleep on their back or right side, compared to their left side. The researchers think that on the back or right side, blood flow to the fetus might be reduced. Risk of stillbirth was higher in those pregnant women who slept regularly during the day and who slept longer than average at night. Also, there was higher risk of stillbirth in pregnant women who woke up to empty their bladders less than two times per night. Finally, there was no link between snoring, daytime sleepiness, and risk of stillbirth.

This was a small study and relied on women's self-report. Most people are not aware of how much time they sleep in any position, so these results should be interpreted carefully.