One of the jobs I had in college was loading trucks for UPS. It was the most exhausting job I’ve ever had. It made Army Basic Training seem like working at a library. One night I came home so worn out that I couldn’t even turn to my side to go to sleep. After an entire childhood as a side sleeper, I became a back sleeper. And until recently I remained a back sleeper.
Me as side sleeper (2 days old)
On the night of January 23rd I woke up with a severe headache and discovered I was having trouble breathing. I was alarmed enough to spend a few hours researching sleep apnea. I had always assumed that because I am lean and do not snore that sleep apnea wasn’t possible. Turns out that was a false assumption. One of the things I learned was that you can increase oxygen flow by sleeping on your side. From the Wikipedia page on sleep apnea:
For mild cases of sleep apnea, physicians often recommend sleeping on one’s side, which can prevent the tongue and palate from falling backwards in the throat and blocking the airway.
I wasn’t even sure I had even a minor case of sleep apnea, but this was worth trying. I had assumed it was going to be a hard habit to switch from being a back sleeper to a side sleeper. Well, it took just 3 nights to break the habit. I must be getting good at this self experimentation stuff. I never thought I could break such an ingrained habit in less than a week. Anyway, some interesting data appears to be surfacing. I hesitate to get excited about this though, because I’ve been burned by initial trends too many times already.
Measuring Sleep Quality
Starting last August 21st, I began tracking sleep quality independently from headaches. Although they are correlated, that correlation is not 100%. Sleep quality can be improved by improving a response to a headache of a given severity. A poor response results in poor sleep quality. A good response results in an improved Sleep Quality score even at the same severity. Side sleep – so far – seems to be having a positive impact on Sleep Quality. To the data!
AVG Night HA AVG Sleep Quality # Bad HA (3+) # Very Bad HA (4+)
APR 2011 1.07 - 6 2
MAY 2011 0.71 - 5 1
JUN 2011 1.37 - 9 5
JUL 2011 1.94 - 13 7
AUG 2011 1.68 - 9 6
SEP 2011 0.90 3.87 5 2
OCT 2011 2.13 3.26 14 6
NOV 2011 1.45 3.76 8 6
DEC 2011 1.26 4.06 9 5
JAN 2012 1.35 3.81 5 2
FEB 2012 1.03 4.14 6 2
BACK SLEEP (161) 1.46 3.70 47 (29%) 24 (15%)
SIDE SLEEP (35)* 1.06 4.14 8 (23%) 2 (6%)
* The Side Sleep numbers uses 5 days worth of March 2012 data. AVG=average, HA=Headache, Headaches are scored on a scale of 5, with 0 representing no headache and 5 being the most intense. Sleep Quality is also ranked on a scale of 5, with 5 being perfect sleep.
Looking at the data, it appears that there was some improvement when I went from being a back sleeper to a side sleeper. I hesitate to get excited, because I may just not have enough data to draw a true conclusion. My hunch tells me that sleeping on my side is increasing my sleep quality by delaying the headache until later in the night. And maybe by delaying the headache, it surfaces with a lower intensity.
Trading One Problem For Another?
Since I started side sleep, I have noticed many mornings that I wake up with pressure in my right ear. Almost like the first few times I flew in an airplane. It isn’t painful, but it is annoying. I’ll happily take a few hours of ear pressure over a sinus headache any day, as I don’t feel it until after I wake up. This might even be a clue to the root causes of the headache?
I’ll continue sleeping on my side and collecting more data. The hunt continues.
Ali
Mar 6, 2012 — 9:00 am
I again find myself intrigued with your methods and results.
I have always been a side sleeper, but have found that sleeping on my side allows my jaw to sit off-kilter. I clench (sometimes grind) my teeth in my sleep and my front-right-top tooth has an indent where my front (2nd position)-left-bottom tooth has dug into it. I always thought my teeth were just a bit uneven until a dentist lined them up for me. It’s a perfect fit that I never would have put together because it strains my jaw when I manually move it that far over.
As you can imagine, clenching my teeth causes headaches (and jaw pain), and clenching them off-kilter just heightens the aches as all the pressure is focused on those two teeth instead of being distributed across my entire jaw line.
On the other hand, I just can’t manage to sleep on my back as I prefer to bend my knees as I sleep.
What I’ve started doing is sleeping somewhere between on my side and on my back: I sleep with a pillow against my back at an angle that allows my knees to be bent while also allowing the back of my head to be resting on the pillow/mattress (sometimes I don’t use a pillow for my head). Not only does my jaw align correctly if I’m looking straight up, it seems to allow my jaw to hang open just slightly. I’d rather have a bit of a dry mouth than clench my jaw all night long. 8)
As for the ear pressure, perhaps your sinuses are draining to that side of your head? Not sure about where you are, but here in FL it’s the worst time of year for me in regards to sinuses.
Your next experiment might be to sleep at a bit of an incline, possibly slowing or stopping the sinus pressure build up that happens while you’re lying down.
MAS
Mar 6, 2012 — 9:08 am
@Ali – I probably spend 70% of the night on my left side, which makes the fact the pressure is only the right side more bizarre. Last summer I experimented with adjusting the angle of my bed, but that really disturbed my sleep.
Aaron
Mar 7, 2012 — 8:35 pm
Interesting. For me personally, the tongue and palate falling back into your throat thing happens when I try to sleep on my back. It restricts my breathing and wakes me up … in other words, I cannot sleep on my back.
Aside from this, I think getting more oxygen on your side has to do with gravity acting against the ‘direction’ of your lungs in the two different positions.
Regardless of why, more oxygen is more oxygen and just may be a find in your headache hunt. By the way, did you get sinus headaches before college when you were still a side sleeper?
MAS
Mar 7, 2012 — 8:48 pm
@Aaron – I don’t recall getting the headaches in college. I really wish I would have started tracking the data many years ago.
Also this study on sleeping positions shows that sleeping on your back isn’t Paleo. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1119282/
balor123
Mar 12, 2012 — 8:19 am
I’m 5’10” medium build and 155lbs and have an AHI of 50 at age 30 – you’re not alone 🙂 I estimate that it was untreated for about 10 years. I use a CPAP now and I’m guessing that this condition is probably more responsible than my SAD diet for my current ailments. With roughly 1/4 of American men estimated to have this condition, it’s a surprise that we don’t all undergo testing routinely. Anyway, wear a t-shirt backwards and put a tennis ball in the pocket to stay on your side. You can get an overnight oximeter for about $100 to see if it’s working, though a sleep study is the gold standard as in many cases the oximeter won’t show the apneas and hypopneas.
MAS
Mar 12, 2012 — 8:24 am
@balor123 – I had to look up the word AHI.
http://sleepdisorders.about.com/od/sleepdisorderevaluation/a/What-Is-Ahi.htm
50 is a lot!
Turns out I didn’t need the tennis ball trick. Once I fell asleep it was easy to stay on my side. It just took a few nights to kick start my sleep on the side. Now I’ve converted. I will sleep on my back only for short naps.
balor123
Mar 12, 2012 — 8:29 am
Yes it is. Sleep studies showed that disturbances only occurred while sleeping on my back. It also showed that I start on my side and move to my back within ~30min of falling asleep. Not sure what I can do to train myself not to sleep on my back but I can certainly sympathize with the sleeping on your back is not healthy experience 🙂 Will retest in a year or two to see if going Paleo improves sleep apnea. To my knowledge, no one has looked at this yet!
rachel- even one sparrow
May 22, 2013 — 7:02 pm
This is fascinating! I have always been a side sleeper, especially after two pregnancies (you basically have to sleep on your side, and they encourage the left side). However, I’ve recently been seeing a chiropractor to improve my running and relieve sciatica. Apparently, I’ve been slowly rotating my hips over these years by side sleeping and it has caused one leg to be longer than the other. He told me to only sleep on my back. Now I’m confused! I get such better sleep on my side but I thought that was because of what I was used to. But I’ve been trying the back thing (but after I feed my daughter at 4 in the morning, I “treat” myself to sleeping on my side!).
MAS
Apr 16, 2014 — 11:41 am
Closing out comments on this post.
https://criticalmas.org/2014/04/last-post-headaches/