Brain Basics: Understanding Sleep Part 2

Sleep and Circadian Rhythms

Circadian rhythms are regular changes in mental and physical characteristics that occur in the course of a day (circadian is Latin for "around a day"). Most circadian rhythms are controlled by the body's biological "clock." This clock, called the suprachiasmatic nucleus or SCN, is actually a pair of pinhead-sized brain structures that together contain about 20,000 neurons. The SCN rests in a part of the brain called the hypothalamus, just above the point where the optic nerves cross. Light that reaches photoreceptors in the retina (a tissue at the back of the eye) creates signals that travel along the optic nerve to the SCN.

Signals from the SCN travel to several brain regions, including the pineal gland, which responds to light-induced signals by switching off production of the hormone melatonin. The body's level of melatonin normally increases after darkness falls, making people feel drowsy. The SCN also governs functions that are synchronized with the sleep/wake cycle, including body temperature, hormone secretion, urine production, and changes in blood pressure.

By depriving people of light and other external time cues, scientists have learned that most people's biological clocks work on a 25-hour cycle rather than a 24-hour one. But because sunlight or other bright lights can reset the SCN, our biological cycles normally follow the 24-hour cycle of the sun, rather than our innate cycle. Circadian rhythms can be affected to some degree by almost any kind of external time cue, such as the beeping of your alarm clock, the clatter of a garbage truck, or the timing of your meals. Scientists call external time cues zeitgebers (German for "time givers").

When travelers pass from one time zone to another, they suffer from disrupted circadian rhythms, an uncomfortable feeling known as jet lag. For instance, if you travel from California to New York, you "lose" 3 hours according to your body's clock. You will feel tired when the alarm rings at 8 a.m. the next morning because, according to your body's clock, it is still 5 a.m. It usually takes several days for your body's cycles to adjust to the new time.

To reduce the effects of jet lag, some doctors try to manipulate the biological clock with a technique called light therapy. They expose people to special lights, many times brighter than ordinary household light, for several hours near the time the subjects want to wake up. This helps them reset their biological clocks and adjust to a new time zone.

Symptoms much like jet lag are common in people who work nights or who perform shift work. Because these people's work schedules are at odds with powerful sleep-regulating cues like sunlight, they often become uncontrollably drowsy during work, and they may suffer insomnia or other problems when they try to sleep. Shift workers have an increased risk of heart problems, digestive disturbances, and emotional and mental problems, all of which may be related to their sleeping problems. The number and severity of workplace accidents also tend to increase during the night shift. Major industrial accidents attributed partly to errors made by fatigued night-shift workers include the Exxon Valdez oil spill and the Three Mile Island and Chernobyl nuclear power plant accidents. One study also found that medical interns working on the night shift are twice as likely as others to misinterpret hospital test records, which could endanger their patients. It may be possible to reduce shift-related fatigue by using bright lights in the workplace, minimizing shift changes, and taking scheduled naps.

Many people with total blindness experience life-long sleeping problems because their retinas are unable to detect light. These people have a kind of permanent jet lag and periodic insomnia because their circadian rhythms follow their innate cycle rather than a 24-hour one. Daily supplements of melatonin may improve night-time sleep for such patients. However, since the high doses of melatonin found in most supplements can build up in the body, long-term use of this substance may create new problems. Because the potential side effects of melatonin supplements are still largely unknown, most experts discourage melatonin use by the general public.

Sleep and Disease

Sleep and sleep-related problems play a role in a large number of human disorders and affect almost every field of medicine. For example, problems like stroke and asthma attacks tend to occur more frequently during the night and early morning, perhaps due to changes in hormones, heart rate, and other characteristics associated with sleep. Sleep also affects some kinds of epilepsy in complex ways. REM sleep seems to help prevent seizures that begin in one part of the brain from spreading to other brain regions, while deep sleep may promote the spread of these seizures. Sleep deprivation also triggers seizures in people with some types of epilepsy.

Neurons that control sleep interact closely with the immune system. As anyone who has had the flu knows, infectious diseases tend to make us feel sleepy. This probably happens because cytokines, chemicals our immune systems produce while fighting an infection, are powerful sleep-inducing chemicals. Sleep may help the body conserve energy and other resources that the immune system needs to mount an attack.

Sleeping problems occur in almost all people with mental disorders, including those with depression and schizophrenia. People with depression, for example, often awaken in the early hours of the morning and find themselves unable to get back to sleep. The amount of sleep a person gets also strongly influences the symptoms of mental disorders. Sleep deprivation is an effective therapy for people with certain types of depression, while it can actually cause depression in other people. Extreme sleep deprivation can lead to a seemingly psychotic state of paranoia and hallucinations in otherwise healthy people, and disrupted sleep can trigger episodes of mania (agitation and hyperactivity) in people with manic depression.

Sleeping problems are common in many other disorders as well, including Alzheimer's disease, stroke, cancer, and head injury. These sleeping problems may arise from changes in the brain regions and neurotransmitters that control sleep, or from the drugs used to control symptoms of other disorders. In patients who are hospitalized or who receive round-the-clock care, treatment schedules or hospital routines also may disrupt sleep. The old joke about a patient being awakened by a nurse so he could take a sleeping pill contains a grain of truth. Once sleeping problems develop, they can add to a person's impairment and cause confusion, frustration, or depression. Patients who are unable to sleep also notice pain more and may increase their requests for pain medication. Better management of sleeping problems in people who have other disorders could improve these patients' health and quality of life.

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Sleep Disorders

At least 40 million Americans each year suffer from chronic, long-term sleep disorders each year, and an additional 20 million experience occasional sleeping problems. These disorders and the resulting sleep deprivation interfere with work, driving, and social activities. They also account for an estimated $16 billion in medical costs each year, while the indirect costs due to lost productivity and other factors are probably much greater. Doctors have described more than 70 sleep disorders, most of which can be managed effectively once they are correctly diagnosed. The most common sleep disorders include insomnia, sleep apnea, restless legs syndrome, and narcolepsy.

Insomnia

Almost everyone occasionally suffers from short-term insomnia. This problem can result from stress, jet lag, diet, or many other factors. Insomnia almost always affects job performance and well-being the next day. About 60 million Americans a year have insomnia frequently or for extended periods of time, which leads to even more serious sleep deficits. Insomnia tends to increase with age and affects about 40 percent of women and 30 percent of men. It is often the major disabling symptom of an underlying medical disorder.

For short-term insomnia, doctors may prescribe sleeping pills. Most sleeping pills stop working after several weeks of nightly use, however, and long-term use can actually interfere with good sleep. Mild insomnia often can be prevented or cured by practicing good sleep habits.. For more serious cases of insomnia, researchers are experimenting with light therapy and other ways to alter circadian cycles.

Sleep Apnea

Sleep apnea is a disorder of interrupted breathing during sleep. It usually occurs in association with fat buildup or loss of muscle tone with aging. These changes allow the windpipe to collapse during breathing when muscles relax during sleep. This problem, called obstructive sleep apnea, is usually associated with loud snoring (though not everyone who snores has this disorder). Sleep apnea also can occur if the neurons that control breathing malfunction during sleep.

During an episode of obstructive apnea, the person's effort to inhale air creates suction that collapses the windpipe. This blocks the air flow for 10 seconds to a minute while the sleeping person struggles to breathe. When the person's blood oxygen level falls, the brain responds by awakening the person enough to tighten the upper airway muscles and open the windpipe. The person may snort or gasp, then resume snoring. This cycle may be repeated hundreds of times a night. The frequent awakenings that sleep apnea patients experience leave them continually sleepy and may lead to personality changes such as irritability or depression. Sleep apnea also deprives the person of oxygen, which can lead to morning headaches, a loss of interest in sex, or a decline in mental functioning. It also is linked to high blood pressure, irregular heartbeats, and an increased risk of heart attacks and stroke. Patients with severe, untreated sleep apnea are two to three times more likely to have automobile accidents than the general population. In some high-risk individuals, sleep apnea may even lead to sudden death from respiratory arrest during sleep.

An estimated 18 million Americans have sleep apnea. However, few of them have had the problem diagnosed. Patients with the typical features of sleep apnea, such as loud snoring, obesity, and excessive daytime sleepiness, should be referred to a specialized sleep center that can perform a test called polysomnography. This test records the patient's brain waves, heartbeat, and breathing during an entire night. If sleep apnea is diagnosed, several treatments are available. Mild sleep apnea frequently can be overcome through weight loss or by preventing the person from sleeping on his or her back. Other people may need special devices or surgery to correct the obstruction. People with sleep apnea should never take sedatives or sleeping pills, which can prevent them from awakening enough to breathe.

Restless Legs Syndrome

Restless legs syndrome (RLS), a familial disorder causing unpleasant crawling, prickling, or tingling sensations in the legs and feet and an urge to move them for relief, is emerging as one of the most common sleep disorders, especially among older people. This disorder, which affects as many as 12 million Americans, leads to constant leg movement during the day and insomnia at night. Severe RLS is most common in elderly people, though symptoms may develop at any age. In some cases, it may be linked to other conditions such as anemia, pregnancy, or diabetes.

Many RLS patients also have a disorder known as periodic limb movement disorder or PLMD, which causes repetitive jerking movements of the limbs, especially the legs. These movements occur every 20 to 40 seconds and cause repeated awakening and severely fragmented sleep. In one study, RLS and PLMD accounted for a third of the insomnia seen in patients older than age 60.

RLS and PLMD often can be relieved by drugs that affect the neurotransmitter dopamine, suggesting that dopamine abnormalities underlie these disorders' symptoms. Learning how these disorders occur may lead to better therapies in the future.

Narcolepsy

Narcolepsy affects an estimated 250,000 Americans. People with narcolepsy have frequent "sleep attacks" at various times of the day, even if they have had a normal amount of night-time sleep. These attacks last from several seconds to more than 30 minutes. People with narcolepsy also may experience cataplexy (loss of muscle control during emotional situations), hallucinations, temporary paralysis when they awaken, and disrupted night-time sleep. These symptoms seem to be features of REM sleep that appear during waking, which suggests that narcolepsy is a disorder of sleep regulation. The symptoms of narcolepsy typically appear during adolescence, though it often takes years to obtain a correct diagnosis. The disorder (or at least a predisposition to it) is usually hereditary, but it occasionally is linked to brain damage from a head injury or neurological disease.

Once narcolepsy is diagnosed, stimulants, antidepressants, or other drugs can help control the symptoms and prevent the embarrassing and dangerous effects of falling asleep at improper times. Naps at certain times of the day also may reduce the excessive daytime sleepiness.

In 1999, a research team working with canine models identified a gene that causes narcolepsy–a breakthrough that brings a cure for this disabling condition within reach. The gene, hypocretin receptor 2, codes for a protein that allows brain cells to receive instructions from other cells. The defective versions of the gene encode proteins that cannot recognize these messages, perhaps cutting the cells off from messages that promote wakefulness. The researchers know that the same gene exists in humans, and they are currently searching for defective versions in people with narcolepsy.

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The Future

Sleep research is expanding and attracting more and more attention from scientists. Researchers now know that sleep is an active and dynamic state that greatly influences our waking hours, and they realize that we must understand sleep to fully understand the brain. Innovative techniques, such as brain imaging, can now help researchers understand how different brain regions function during sleep and how different activities and disorders affect sleep. Understanding the factors that affect sleep in health and disease also may lead to revolutionary new therapies for sleep disorders and to ways of overcoming jet lag and the problems associated with shift work. We can expect these and many other benefits from research that will allow us to truly understand sleep's impact on our lives.

Brain Basics: Understanding Sleep Part 1

Sleep: A Dynamic Activity

Until the 1950s, most people thought of sleep as a passive, dormant part of our daily lives. We now know that our brains are very active during sleep. Moreover, sleep affects our daily functioning and our physical and mental health in many ways that we are just beginning to understand.

Nerve-signaling chemicals called neurotransmitters control whether we are asleep or awake by acting on different groups of nerve cells, or neurons, in the brain. Neurons in the brainstem, which connects the brain with the spinal cord, produce neurotransmitters such as serotonin and norepinephrine that keep some parts of the brain active while we are awake. Other neurons at the base of the brain begin signaling when we fall asleep. These neurons appear to "switch off" the signals that keep us awake. Research also suggests that a chemical called adenosine builds up in our blood while we are awake and causes drowsiness. This chemical gradually breaks down while we sleep.

During sleep, we usually pass through five phases of sleep: stages 1, 2, 3, 4, and REM (rapid eye movement) sleep. These stages progress in a cycle from stage 1 to REM sleep, then the cycle starts over again with stage 1 (see figure 1 ). We spend almost 50 percent of our total sleep time in stage 2 sleep, about 20 percent in REM sleep, and the remaining 30 percent in the other stages. Infants, by contrast, spend about half of their sleep time in REM sleep.

During stage 1, which is light sleep, we drift in and out of sleep and can be awakened easily. Our eyes move very slowly and muscle activity slows. People awakened from stage 1 sleep often remember fragmented visual images. Many also experience sudden muscle contractions called hypnic myoclonia, often preceded by a sensation of starting to fall. These sudden movements are similar to the "jump" we make when startled. When we enter stage 2 sleep, our eye movements stop and our brain waves (fluctuations of electrical activity that can be measured by electrodes) become slower, with occasional bursts of rapid waves called sleep spindles. In stage 3, extremely slow brain waves called delta waves begin to appear, interspersed with smaller, faster waves. By stage 4, the brain produces delta waves almost exclusively. It is very difficult to wake someone during stages 3 and 4, which together are called deep sleep. There is no eye movement or muscle activity. People awakened during deep sleep do not adjust immediately and often feel groggy and disoriented for several minutes after they wake up. Some children experience bedwetting, night terrors, or sleepwalking during deep sleep.

When we switch into REM sleep, our breathing becomes more rapid, irregular, and shallow, our eyes jerk rapidly in various directions, and our limb muscles become temporarily paralyzed. Our heart rate increases, our blood pressure rises, and males develop penile erections. When people awaken during REM sleep, they often describe bizarre and illogical tales – dreams.

The first REM sleep period usually occurs about 70 to 90 minutes after we fall asleep. A complete sleep cycle takes 90 to 110 minutes on average. The first sleep cycles each night contain relatively short REM periods and long periods of deep sleep. As the night progresses, REM sleep periods increase in length while deep sleep decreases. By morning, people spend nearly all their sleep time in stages 1, 2, and REM.

People awakened after sleeping more than a few minutes are usually unable to recall the last few minutes before they fell asleep. This sleep-related form of amnesia is the reason people often forget telephone calls or conversations they've had in the middle of the night. It also explains why we often do not remember our alarms ringing in the morning if we go right back to sleep after turning them off.

Since sleep and wakefulness are influenced by different neurotransmitter signals in the brain, foods and medicines that change the balance of these signals affect whether we feel alert or drowsy and how well we sleep. Caffeinated drinks such as coffee and drugs such as diet pills and decongestants stimulate some parts of the brain and can cause insomnia, or an inability to sleep. Many antidepressants suppress REM sleep. Heavy smokers often sleep very lightly and have reduced amounts of REM sleep. They also tend to wake up after 3 or 4 hours of sleep due to nicotine withdrawal. Many people who suffer from insomnia try to solve the problem with alcohol – the so-called night cap. While alcohol does help people fall into light sleep, it also robs them of REM and the deeper, more restorative stages of sleep. Instead, it keeps them in the lighter stages of sleep, from which they can be awakened easily.

People lose some of the ability to regulate their body temperature during REM, so abnormally hot or cold temperatures in the environment can disrupt this stage of sleep. If our REM sleep is disrupted one night, our bodies don't follow the normal sleep cycle progression the next time we doze off. Instead, we often slip directly into REM sleep and go through extended periods of REM until we "catch up" on this stage of sleep.

People who are under anesthesia or in a coma are often said to be asleep. However, people in these conditions cannot be awakened and do not produce the complex, active brain wave patterns seen in normal sleep. Instead, their brain waves are very slow and weak, sometimes all but undetectable.

How Much Sleep Do We Need?

The amount of sleep each person needs depends on many factors, including age. Infants generally require about 16 hours a day, while teenagers need about 9 hours on average. For most adults, 7 to 8 hours a night appears to be the best amount of sleep, although some people may need as few as 5 hours or as many as 10 hours of sleep each day. Women in the first 3 months of pregnancy often need several more hours of sleep than usual. The amount of sleep a person needs also increases if he or she has been deprived of sleep in previous days. Getting too little sleep creates a "sleep debt," which is much like being overdrawn at a bank. Eventually, your body will demand that the debt be repaid. We don't seem to adapt to getting less sleep than we need; while we may get used to a sleep-depriving schedule, our judgment, reaction time, and other functions are still impaired.

People tend to sleep more lightly and for shorter time spans as they get older, although they generally need about the same amount of sleep as they needed in early adulthood. About half of all people over 65 have frequent sleeping problems, such as insomnia, and deep sleep stages in many elderly people often become very short or stop completely. This change may be a normal part of aging, or it may result from medical problems that are common in elderly people and from the medications and other treatments for those problems.

Experts say that if you feel drowsy during the day, even during boring activities, you haven't had enough sleep. If you routinely fall asleep within 5 minutes of lying down, you probably have severe sleep deprivation, possibly even a sleep disorder. Microsleeps, or very brief episodes of sleep in an otherwise awake person, are another mark of sleep deprivation. In many cases, people are not aware that they are experiencing microsleeps. The widespread practice of "burning the candle at both ends" in western industrialized societies has created so much sleep deprivation that what is really abnormal sleepiness is now almost the norm.

Many studies make it clear that sleep deprivation is dangerous. Sleep-deprived people who are tested by using a driving simulator or by performing a hand-eye coordination task perform as badly as or worse than those who are intoxicated. Sleep deprivation also magnifies alcohol's effects on the body, so a fatigued person who drinks will become much more impaired than someone who is well-rested. Driver fatigue is responsible for an estimated 100,000 motor vehicle accidents and 1500 deaths each year, according to the National Highway Traffic Safety Administration. Since drowsiness is the brain's last step before falling asleep, driving while drowsy can – and often does – lead to disaster. Caffeine and other stimulants cannot overcome the effects of severe sleep deprivation. The National Sleep Foundation says that if you have trouble keeping your eyes focused, if you can't stop yawning, or if you can't remember driving the last few miles, you are probably too drowsy to drive safely.

What Does Sleep Do For Us?

Although scientists are still trying to learn exactly why people need sleep, animal studies show that sleep is necessary for survival. For example, while rats normally live for two to three years, those deprived of REM sleep survive only about 5 weeks on average, and rats deprived of all sleep stages live only about 3 weeks. Sleep-deprived rats also develop abnormally low body temperatures and sores on their tail and paws. The sores may develop because the rats' immune systems become impaired. Some studies suggest that sleep deprivation affects the immune system in detrimental ways.

Sleep appears necessary for our nervous systems to work properly. Too little sleep leaves us drowsy and unable to concentrate the next day. It also leads to impaired memory and physical performance and reduced ability to carry out math calculations. If sleep deprivation continues, hallucinations and mood swings may develop. Some experts believe sleep gives neurons used while we are awake a chance to shut down and repair themselves. Without sleep, neurons may become so depleted in energy or so polluted with byproducts of normal cellular activities that they begin to malfunction. Sleep also may give the brain a chance to exercise important neuronal connections that might otherwise deteriorate from lack of activity.

Deep sleep coincides with the release of growth hormone in children and young adults. Many of the body's cells also show increased production and reduced breakdown of proteins during deep sleep. Since proteins are the building blocks needed for cell growth and for repair of damage from factors like stress and ultraviolet rays, deep sleep may truly be "beauty sleep." Activity in parts of the brain that control emotions, decision-making processes, and social interactions is drastically reduced during deep sleep, suggesting that this type of sleep may help people maintain optimal emotional and social functioning while they are awake. A study in rats also showed that certain nerve-signaling patterns which the rats generated during the day were repeated during deep sleep. This pattern repetition may help encode memories and improve learning.

What Are The Best Sleep Positions During Pregnancy?

During pregnancy you may find yourself wrestling in bed trying to get comfortable before falling asleep. Unfortunately, your regular sleep positions may no longer work for you during pregnancy. There are a number of reasons that cause this new discomfort, but there are some positions that you can try that may help you get your much needed rest.

Why am I so uncomfortable in my normal positions?

When you are pregnant your body goes through a variety of changes. These changes tend to disrupt your usual peaceful slumber. Reasons may include:

• Increased size of abdomen
• Back pain
• Heartburn
• Shortness of breath
• Insomnia

What are the best sleep positions?

The best sleep position during pregnancy is "SOS" (sleep on side). Even better is to sleep on your left side. Sleeping on your left side will increase the amount of blood and nutrients that reach the placenta and your baby. Keep your legs and knees bent and a pillow between your legs.

• If you find that you are having problems with back pain, use the "SOS" position and try placing a pillow under your abdomen as well.
• If you are experiencing heartburn during the night, you may want to try propping your upper body with pillows.
• In late pregnancy you may experience shortness of breath; try lying on your side or propped up with pillows.

These suggestions may not sound completely comfortable, especially if you are used to sleeping on your back or stomach, but try them out and you may find that they work. Keep in mind that you may not stay in one position all night and rotating positions is fine.

What positions should I avoid?

Sleeping on your back: This can cause problems with backaches, breathing, digestive system, hemorrhoids, low blood pressure and decrease in circulation to your heart and your baby. This is a result of your abdomen resting on your intestines and major blood vessels (the aorta and vena cava).
Sleeping on your stomach: When you are farther along in your pregnancy, your abdomen undergoes physical changes and makes it more difficult for you to lay on your stomach.

Best Sleep Positions To Rid Aches And Pains

Body+Soul, June 2009

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The way you sleep at night can make a huge difference in how you feel during the day. Discover potential pitfalls of your slumber style and how to fix ensuing aches and pains. You spend about a third of your life sleeping; it's time that should feel relaxing and mentally and physically restorative.
But depending on the position you rest in, your nightly slumber could contribute to a range of daytime problems. Pain in the lower back and neck, numbness in your arms and fingers, chronic shallow breathing (which, in turn, leads to low energy) -- these can all result from snuggling up the "wrong" way.
"Sleep is when your body recovers," says chiropractor Lisa Kirsch of Tribeca Chiropractic in New York City. "If your sleeping position forces your spine out of alignment or compresses your muscles, nerves, or organs, your body can't heal itself effectively."
The ideal position? On your back with no pillow, says Jonathan FitzGordon, an alignment specialist in private practice in Brooklyn, New York. "It's optimal because it allows your spine to rest with its natural curves in place." But if you can't fall asleep that way -- or if you unconsciously roll into other positions -- you can still take steps to mitigate any resulting problems. To that end, Kirsch and FitzGordon helped us identify the three most common troublesome sleeping styles --and key stretches to counteract their ill effects.
"Animals stretch as soon as they wake up," says FitzGordon. "Kids do, too. Sadly, adults don't." All it takes is about 10 minutes each morning to reinvigorate yourself, say our experts. So roll out of bed and make the following moves part of your wake-up routine.

Position: Side with Arm Under HeadAffects neck, shoulders, arms, fingersIt may feel comfy, but resting your head (which weighs, on average, 10 pounds) on your arm for hours at a time stresses the body.
"This position presses on the nerves that run through the top of the shoulder and down the arm, resulting in numbness in your fingers," FitzGordon explains. The shoulder you sleep on also gets hiked up toward your ear, which constricts the muscles of the shoulder and neck.

Pillow talk 
If you're a side sleeper, look for a pillow that fills the space between your ear and the outer edge of your shoulder when you're lying on your side. "Your pillow should enable both sides of your neck to be equally long," FitzGordon says, which promotes easier breathing and prevents overstretching on one side of your neck. Any pillow that maintains its shape (foam, for instance) is fine. To keep you from hiking one leg up, which rotates the pelvis and contorts the lower spine, Kirsch suggests placing a pillow that is 6 to 8 inches high between your knees.
Fix: shoulder stretchWhat it does: Stretches the back of the shoulders, which tend to get compressed by the weight of your head.
How to do it: Sit tall, core tight, and extend your left arm straight out to your side at shoulder height, palm facing down. Now reach that arm across your chest and use your right hand to draw it in closer to you. Relax for five breaths, then switch arms. Stretch each side three times.

Fix: cow face poseWhat it does: Stretches and brings balance to the muscles of the neck as well as the shoulders. Opens the chest.
How to do it: Hold a strap in your right hand. Standing with your core tight, raise your right arm straight up and turn your hand so the palm faces behind you. Now bend your elbow and bring your hand as far down your back as you can. Reach the left arm straight out to your side, then turn your palm to face behind you. Bend your left elbow and bring your left arm behind your back; grab the strap with your left hand. Relax for five breaths. Repeat on other side.

Position: On StomachAffects lower back, neck, lungs"Sleeping on your stomach is the worst position for your spine," FitzGordon says. It flattens the natural curve in the lower back and keeps your head turned to one side all night, which distorts the alignment of the spine in your neck. All of this leads to chronic lower back pain, neck pain, and headaches. And because your body weight compresses your lungs, stomach sleeping also impedes your ability to breathe deeply.
Pillow talk 
Kirsch implores her stomach-sleeping patients to change their habits altogether. She recommends investing in a body pillow (go with the long, thin rectangle or cylinder style) to make side sleeping more compelling. It mimics the pressure on the front of the body that sleeping on your stomach offers, she says, but without compressing your organs. "Placing a body pillow between your knees and hugging it with your arms will keep your pelvis, shoulders, and spine balanced," she says.
Fix: side stretchWhat it does: Opens the sides of the torso, creating more space for the lungs to expand. Stretches the quadratus lumborum, thus helping to maintain proper lower back curve.
How to do it: Stand tall with abs engaged and hands clasped behind your head. Keeping your spine long, bend to the right as if making a rainbow shape with your torso; go as far as is comfortable. Stay five breaths, breathing naturally, then return to the starting position. Repeat to the left. Stretch each side three times.

Fix: easy bridge poseWhat it does: Restores the curve in the lower back, which helps restore your neck's alignment as well. Opens the chest and stretches the diaphragm, improving your ability to breathe deeply.
How to do it: Lie on your back with your knees bent and feet flat, about 12 inches from your hips. To a count of three, reach your arms overhead and lift your hips off the floor; your head, arms, shoulders, and feet remain grounded. Keep your butt soft and core tight as you hold the stretch for a count of three. Now lower your arms and roll your spine, one vertebra at a time, back down to the mat. Repeat five times.

Position: On back with a big pillowAffects neck, throat, chestAlthough sleeping on your back may seem innocuous, if you've got a thick pillow under your head, your neck pays a steep price. "A thick pillow pushes your head forward, exactly opposite the natural curve of the spine in the neck," says Kirsch. Neck pain and headaches can result. This position also impedes the flow of air through your throat and closes off the top of the chest, which decreases breathing capacity.

Pillow talk
Back sleepers who still want a pillow should choose the thinnest one they can stand. A soft down pillow compresses the most. If you often wake up during the night with a neck ache or headache, Kirsch recommends keeping a small neck-roll pillow (such as the Silk Neck Pillow, available at huggermugger.com) on hand: Remove your pillow and place the roll under the back of your neck for several minutes to reset the spinal curve and ward off further pain, then go back to sleep using your usual pillow. Or create your own neck roll by tightly rolling a thin bath towel.

Fix: neck releaseWhat it does: Balances and stretches the neck muscles, freeing the vertebrae in your neck to find their natural alignment.
How to do it: Sit tall on the edge of a chair. Drop your right ear toward your right shoulder until you feel a strong yet bearable stretch. Hold for five breaths. Return to center, then drop your left ear toward your left shoulder and hold for five breaths. Return to center. Turn your head as far as you comfortably can to the right; stay for five breaths. Come to center. Repeat to the left.

Fix: reclined heart openerWhat it does: Opens the chest and encourages the head and neck to move backward. Stretches the anterior longitudinal ligament, which can shorten when you spend too much time with your head in a forward position.
How to do it: Lie flat on a mat on the floor with a rolled up blanket or towel placed horizontally under your shoulder blades. Rest your arms out to the sides in a T, palms facing up. Relax and breathe deeply for at least two minutes, gradually working up to as long as 15 minutes.

What Does Your Sleep Position Say About Your Personality Type?

Professor Chris Idzikowski, director of the Sleep Assessment and Advisory Service, says that a study of 1,000 Brits revealed that the six most common sleeping positions are indicative of personality type.

If this sounds ridiculous (and honestly, I'd love to see information on this study and the analysis fleshed out further than any of the reports I could find), consider that Idzikowski says it comes down to body language.

"We are all aware of our body language when we are awake but this is the first time we have been able to see what our subconscious posture says about us," Idzikowski said. "What's interesting is that the profile behind the posture is often very different from what we would expect."

The research also links certain sleeping positions with health risks. Some aid digestion while others spur on snoring and restlessness.

Here are the six common sleeping positions and correlated personality traits and health implications, according to this study.

[graphic via BBC.com]

• Fetus position - A whopping 41% of participants sleep in this curled-up manner. Women are twice as likely to rest like this and it is listed as the most common position. These sleepers are said to have a tough exterior but are still sensitive and may appear to be shy but warm up quickly.

• Log position - If you sleep on your side with both arms down, you are a social, easy-going person who is trusting, sometimes to the point of being gullible. The study showed 15% of people sleep like a log.

• Yearner position - A close third is the side-lying position with both arms out in front of the body, with 13% of partipants sleeping like this. Yearners are noted to be open-minded and still cynical, suspicious, and stubborn about sticking to decisions once they are made.

• Soldier position - These sleepers lie on their backs with arms down and kept close to the body. This 8% study is said to be reserved, quiet, without fuss, and hold themselves and others to a high standard. Soldier sleepers have a higher likelihood for snoring due to the flat-back position, which may not cause them to wake up often but may result in a less restful night's sleep.

• Freefall position - Those people who lie on their bellies with arms under or wrapped around a pillow with head turned to the side, make up 7% of the population studied. Freefallers are brash, outgoing, and are very uncomfortable with criticism.

• Starfish position - Sleepers who lie on their backs with arms up near their head or the pillow account for 5% of participants. These people are good listeners, helpful, and are uncomfortable being the center of attention. People who sleep in starfish position are more likely to snore and to suffer from a poor night's sleep more often.

If you think you are one of those people who move through all of these positions, that's not likely to really be the case. Idzikowski said the research reveals most people stay in the same position all night and only 5% lay differently night by night. Also interesting is that the study showed only one in ten people cover their bodies entirely with a blanket, with most people exposing an arm, leg, or both feet.

The Best Sleeping Positions

Good night’s sleep is important for numerous health benefits. The best position is to sleep on your back, according to a new study.

It prevents neck and back pain, reduces acid reflux and minimizes wrinkles. Sleeping on your back makes it easy for your head, neck and spine to maintain a neutral position.

However, people with severe snoring or sleep apnea should avoid sleeping on their back. This position is recommended for people with neck pain along with a cervical roll or pillow.

The next best position is the side position. This position is great for your overall health. It prevents neck and back pain, reduces acid reflux and reduces snoring. This position is ideal for women who are pregnant. Women in late pregnancy should sleep on their left side to increase blood flow to the baby.

Side sleeping keeps your spine elongated preventing back soreness.

Side—sleeping, however, tends to constrict the shoulder and neck muscles due to the weight of the head on the arm all night. Side—sleepers should do a shoulder stretch to stretch the back of the shoulders and prevent soreness.

Side—sleeping also might worsen facial wrinkles and increase breast sagging over time. This sleep position is recommended for people with back pain with a pillow under your knees to relieve strain on the lumbar spine. The worst position to sleep in is on your stomach.

The stomach position eases snoring but is bad for your neck and back. Stomach—sleeping makes it difficult to maintain a neutral position with your spine. It puts pressure on joints and muscles, which can irritate nerves and lead to pain, numbness and tingling.

Sleep Apnea: Causes and Risk Factors

Anyone can have sleep apnea—young, old, male, female, and even children can suffer. However, certain risk factors have been associated with obstructive and central sleep apnea.

Risk factors for obstructive sleep apnea

You have a higher risk for obstructive sleep apnea if you are:

• Overweight
• Male
• Related to someone who has sleep apnea

• Over the age of 65
• Black, Hispanic, or a Pacific Islander
• A smoker

Other risk factors for obstructive sleep apnea include certain physical attributes, such as having a thick neck, deviated septum, receding chin, or enlarged tonsils or adenoids (the most common cause of sleep apnea in children). Your airway may be blocked or narrowed during sleep simply because your throat muscles tend to relax more than normal. Allergies or other medical conditions that cause to nasal congestion and blockage can also contribute to sleep apnea.

Risk factors for central sleep apnea

Like obstructive sleep apnea, central sleep apnea is more common in males and people over the age of 65. However, unlike obstructive sleep apnea, central sleep apnea is often associated with serious illness, such as heart disease, stroke, neurological disease, or spinal or brainstem injury.

Self-help treatment options for sleep apnea

While a diagnosis of sleep apnea can be scary, it is a treatable condition. In fact, there are many things you can do on your own to help, particularly for mild to moderate sleep apnea. Home remedies and lifestyle modifications can go a long way in reducing sleep apnea symptoms.
Lifestyle changes that can help sleep apnea

• Lose weight. Some people find that even moderate to severe sleep apnea can be completely corrected by losing excess weight. For others, even a small amount of weight loss can open up the throat and improve sleep apnea symptoms.
• Quit smoking. Smoking is believed to contribute to sleep apnea by increasing inflammation and fluid retention in your throat and upper airway.
• Avoid alcohol, sleeping pills, and sedatives, especially before bedtime, because they relax the muscles in the throat and interfere with breathing.
• Avoid caffeine and heavy meals within two hours of going to bed.
• Maintain regular sleep hours. Sticking to a steady sleep schedule will help you relax and sleep better. Apnea episodes decrease when you get plenty of sleep.

Bedtime tips for preventing sleep apnea

• Sleep on your side. Avoid sleeping on your back, as gravity makes it more likely for your tongue and soft tissues to drop and obstruct your airway.
• Try the tennis ball trick. In order to keep yourself from rolling onto your back while you sleep, sew a tennis ball into a pocket on the back of your pajama top. Or wedge a pillow stuffed with tennis balls behind your back.
• Prop your head up. Elevate the head of your bed by 4 to 6 inches or elevate your body from the waist up by using a foam wedge. You can also use a special cervical pillow.
• Open your nasal passages. Try to keep your nasal passages open at night using a nasal dilator, saline spray, breathing strips, or a neti pot.

Throat exercises to reduce sleep apnea

Studies show that throat exercises may reduce the severity of sleep apnea by strengthening the muscles in airway, making them less likely to collapse.

• Press tongue flat against the floor of mouth and brush top and sides with toothbrush. Repeat brushing movement 5 times, 3 times a day.
• Press length of tongue to roof of mouth and hold for 3 minutes a day.
• Place finger into one side of mouth. Hold finger against cheek while pulling cheek muscle in at same time. Repeat 10 times then rest and alternate sides. Repeat sequence 3 times.
• Purse lips as if to kiss. Hold lips tightly together and move them up and to the right the up and to the left 10 times. Repeat sequence 3 times.
• Place lips on a balloon. Take a deep breath through your nose then blow out through your mouth to inflate balloon as much as possible. Repeat 5 times without removing balloon from mouth.

Medical treatment options for sleep apnea

If your sleep apnea is moderate to severe, or you’ve tried self-help strategies and lifestyle changes without success, it’s important to see a sleep doctor. A sleep specialist can evaluate your symptoms and help you find an effective treatment. Treatment for sleep apnea has come a long way in recent times, so take some time to explore the new options. Even if you were unhappy with sleep apnea treatment in the past, chances are you can find something that works and feels comfortable to you.
Treatments for central and complex sleep apnea usually include:

• Treating the underlying medical condition causing the apnea, such as a heart or neuromuscular disorder.
• Using supplemental oxygen while you sleep.
• Breathing devices that are also used to manage obstructive sleep apnea.

Medications are only available to treat the sleepiness associated with sleep apnea, not the apnea itself, so should only be used in conjunction with other proven sleep apnea treatments.

CPAP for sleep apnea

Continuous Positive Airflow Pressure, or CPAP for short, is the most common treatment for moderate to severe obstructive sleep apnea. In many cases, you’ll experience immediate symptom relief and a huge boost in your mental and physical energy. The CPAP device is a mask-like machine that provides a constant stream of air which keeps your breathing passages open while you sleep. Most CPAP devices are the size of a tissue box.

If you’ve given up on sleep apnea machines in the past because of discomfort, you owe it to yourself to give them a second look. CPAP technology is constantly being updated and improved. The new CPAP devices are lighter, quieter, and more comfortable, so make sure your sleep apnea device is up to date.

CPAP for sleep apnea: tips and troubleshooting

Having trouble with your new sleep apnea device? It can take some time to get accustomed to sleeping while wearing a CPAP device. It’s natural to miss sleeping the “old way,” but there are things you can to do make the adjustment easier.

• Make sure your CPAP device fits correctly. A correct fit makes a huge difference. Make sure the straps are not too tight or too loose and that the mask seals completely over your nose and mouth. Schedule regular appointments with your doctor to check the fit and evaluate your treatment progress.
• Ease into it. Start by using your CPAP device for short periods during the day. Use the “ramp” setting to gradually increase air pressure. It’s normal to need several months to get used to sleeping this way.
• Upgrade your CPAP device with customized options. Customize the mask, tubing and straps to find the right fit. Ask your doctor about soft pads to reduce skin irritation, nasal pillows for nose discomfort, and chin-straps to keep your mouth closed and reduce throat irritation.
• Use a humidifier to decrease dryness and skin irritation. Try a special face moisturizer for dry skin. Many CPAP devices now come with a built-in humidifier.
• Try a saline nasal spray or a nasal decongestant for nasal congestion.
• Keep your mask, tubing and headgear clean. To ensure maximum comfort and benefit, replace CPAP and humidifier filters regularly and keep the unit clean.
• Mask the sound of the CPAP machine. If the sound of the CPAP machine bothers you, place it beneath the bed reduce the noise. You can also try using a sound machine or white noise machine help you sleep.

Other breathing devices for sleep apnea

In addition to CPAP, there are other adjustable airway pressure devices that a sleep specialist may recommend:

• Bilevel positive airway pressure (BPAP) devices can be used for those who are unable to adapt to using CPAP, or for central sleep apnea sufferers who need assistance for a weak breathing pattern. This device automatically adjusts the pressure while you're sleeping, providing more pressure when you inhale, less when you exhale. Some BPAP devices will also automatically deliver a breath if it detects you haven't taken one for a certain number of seconds.
• Adaptive servo-ventilation (ASV) can be used for treating central sleep apnea as well as obstructive sleep apnea. The device stores information about your normal breathing pattern and automatically uses airflow pressure to prevent pauses in your breathing while you’re asleep.

Dental devices and surgery for sleep apnea

If you’ve tried CPAP and self-help tips and your sleep apnea persists, you may benefit from a dental device or surgical treatment.

Dental devices for sleep apnea

Most dental devices are acrylic and fit inside your mouth, much like an athletic mouth guard. Others fit around your head and chin to adjust the position of your lower jaw. Two common oral devices are the mandibular repositioning device and the tongue retaining device. These devices open your airway by bringing your lower jaw or your tongue forward during sleep.

Dental devices are only effective for mild to moderate sleep apnea. There are also a number of troubling side effects from using this type of treatment, including soreness, saliva build-up, nausea, and damage or permanent change in position of the jaw, teeth, and mouth.

It is very important to get fitted by a dentist specializing in sleep apnea, and to see the dentist on a regular basis for any dental problems that may occur. You may also need to periodically have your dentist adjust the mouthpiece to fit better.

Surgery as treatment for sleep apnea

If you have exhausted other apnea treatment options, you may want to discuss surgical options with your doctor or sleep specialist. Surgery can increase the size of your airway, thus reducing your episodes of sleep apnea.

The surgeon may remove tonsils, adenoids, or excess tissue at the back of the throat or inside the nose. Or, the surgeon may reconstruct the jaw to enlarge the upper airway. Surgery carries risks of complications and infections, and in some rare cases, symptoms can become worse after surgery

Sleep Apnea As A Cause of Excessive Sleepiness

What Is Sleep Apnea?
Sleep apnea (AP-ne-ah) is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep.
Breathing pauses can last from a few seconds to minutes. They often occur 5 to 30 times or more an hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound.
Sleep apnea usually is a chronic (ongoing) condition that disrupts your sleep. You often move out of deep sleep and into light sleep when your breathing pauses or becomes shallow.
This results in poor sleep quality that makes you tired during the day. Sleep apnea is one of the leading causes of excessive daytime sleepiness.

Overview

Sleep apnea often goes undiagnosed. Doctors usually can't detect the condition during routine office visits. Also, there are no blood tests for the condition.
Most people who have sleep apnea don't know they have it because it only occurs during sleep. A family member and/or bed partner may first notice the signs of sleep apnea.
The most common type of sleep apnea is obstructive sleep apnea. This most often means that the airway has collapsed or is blocked during sleep. The blockage may cause shallow breathing or breathing pauses.
When you try to breathe, any air that squeezes past the blockage can cause loud snoring. Obstructive sleep apnea is more common in people who are overweight, but it can affect anyone. For example, small children may have enlarged tonsil tissues in their throats, which can lead to obstructive sleep apnea.
The animation below shows how obstructive sleep apnea occurs. Click the "start" button to play the animation. Written and spoken explanations are provided with each frame. Use the buttons in the lower right corner to pause, restart, or replay the animation, or use the scroll bar below the buttons to move through the frames.

The animation shows how air flow to the lungs can be blocked, causing sleep apnea.

Central sleep apnea is a less common type of sleep apnea. This disorder happens if the area of your brain that controls your breathing doesn't send the correct signals to your breathing muscles. As a result, you'll make no effort to breathe for brief periods.
Central sleep apnea can occur in anyone. However, it's more common in people who have certain medical conditions or use certain medicines.
Central sleep apnea often occurs with obstructive sleep apnea, but it can occur alone. Snoring doesn't typically happen with central sleep apnea.

Fatigue and Excessive Sleepiness

National Sleep Foundation

Do you find it difficult to get out of bed in the morning? Do you sometimes feel sleepy while watching television or driving? If so, you may be one of the millions of Americans who suffer from excessive sleepiness, a condition that can significantly reduce quality of life, decrease productivity and interfere with relationships. Most people feel tired occasionally, but excessive sleepiness that persists is neither normal nor healthy.

CAUSES:

One of the primary causes of excessive sleepiness among Americans is self-imposed sleep deprivation. In the U.S. and many other parts of the world, sleep loss may occur as a result of economic or societal pressures. People may skimp on sleep in hopes of getting more done, and widespread access to technology makes it possible to stay busy (at the computer, for example) around the clock. By some estimates, people now sleep about 20 percent less than they did a century ago.
Working at night and sleeping during the day can also cause excessive sleepiness. Some people are able to adjust to such a schedule. However, others may never overcome the body’s natural tendency to be awake during the day and asleep at night. A similar phenomenon occurs with jet lag, in which the body is “out of sync” with the natural environment. In general, symptoms of jet lag increase with the number of time zones crossed. That is, someone flying from Beijing to San Francisco is more likely to suffer worse jet lag than someone flying from San Francisco to New York.
Excessive sleepiness is also linked with a number of primary sleep disorders. For example, sleep disordered breathing (SDB), which includes snoring and obstructive sleep apnea (OSA), is often associated with excessive sleepiness. Because SDB may result in frequent interruptions during sleep, it can lead to abnormal sleepiness during waking hours no matter how many hours a person actually spent in bed.
Insomnia is another main cause of perceived daytime sleepiness or fatigue. Insomnia symptoms may include difficulty falling asleep, difficulty staying asleep, and/or waking up still tired as well as daytime impairments such as excessive sleepiness, cognitive deficits (e.g., concentration and memory problems), fatigue, and irritability.
Narcolepsy is a neurological disorder characterized by disabling sleepiness. Most patients begin to experience symptoms in their teens or 20s, but symptoms may appear in younger children or older adults. Narcolepsy is also recognized by insomnia at bedtime, sudden sleep attacks, cataplexy (sudden muscular weakness), hallucinations, and sleep paralysis.
Restless legs syndrome (RLS) is a neurological disorder characterized by unpleasant sensations in the legs and a strong urge to move them. People who suffer from RLS may mistake the problem for insomnia since RLS symptoms are usually worse at night, leading to insomnia at night and excessive sleepiness during the day.
The good news is that these sleep disorders can be easily diagnosed and effectively treated. If you have excessive daytime sleepiness and/or feel you may suffer from a sleep disorder, talk to a healthcare professional about the problem as soon as possible.
Excessive sleepiness may also be caused by a variety of physical and mental illnesses as well as some medications. If you suffer from a medical condition and you are experiencing excessive sleepiness, talk to your healthcare professional about the problem. In many cases, properly treating the medical condition may alleviate sleepiness. In other cases, sleepiness must be treated independently.

POLL DATA:

Excessive sleepiness is not just a matter of feeling lousy – it can also affect mood, relationships, work, and quality of life. According to the results of NSF's 2008 Sleep in America poll:

• 36 percent of American drive drowsy or fall asleep while driving
• 29 percent of Americans fall asleep or become very sleepy at work
• 20 percent have lost interest in sex because they are too sleepy
• 14 percent report having to miss family events, work functions, and leisure activities in the past month due to sleepiness

Each of these consequences can have an enormous impact on an individual’s health and happiness.
One of the most serious risks associated with excessive sleepiness is drowsy driving. NSF's 2008 poll revealed that a whopping 36 percent of American adults have nodded off or fallen asleep while driving. Sleepiness and driving do not mix. If you feel sleepy, you should not drive. Visit drowsydriving.org to learn how to prevent a drowsy driving-related crash.
There are several tools used to evaluate a person for excessive sleepiness. An individual’s personal report of how they feel is also important in characterizing a sleepiness problem. Interviewing a person’s bed partner or those sleeping nearby is also helpful in identifying things that occur during sleep (e.g., snoring and breathing pauses during sleep).
Special questionnaires developed specifically to provide insight regarding daytime sleepiness (these include the Epworth Sleepiness Scale and Stanford Sleepiness Scale). Sleep diaries may also be helpful in assessing and evaluating sleepiness as well as any underlying factors. Additionally, there are several tests that may be employed when a sleep disorder such as SDB or narcolepsy is suspected. Such tests may include an overnight sleep study or “polysomnogram,” and the Multiple Sleep Latency Test (MSLT).

TREATMENT:

Once a cause for excessive sleepiness is determined, there are generally a range of treatment options available to patients, including behavioral and pharmacological (drug) therapies. For example, if the primary cause of sleepiness is OSA, continuous positive airway pressure (CPAP) or an oral appliance may be prescribed. If excessive sleepiness persists in OSA patients using CPAP or is the result of narcolepsy, approved medications may be appropriate. For sleepiness caused by voluntary sleep deprivation or poor sleep habits, treatment will center on adopting behavioral measures to make getting adequate sleep a top priority.

COPING:

Although everyone should employ all the elements of good sleep hygiene, this is particularly important for anyone with excessive sleepiness. These are behaviors and habits that can promote healthy sleep, which helps improve alertness during the day. They include:

• Maintaining a consistent sleep schedule, even on the weekends
• Developing a regular, relaxing bedtime routine
• Using your bedroom only for sleep and sex; if you do this, you will strengthen the association between bed and sleep
• Create a sleep environment that is dark, quiet, comfortable and slightly cool
• Removing all work materials, televisions, phones, and other distractions from the bedroom
• Avoiding caffeine in the second half of the day
• Limiting alcohol – it can disturb sleep

For some people with excessive sleepiness, adopting healthy sleep habits is enough to resolve the problem.
People vary in their need for sleep, but experts agree that for most adults the amount needed to feel one’s best is somewhere between seven and nine hours per night. Teens and young adults usually need nine hours of sleep or more per night. If you suffer from excessive sleepiness that persists for more than three weeks despite allowing adequate time for sleep, discuss the problem with your healthcare professional.

Proper Pillow Placement For Any Sleeping Position

 

By Maddie Rudd

Sleep is one of the most elemental of human needs. Good sleep refreshes and rejuvanates the body and soul; bad sleep can make for a miserable day, week, month, or even year!*

Getting enough sleep can be difficult, and it certainly doesn't help if you can't seem to find a comfortable position. When you wake up in the morning with a cramp, what are the first words out of your mouth? "I must have slept wrong." Avoid tossing and turning (and prevent cricks in the neck!) by using proper pillow placement to align the spine and muscles for optimal relaxation.

*Trivia: There is a family in Italy for whom insomnia runs in the genetics. Upon reaching adulthood, carriers of the gene gradually get less and less rest, in spite of all attempts at treatment, until they eventually pass away from sleep deprivation.

Pillow Placement for Good Sleep

The natural curvature of the spine is illustrated here.

Did your parents ever tell you to "stand up straight?" As it turns out, they were giving you bad advice. The spine, when in proper alignment, possesses a natural S-curve, which pillows should support during sleep, so that your muscles don't have to. Misalignment causes your muscles to seize up, causing the cramps that wake you up in the middle of the night or the sore shoulder that bothers you for days after a bad sleep.
Proper pillow placement varies for different sleeping positions, but the principles are the same. Your body is probably used to sleeping one way, but you may want to try all the positions anyway, as pillow placement can make quite a change. It may feel unnatural at first, but when your body adjusts, it will end up thanking you.

Pillow Placement for Stomach Sleepers

Place the pillow under the hips and/or lower stomach.

Hip-Support Pillows

You've heard that stomach sleepers shouldn't use a pillow, or worse, that you should never sleep on your stomach at all. The fact is, sleeping face down is a natural human instinct, and with proper pillow placement, there is nothing wrong with it at all.

Place a pillow under the hips to take stress off of your lower back and neck. If you have a hard mattress, or otherwise find it too uncomfortable not to have cushioning for your face, try shifting the other pillow from your hips to under your ankles.

Pillow Placement for Side Sleepers

Place a pillow under the head and neck, and one between the knees.

Body Pillows On Sale

Sleeping on your side comes highly recommended by chiropractors, and, if you snore, your spouse as well. Also called the fetal position, this is the position God or Nature chose for us for the duration of our 9-month stay in the womb.

Place one or two pillows under the head and neck, depending on their thickness, to ensure that your cervical spine (see first illustration) is straight and elongated. An extra pillow between the knees opens your hips and prevents knees from knocking together or legs from chafing.
Another option is to buy a body pillow, which provides a "partner" to throw your limbs over... and best of all, it doesn't move just when you're getting comfortable.

Pillow Placement for Back Sleepers

Place one pillow under your head and one beneath the knees.

Sleeping on your back opens the lungs... and, unfortunately, can sometimes result in the worst snoring, for those prone to it. If you're not one of those (or if you sleep alone), put a pillow under the head, and another under the knees to relieve pressure on the lower back.

Facts About The History Of Pillows

Pillow Talk

|PAMELA DIAMOND

If your historic knowledge of pillows only goes back to the mid-'60s when the Fab Four were photographed having a staged pillow fight in the George V Hotel in Paris, then it's time you added a few more facts:
* The concept of the bed pillow is believed to date back to prehistoric times, when a pillow used to be simply a stone, a piece of wood or bundled grass.
* The first pillow was best described by Confucius five centuries before the birth of Christ: "With coarse rice to eat, with water to drink, and my bended arm for a pillow--I have still joy in the midst of these things."
* One theory has it that makura ("pillow" in Japanese) is derived from tamakura, which means resting your head on your hands.
* In 1897 Sears, Roebuck and Co. offered catalog customers 63 styles of pillows and fillings, with prices ranging from 45 cents to $6.10.
* Early Hollywood filmmakers used pillow fights on screen to stir emotions. The amount of feathers pounded from the casings depicted the degree of conflict.
* Interior designers used to be called "pillow puffers."
* The average comfort lifetime of feather pillows is 8 to 10 years, down pillows 5 to 10 years and polyester 6 months to 2 years.

Fall Asleep Faster With The Right Pillow

Pillow Support and Comfort

By: John Schubbe

It is a very comforting feeling to have just the right pillow to rest an achy, tired body on. In addition to providing comfort, the right pillows can also provide the necessary support for the neck and spine—alleviating or preventing many common forms of back pain and neck pain.

Main benefits of Pillows

Use of a pillow while sleeping has two main functions:

 Support: From a physical perspective, pillows prop up the head, neck and shoulders - keeping them in alignment, relieving pressure and counterbalancing the points in the body.

Comfort: From a more subjective perspective, pillows create a feeling of comfort, which aids in getting a good night’s sleep and feeling well rested.

Mattress Top Pillow

The traditional pillow is the mattress top pillow - used to provide support for the head, neck, and upper spine while the body is lying in bed in a resting position. For optimum support, it is best to select a pillow that has the following characteristics:

Pillow is designed to keep the spine in natural alignment

The human neck curves slightly forward (to sustain the weight of the head when upright), and it’s important to maintain this curve when in a resting position. If the height of the pillow is too high when sleeping sideways or on the back, the neck is bent abnormally forward or to the side, causing muscle strain on the back of the neck and shoulders. This type of position may also cause narrowing of the air pipe, resulting in obstructed breathing, and sometimes snoring, which can hinder sleep. Conversely, if the height of the pillow is too low, the neck muscles can also be strained.

Based on the body’s measurements and personal preference, the pillow should maintain a height of 4 to 6 inches, properly supporting the head and neck (and shoulders when lying on back).

Pillow feels comfortable

A large part of what makes a good pillow is personal preference. If the pillow feels comfortable, it’s likely to help one relax, get a good night’s sleep, and feel well rested in the morning. The pillow's surface can also be a source of comfort - some people prefer a pillowcase with a cool, smooth feeling (such as cotton), some prefer warmth (such as flannel), etc.

Pillow is adjustable

To help the pillow conform to various sleep positions, it is best if the pillow can be adjusted to fit the unique shape and curves and sleeping position of the user. A pillow should mold to one’s individual shape and alleviate any pressure points.

One’s sleep position will dictate how a traditional mattress top pillow can be used to provide the appropriate support.

Using a pillow while sleeping on the back

When lying on the back, a pillow should support the natural curvature of the cervical spine, with adequate support under the head, neck, and shoulders.

When sleeping on the back, the height of the pillow should be lower than in the sideways position. Placing a pillow or two beneath the knees further alleviates any back strain, and is the gentlest position on the back.

Using a Pillow while Sleeping on the Side

When lying on one’s side, a pillow should support the head and neck such that the spine maintains a straight and natural horizontal line. Weight should be evenly distributed so as not to create unnatural bending or pressure.

Some people may prefer placing a small pillow or rolled up towel under their waist while lying on the side for additional support.

Using a Pillow while Sleeping on the Stomach

If sleeping or resting on the stomach is preferred, the pillow should be relatively flat, or the head should rest directly on the mattress, so that the head and neck aren’t turned unnaturally to either side. In this position, it is often best to place another relatively flat pillow under the stomach to help the spine keep its natural alignment.

Over time, most pillows will begin to lose their firmness and no longer support the neck adequately. When the pillow has reached this stage, it should be replaced.

Different Types of Pillows

Rest and sleep are the body's chance to heal itself from the postural, physical and nervous insults of the previous day. The use of some of the following pillows can improve the quality of rest and repair, allowing one to wake up more rested and ready to face another day.

Pillow Choice Should be Based on Personal Preference

It is important to note that not all pillows work well for everyone. A short trial of one week should be enough time to decide whether or not the pillow is providing benefit.

Knee pillows. Using a traditional (mattress top) pillow either between the knees (when sleeping on the side) or below the knees (when sleeping on the back) is important to alleviate strain on the lower back.

 When sleeping on the side, bending the knees and placing a pillow between the knees prevents the knees from coming together and keeps the spine in the neutral position. When there is no support between the legs, the upper leg rotates downward, pulling the pelvis, and distorting the natural line of the spine. Adding support between the knees can prevent back pain induced by these types of forces and allow the back to heal and more properly rest while sleeping.

Usually, a firm pillow between the knees works better than a softer pillow because it serves somewhat as a kickstand to keep the upper leg from rotating over the lower leg.

When sleeping on the back, placing a pillow underneath the back of the knees helps reduce the load on the lower back. Some people even prefer to have two pillows to elevate their knees higher. With two or more pillows underneath the knees, the lumbar spine is flattened, putting less force on the pain sensitive facet joints of the spine.

This position is the best overall to help the back rest comfortably, and many people find that this is the only way they can sleep during an acute phase of back pain or while recovering from spine surgery.

Body pillows. A pillow that is as long as the body can serve several functions for people who prefer to sleep on their side, as the top portion can be used to support the head and neck, while the bottom portion supports the knees and legs. Some people find this more comfortable than using separate pillows for the head and knees. In particular, women who are pregnant may find that a body pillow that provides added support for the abdominal area helps them rest comfortably. Throwing the top leg over the body pillow while side sleeping should be avoided, as this places torque (twisting force) on the lower thoracic and lumbar spine.

Neck pillows. A pillow that is contoured to fill the spaces under the head and neck can be helpful for people with neck pain. Also called cervical pillows or orthopedic pillows, this type of pillow has a deeper depression where the head lies, and extra support under the neck. People with neck pain may favor these pillows, as they fill the hollow space created by the neck and help keep the neck in alignment with the spine. Some orthopedic pillows tend to wear out after one or two years and may need replacing.

Travel pillows. A "U" shaped pillow that is curved to fit snuggly around the neck can be used for sleeping or supporting the head when in a seated position. This type of pillow prevents the head from bending too far to one side or the other. It also creates a support so that the weight of the head is partially taken care of by the pillow. This relieves some of the work done by the muscles keeping the head up and may be beneficial while sleeping in a sitting position, such as in an airplane or in a car.

Lower back support pillows. A lower back support pillow helps provide support for the inward curve in the lumbar spine. Sitting for extended periods of time without any lower back support can create muscle tension and pain in the lower back and legs (e.g. sciatica). Used when in a seated position, a lumbar support pillow fills the natural gap that is created between the lower spine and the chair.

Lumbar back support is also helpful when sitting in a car. When the lumbar curve is supported, the downward forces of gravity and driving are absorbed much like a coiled spring, as opposed to a non-supported straight or slouched lumbar spine.

Donut pillows. As the name implies, this is a donut-shaped pillow that is placed on the seat portion of a chair. With either a depression or a hole in the center of the pillow, one can sit with much less pressure in the coccyx region (the tailbone). People who have suffered a broken or bruised tailbone or have coccygeal pain (such as coccydynia) may need this type of pillow in order to sit without pain.

Summary of Pillow Support and Comfort

Use of a variety of pillows for both comfort and support can make a big difference in alleviating or avoiding back pain or neck pain and getting a good night’s sleep. For people with spinal disorders, the right type of support can be especially important in helping the spine rest comfortably. It is hoped that this information can assist you to select the right pillows for the best sleep and that you will fall asleep faster thereafter.