Why your sleeping position is shortening your life

From telegraph.co.uk 

Back, front or side? The position you favour has the potential to trigger its own set of health issues, from acid reflux to brain health

How many of us monitor our sleep posture? We have a favourite position; we fall asleep and that’s generally as far as it goes. But sleep position can have profound implications not only for the quality of sleep, but also for long-term health. Indeed, in the worst-case scenarios, a bad sleep posture may be slowly killing you.

Despite the impact sleep posture can have on conditions such as dementia and heart disease, research is limited and tends to focus on aches and pains. But back pain is just one implication of an unsuitable sleep position.

Chartered physiotherapist, sleep expert and author of The Good Sleep Guide, Sammy Margo, explains: “Sleep positions can significantly affect your overall health, comfort, and the quality of your sleep. Each position has its pros and cons and understanding them can help you make adjustments for better sleep and health outcomes.”

Dr Kat Lederle is a sleep scientist and the author of Sleep Sense. She points out that lifestyle factors in the day are usually the cause of postural problems at night.

“What you do in the day generally triggers the pain and discomfort that is felt when you sleep in certain positions. One of the most common contributing factors to this is a sedentary lifestyle, so it is important to move regularly during the day.”

The health risks of your sleep position – and how to mitigate them

Side sleeping

Depending on which side you lie, there are different health implications CREDIT: Andrew Crowley

Side sleeping is the most common position but there are health implications for certain people depending on whether they lie on their left or right side.

It is advised that pregnant women and anyone who suffers from acid reflux or gastroesophageal reflux disease (GERD) or other gut problems sleep on their left side.

“This is because the stomach is lower than your oesophagus,” explains Margo.

People with heart conditions, on the other hand, are advised to try sleeping on their right side to alleviate pressure on the heart. Studies show that when people lie on their left side the position of their heart shifts due to gravity. This causes changes in the heart’s electrical activity. Tissues and structures between the lungs hold the heart in place when you sleep on your right side.

Sleep position may also have an impact on brain health. During sleep the brain’s glymphatic system “washes” waste toxins away from the brain. There is evidence that suggests this process works better when we sleep on our right side.

“That is potentially of interest to people at risk of dementia or Alzheimer’s or any kind of neurodegenerative disease,” says Lederle.

Postural problems can occur with side sleepers depending on body shape, as Margo explains. “Women with hourglass figures sleeping on a soft mattress will sink into a banana shape and that will cause a strain on the spine and hips. While men who side-sleep can tend to get more pain in their shoulders as they get older and their muscles weaken.”

Side sleeping can also cause wrinkles and breast sagging because the skin on the face can get pressed against bedding and gravity can pull breast tissue and stretch skin.

One 2022 study by Beijing Forestry University and Chenzhou Vocational Technical College looked at the relationship between sleeping position and sleep quality. It used flexible wearable sensors to monitor sleep position and turning frequency. It concluded that subjects without sleep disorders who prefer to sleep on their side will sleep better than those who like to sleep on their back and that a higher frequency of turning during sleep will reduce sleep quality. 

Another study published in 2021 looked at relationships between sleep posture, back pain and quality of sleep. It reported that positions in which the spine was twisted can cause tissue microdamage and muscle spasms. The study compared common positions such as supine (back sleeping), provocative side lying (where the sleeper twists at the hip with one leg over the other), protected side lying (where the sleeper places a hand between the thighs and crosses the other arm over the chest), and prone (front sleeping).

It concluded that while it is not known if sleep posture is a risk factor for acute onset or recurrent back pain, participants with symptoms and stiffness in the morning spent more of the night in provocative (i.e. twisted at the hip) sleep postures.

To mitigate some of the problems associated with side sleeping Margo recommends using a thick pillow to align the head and neck with your spine and placing a pillow between your knees to support your hips and reduce strain on your lower back.

Back sleeping

Sleep apnoea is the most common health problem associated with back sleeping CREDIT: Andrew Crowley

One of the most common health problems associated with back sleeping is sleep apnoea, a condition whereby the soft tissue at the back of the throat relaxes and collapses the airway causing snoring and interrupted breathing.

Lederle explains: “This has implications for wider health and often goes hand in hand with obesity. It disrupts the continuity and quality of sleep. It can lead to tiredness, which can be a problem for people driving. There are also physical health implications. We know that poor quality sleep raises the risk of diabetes, heart disease and other comorbidities. Sleep apnoea opens the door to all these other conditions.”

One way to try to lessen the problem is to sleep in an elevated position.

However, for those who suffer from back and neck pain, back sleeping is often the best option.

Margo says: “The optimal position for spine alignment is lying on your back with a pillow under the knees to soften the back. This position preserves the natural contours of your spine. It can also minimise wrinkles.”

She also points out that for those who do not suffer from sleep apnoea, back sleeping can be a good position to train yourself into as you get older as back sleepers tend to have less back pain and back sleeping is also required for post-operative patients.

Front sleeping

'Twisting your neck to the side puts strain on your neck,' explains Margo CREDIT: Andrew Crowley

While stomach sleeping may reduce snoring because it can help keep the airways more open than back sleeping, it is the position most likely to lead to increased neck and back pain.

“Twisting your neck to the side puts strain on your neck, and stomach sleeping can also arch your spine,” explains Margo.

“Direct pressure on the face can contribute to wrinkles over time,” she adds.

To help alleviate postural pain front sleepers are advised to use a thin pillow or no pillow at all to keep the neck in a more neutral position and to place a pillow under the pelvis to help keep the lower back supported.

How to change your sleep position

It is normal to move around at night, some people are more active than others and if you move, it is not always indicative of problematic sleep.

If you want to change your regular sleep position, gradually train yourself. For example, if you want to change from a back sleeper to a side sleeper lie on your favoured side for five minutes the first night and then roll onto your back. The following night increase to six minutes, then seven and so on. Start slowly and build up until you get used to the position.

https://www.telegraph.co.uk/health-fitness/wellbeing/sleep/best-sleeping-positions-for-your-health-posture-back-pain/?WT.mc_id=e_DM320358&WT.tsrc=email&etype=Edi_Edi_New_Sub&utmsource=email&utm_medium=Edi_Edi_New_Sub20240506&utm_campaign=DM320358

Sleep and Lower Back Pain

From psychologytoday.com/ca

By Michael J Breus Ph.D.

Let’s face it: a lot has changed in 2020–and for many Americans, that means working from home. A side effect? For many of us, it also may mean an increase in low back pain and sciatica, which impacts everything from our daily lives to how well we sleep at night.

As someone who has not only suffered personally from back pain, but also has a wife whose back pain used to keep her up at night, I know first hand what a big…well, pain, sciatica, back and even neck pain can be. While a healthy sleep environment can help, sometimes it’s just not enough.

Justin Thottam, D.O. with the Spine Centre at Miami Neuroscience Institute has seen a 30 percent increase in patients with back pain, and that’s made worse as people work in uncomfortable environments and put off seeing doctors. 

This week, I’m going to encourage you to stop ignoring your back pain and sciatica, tell you how back pain is killing your sleep, and offer my sleep hacks to sleep better. 

How common are back pain and sciatica?

Trust me when I say that, if you suffer from back pain like I have, you’re in good company. According to the American Chiropractic Association, back pain is the main cause of workplace disability worldwide, costs $50 billion for American healthcare, and will impact as many as 80 percent of us, to some extent, in our lives.

Sciatica, which is described as pain that radiates down the spine and legs, adds to back pain woes. 5 to 10 percent of us with back pain also have sciatica, and while researchers say many recover, as many as 20 to 30 percent have chronic sciatica.

                                                        Source: Deposit Photos

Night Time Wakening and Poor Pain Control

Lower pain tolerance causes a rise in nerve activation–and that can result in disrupted sleep cycles. Because we may wake up more due to that nerve activation, we’re also less likely to go through all important sleep cycles. That can lead to less deep and REM sleep, leading you to feel groggy the next day. 

Pain Medications

One of the most common treatments for back pain and sciatica comes in the form of medication, whether it’s over the counter or even powerful prescription medications. The use of opioids have been linked to lower sleep quality, less REM sleep, and even disrupted sleep patterns.

A small 2016 study published in Anaesthesia took a look how sleep patterns for chronic back pain sufferers were impacted by opioid use. Participants on the highest dosage of opioids displayed brain activity linked to irregular sleep patterns. While more research needs to be done, it fits into previous research about medication and impact on how we sleep. 

Depression/ Anxiety Induced Insomnia 

I’ve discussed how mental health issues, especially chronic anxiety and depression can lead to insomnia. It turns out that just having chronic back pain can also lead to increased symptoms of both depression and depression-induced insomnia. 

In the largest study of the pain-mental health connection, 200,000 adults in 43 countries were sampled using a self reporting questionnaire. Those with chronic back pain were two times more likely to exhibit anxiety, depression, psychosis, stress, and subsequent sleep deprivation. 

Sleep Apnoea

Of all the connections I’ve looked into between sleep deprivation and back or sciatica pain, this one is perhaps the most surprising. Over the past decade, it’s become clear that many people who have sleep apnoea also have some form of back pain. 

There’s not evidence yet that one causes the other, but one thing is clear: sleep apnoea, coupled with back or sciatica pain, can spell disaster for sleep and even sleep quality. A study published in 2006 suggests that people with  back pain and sleep apnoea, on average, lose 4 hours of sleep per night. It seems, for reasons we don’t yet know, to especially affect REM sleep.

How do I sleep better if I have chronic back pain and/ or sciatica?

The good news is that there are many ways you can start improving your sleep, no matter where you are on your journey to treating your chronic pain. I find that even subtle changes can make a big difference, both for sleep quality and life quality. 

Manage Your Mental Health

The mind-body connection is real and should never be ignored. Even as you manage your back pain, you also need to keep in mind how depression and anxiety can affect your experience of both pain and sleep. Poor mental health can increase our awareness of pain, while coping and relaxation techniques may help do the opposite. 

Ask Your Doctor About Pain Management

If your meds are helping with your back pain but hurting your sleep, consider discussing alternatives with your doctor. While you should never just take yourself off pain medication, lifestyle changes can help with both lower back pain–and even improve sleep quality! Regular aerobic exercise, stretching, and even alternative therapies like reflexology and yoga may improve sleep and help manage moderate pain. 

Invest in a Better Pillow

A better pillow really can make a big difference, especially for back pain. In a 2015 randomized controlled study, patients with low back and lumbar pain were given supportive pillows for their backs. After a twelve week follow up, there were remarkable improvements in pain management, as opposed to improvements made with just physical therapy.

Upgrade Your Mattress

While you’re at it, you should take a long look at your mattress–in fact, changing my mattress is what has made the biggest difference for my personal back pain and improving my sleep. If you’ve had your mattress for longer than 8 to 10 years, it’s time to start shopping. Here are my suggestions for the best mattresses for back pain. 

Consider The Best Sleeping Position For Back Pain

How you sleep matters too. Sleeping on your side is associated with less back pain, and even reduced snoring. Snoring may be a sign of sleep apnoea if you snore regularly you should see a sleep specialist to determine if you have sleep apnoea.  

Other positions that can help with lower back pain relief include sleeping on your back with a pillow under your knees, or sleeping on your stomach with a pillow under your stomach. You may also try sleeping in a reclining position if your bed adjusts or by adding a wedge to your bed to elevate your upper body.

Sleep Well, Be Well.

https://www.psychologytoday.com/ca/blog/sleep-newzzz/202010/sleep-and-lower-back-pain

5 Surprising Sources of Insomnia

From psychologytoday.com
By Michael J Breus Ph.D.

Having a hard time falling asleep?

If so, you’re not the only one. Research indicates one in four Americans suffers from acute, or short-term, insomnia each year. This common sleep disorder includes symptoms like daytime fatigue, having a difficult time concentrating, and frequently waking up during the night. But insomnia is notorious for its best-known symptom: sufferers often have an incredibly hard time falling asleep at night.

Insomnia has been on my mind lately considering the emotional stress many people are dealing with as a result of the coronavirus outbreak.

Stress is often a catalyst for insomnia, and the weight of the stay-at-home orders, coupled with fears a loved one could potentially be affected by COVID-19 or an outcome of it, can be incredibly taxing.

I won’t be surprised at all if data later indicates cases of acute insomnia increased during this time period.

                                                             Source: Deposit photos

There are a number of ways insomnia can negatively impact your health, but the one thing I keep coming back to lately is how important quality sleep is — especially during a pandemic.

You might remember this stat from earlier this year: people who get 6 hours of sleep or less each night are 4.2 times more likely to catch a cold than those who get 7 hours or more. In other words: Not sleeping isn’t doing your immune system any favours.

Sleep is vital right now. That’s why this week I wanted to run through 5 surprising sources of insomnia you might not know about. Watch out for these pitfalls, and you should give yourself a better chance of avoiding a bout of insomnia.

Bed Confusion
This might be a new one for you.
Bed confusion is when your body fails to associate your bed with going to sleep. This typically stems from doing too many activities in your bed that are not directly related to sleep. Whether it’s reading, doing a crossword puzzle, having a late-night snack, or surfing your favourite social media app, you’re better off not doing it in bed.

We are creatures of habit and we also learn cues. Remember Pavlov’s dogs? After some conditioning around cues, they salivated when he rang a bell.
We are not different. When we lay in bed, watch TV, scroll social media, and eat (often mindlessly, especially now), our brain and body start to respond to bed as a place to be activated, not a place to rest.

As a general rule, you want to reserve your bed for two primary functions: sleep and sex. Do that and you’ll help your body avoid bed confusion.

Back Pain
Anyone who has dealt with back pain before knows it’s the worst. One small turn in the wrong direction can suddenly have your body feeling like it’s been stuffed into a trash compactor.

That lingering and often searing pain that accompanies back injuries can make it incredibly difficult to fall asleep and stay asleep — one of insomnia’s trademarks.

Two quick tips to avoid having back pain derail your sleep. For those not suffering from back pain currently, remember to stretch. Stretching each morning for five minutes, especially as you get older, can loosen up your back muscles. This will give you a head start on making sure your back doesn’t keep you up later at night. And for those who do suffer from back pain, try placing a small pillow behind your knees when you go to sleep. This should help alleviate some of the pressure on your spine.

Menopause
To all female readers, please keep in mind: You are especially susceptible to insomnia when going through menopause. This has to do with menopause being driven by a drop in hormone production, including estrogen and progesterone.

Estrogen is known for being a hormone that regulates women’s reproductive function and menstrual cycle, but it also contributes to better sleep. Higher estrogen levels are connected to fewer sleep arousals during the night, as well as an easier time falling asleep.

Progesterone, on the other hand, helps prepare women for pregnancy. It also regulates mood, protects against anxiety, and contributes to a sense of calm. I often refer to progesterone as the “feel good” hormone; it’s been linked to increased production of GABA, a neurotransmitter that promotes better sleep.

Overall, hormones perform a delicate balancing act to help regulate mood, energy levels, libido and sleep — among other functions. Understandably, when there’s a decline in hormone production, it can throw off sleep patterns.

Maybe the most disturbing part of menopause for many women is hot flashes, and bedtime is when they are often noticed most. It’s even worse when your bed partner is as hot as a heater, too!

Your Diet
What you eat also impacts how you sleep.
Researchers from Columbia University earlier this year found that diets high in refined carbohydrates are associated with a higher risk of developing insomnia. That means soda, sugary foods, white rice and white bread are all foods you should eat in moderation.

But what is the temptation when we are bored and stressed? Refined carbohydrates and sugar!
How do these interfere with quality sleep? The reason refined carbs can be a problem, the study indicates, is that the body releases insulin when blood sugar increases rapidly; when blood sugar drops, hormones like adrenaline are released, which may make it harder to fall asleep.

On the opposite end, diets that include a large amount of fruits and vegetables did not increase a person’s risk of insomnia. While containing sugar, the fibre in fruit helps better moderate blood sugar spikes than refined carbs.

Napping
Naps aren’t bad for you. In fact, a well-timed nap comes with a number of health benefits, including giving you an energy boost, helping elevate your mood, and improving your physical performance.

But the old phrase “everything in moderation” certainly applies here. You don’t want your nap interfering with falling asleep at night, but that can often be the case.

To make sure that doesn’t happen, you want to watch out for two things. First, keep your naps to the early afternoon, if possible. Anything after 4:00 p.m. threatens to make it harder for you to fall asleep at a “normal” hour. And second, stay away from taking long naps. Longer than 90 minutes, when REM sleep starts to take place, is too much time. You run the risk of not feeling like you need to go to sleep at night, even though your body isn’t completely rested.

Instead, 20-30 minute “power naps” are a great alternative.
Spend some time focused on eliminating or treating these sources of insomnia and you may find yourself sleeping better and feeling more rested in the morning.

https://www.psychologytoday.com/us/blog/sleep-newzzz/202004/5-surprising-sources-insomnia