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Struggling With Poor Sleep? Here’s One Factor You May Not Have Considered
Struggling With Poor Sleep?
Here’s One Factor You May Not Have Considered
I have recently started consulting for an adjustable bed company, alongside the clinical work I continue to do in sleep, breathing, airway health and orolfacial myofunctional therapy.
You may be wondering:
What does an adjustable bed have to do with the work I do?
And that is a completely valid question.
Before I became involved, I wanted to understand the science. I started looking more closely at the research around positional therapy and what happens to our breathing and upper airway when we sleep flat compared with when the upper body is elevated.
What I discovered was astonishing.
We spend around a third of our lives asleep, yet we don't often consider how the position of our body during those hours may influence our breathing.
What happens to our breathing when we lie flat?
When we move from being upright to lying flat, several important things happen.
Our lung volumes reduce, including Functional Residual Capacity (FRC) essentially the amount of air remaining in the lungs after a normal breath out.
The abdominal contents also place greater pressure against the diaphragm, and the mechanical forces helping to keep the upper airway open are reduced.
Why does that matter?
Because our upper airway is not a rigid tube.
It is surrounded by soft tissue and relies on a combination of anatomy, muscle activity and pressure to remain open while we breathe.
During sleep, we also lose some of the muscle activity that helps support the airway when we are awake.
For someone who already has a narrow or vulnerable airway, lying completely flat can therefore create an additional challenge.
Elevation can change the mechanics
This is where positional therapy becomes particularly interesting.
Elevating the torso can help increase end-expiratory lung volume and restore some of the downward mechanical pull, known as caudal tracheal traction, that helps stabilise the upper airway.
Think of it a little like gently stretching a flexible tube lengthways. Increasing that longitudinal tension can help make the airway less susceptible to narrowing and collapse.
And there is another factor at play: fluid movement.
When we lie flat, fluid that has accumulated in the lower body during the day can shift upwards towards the chest and neck. This is known as a rostral fluid shift.
This can increase the amount of fluid in the tissues surrounding the upper airway, contributing to narrowing and increasing airway resistance.
Elevating the upper body may help counter some of this gravitational fluid movement.
What about snoring and sleep apnoea?
Sleep position is particularly relevant for people whose sleep-disordered breathing is position dependent.
Some people experience considerably more airway obstruction when sleeping flat on their back than when sleeping on their side or with their upper body elevated.
This is one reason I think we need to look beyond simply asking:
"Do you have sleep apnoea?"
Instead, I like to ask:
"What is happening to your airway while you sleep, and what factors are contributing to it?"
For some people, anatomy may be the dominant factor. For others, it may be tongue position, nasal obstruction, respiratory control, muscle tone, sleep stage or body position.
Often, it is a combination.
Women can present very differently
This is another area that particularly interests me.
Sleep-disordered breathing doesn't always look like the stereotypical picture of a man who snores loudly, stops breathing repeatedly and falls asleep during the day.
Women can present differently.
Some may experience subtle inspiratory airflow limitation, where the airway doesn't completely close but becomes narrow enough that the body has to work harder to breathe.
Instead of obvious apnoeas, this increased respiratory effort can contribute to repeated small arousals from sleep and fragmented sleep architecture.
Someone may therefore wake feeling exhausted despite apparently spending enough hours in bed.
This is one of the reasons I am so interested in looking beyond AHI (apnoea, hypopnoea index) alone when assessing sleep and breathing.
REM sleep adds another challenge
During REM sleep, we experience significant muscle relaxation.
For someone with an already vulnerable upper airway, this loss of muscle support can make breathing more difficult.
This is particularly interesting when looking at people whose sleep-disordered breathing is predominantly REM-related.
Again, changing body position and elevating the torso may provide another mechanical strategy to support the airway during sleep.
The other point of difference: vibration therapy
One of the features that particularly interested me about these adjustable beds is that they don't just change body position — they also incorporate vibration therapy.
This immediately caught my attention because so much of my clinical work involves helping people understand the relationship between breathing, sleep and the autonomic nervous system.
Gentle vibration provides sensory input to the nervous system and may promote relaxation and a reduction in physiological arousal. Emerging research into vibration and related forms of somatosensory stimulation suggests potential effects on autonomic regulation, including measures associated with parasympathetic activity.
The parasympathetic nervous system is our "rest and digest" side of the autonomic nervous system, and the vagus nerve is one of its major pathways.
This is particularly relevant around sleep because we want to move away from a state of heightened sympathetic — or "fight or flight" — activation and towards the calmer physiological state that supports rest, recovery and sleep.
I see vibration therapy as another potentially useful tool for helping the body settle before and during sleep, particularly when it is combined with slow breathing and other nervous-system regulation strategies.
Vibration, movement and lymphatic flow
There is another interesting potential benefit: circulation and lymphatic movement.
Unlike the cardiovascular system, the lymphatic system doesn't have a central pump like the heart. Movement, muscle contractions, breathing and changes in tissue pressure all contribute to the movement of lymphatic fluid around the body.
Mechanical vibration can stimulate tissues and muscle activity, and research into whole-body vibration suggests that it may influence peripheral circulation and fluid movement.
The combination of movement, vibration, positioning and breathing provides an interesting area for supporting circulation, fluid movement and relaxation.
And that fits very closely with the way I already think about health: rather than looking at one system in isolation, we need to consider how breathing, circulation, sleep, the nervous system and movement interact.
So, where does an adjustable bed fit in?
This is where the connection to my clinical work became very clear to me.
An adjustable bed isn't simply about comfort.
It provides the ability to change the position of the body and elevate the torso in a controlled way, rather than trying to achieve elevation by stacking pillows underneath the head.
For the right person, this may form part of a broader positional therapy strategy to improve the mechanical environment in which they breathe during sleep.
And with the addition of vibration therapy, there is another dimension, potentially supporting relaxation, parasympathetic regulation, circulation and fluid movement.
An adjustable bed isn't a cure for obstructive sleep apnoea, nor should it replace appropriate assessment or prescribed treatment.
But it may be another valuable tool.
And that is exactly how I view breathing and sleep clinically.
There is rarely one single solution.
We can look at nasal breathing. We can look at tongue position and oral function. We can retrain dysfunctional breathing patterns. We can investigate the airway. We can address sleep habits. We can support nervous-system regulation.
And we can consider the position in which someone spends seven or eight hours breathing every night.
The more I have researched positional therapy, the more I have realised how closely it fits with the work I am already doing.
Sometimes improving breathing isn't about asking someone to do more.
Sometimes it is about creating a better environment for their body to breathe, rest and recover.
If you would like to learn more about how these adjustable beds may be able to help you, please get in touch.
Warmly,
Sal
Sleep, Breathing and Airway Educator
Thank you for your support
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