ZACH MOORE: Welcome to On Health with Houston Methodist. I'm Zach Moore. I'm a photographer and editor here, and I'm also a longtime podcaster.

TODD ACKERMAN: I'm Todd Ackerman, I'm a former medical reporter, currently a health editor at Houston Methodist.

ZACH: And Todd, how do you sleep? And by how, I mean, what position do you like to sleep in?

TODD: Thanks for clarifying that.

ZACH: Yeah.

TODD: I sleep very well, thank you.

ZACH: Yeah.

[Laughing]

TODD: I sleep on my stomach…

ZACH: Okay.

TODD: Which I say somewhat sheepishly because that is -- I think most people do not think of that as the best way.

ZACH: Yeah. If you were a baby, someone would come flip you over.

TODD: A woman once said to me, “That’s how babies sleep.”

[Laughter]

Didn’t really appreciate it.

[Laughter]

You know, I fall asleep very easily on my stomach. I have trouble falling asleep on my back or side.

ZACH: Okay.

TODD: I think as the night goes on, I move around my share and sleep on my side some. But it’s very hard for me to fall asleep not on my stomach.

ZACH: Interesting.

TODD: Which, from a previous blog we did, is the rarest sleep position by people. I think 10-20% sleep that way. How about you?

ZACH: I think I would say the fetal position. One side or the other usually my go-to. I can go to sleep anywhere, though. But I think I like, you know, I’m settling in that way.

TODD: Okay. And that’s how you stay during the night? Does your wife tell you?

ZACH: I might turn left or right, but I’m pretty stationary. I can fall asleep anywhere, I can stay there for as long as it takes.

TODD: This is a real skill of yours. Did you work on this?

ZACH: I was born that way. Born that way, I guess. No, I can fall asleep, you know, on a bus. I mean, it depends on how tired I am, right?

TODD: Yeah, sure.

ZACH: So, if I’m at extreme levels of exhaustion, I will fall asleep.

TODD: Right.

ZACH: So, I like that about myself. And then, I immediately am recharged. You take a five-minute nap out of nowhere, you wake up, you’re alert, you know?

TODD: Sleep on planes?

ZACH: Oh yeah. Big time sleeper on planes.

TODD: Well, you know your sleep position can be very aligned to snoring and sleep apnea, which I know is -- can be an issue for you.

ZACH: Yes, yes. So, that’s part of the problem as far as me sleeping on my back. Like, sometimes -- because I go to sleep so easily, right? So, if I’m tired, I’m gonna lay back, you know, go to sleep on my back. And I have a form of -- I don’t know how serious it is or not, but I have sleep apnea to some degree, as we diagnosed on this podcast.

TODD: Yes. You did follow that up and see a doctor?

ZACH: I did. I do occasionally follow up on the health things we discuss here on the podcast, Todd. I know you’re keeping track.

TODD: Yes.

ZACH: So, I do the mask now. That I don’t -- I don’t wear all the time. My wife wishes I wore it more. But I’ve noticed that if I do go to sleep on my side, she doesn’t wake me up and tell me to put my mask on.

[Laughing]

So, if I go to sleep on my back, “Hey, wake up. Put your mask on,” right?

TODD: It’s, kinda, still loosey goosey. You don’t have, like, a set plan to always sleep on your side?

ZACH: No. Though I should. My wife would probably appreciate me having a more set plan.

TODD: This week’s podcast is with a doctor who will talk a lot about sleep position and its effect on things like snoring and sleep apnea.

ZACH: Who did we talk to today, Todd?

TODD: We talked to Dr. Mas Takashima who’s a sinus specialist and  board-certified Doctor of Sleep Medicine.

[Sound effect plays to signal beginning of interview]

Well, greetings Dr. Takashima.

DR. MAS TAKASHIMA: Great to be here.

TODD: Eager to talk with you again. This time, we’re here to talk about sleep position.

DR. TAKASHIMA: Yeah. Such an important topic, right? Because if you’re not sleeping well because of your sleep position, then overall -- sleep is such an important aspect of our health that I think a lot of people don’t really realize how important it is. You know, we’re supposed to sleep at least eight hours a night. So, if you think about it, that’s about a third of our lives. So, why shouldn’t we be talking about how to improve our sleep via sleep position as well as other aspects that we can change?

TODD: So, very generally, what are all the aspects of health that sleep position can affect?

DR. TAKASHIMA: So, when you talk about sleep, really, you’re trying to get the patient in the most restful, most comfortable position so that their sleep won’t be disturbed. And overall, if you’re a really healthy person, as long as you’re sleeping well, you’re not waking up with aches and pains or discomfort, and/or waking up in the middle of the night because of discomfort or issues with your position, then at that point, you know, as long as you’re sleeping well, that’s all that really matters. But unfortunately, as we all get older, there are certain medical conditions that may benefit by sleep position itself. And so, take for example, sleep disordered breathing. And that’s just the fancy term that we use for snoring. And as many of our listeners probably can relate to, snoring is really dependent quite significantly on sleep position. So, take for example, if you’re sleeping on your back, you’re letting gravity aid in the collapse of your airway. And so, because of that, people tend to snore significantly more. When you’re also on your back, you tend to breathe a little bit less out of your nose as well. And so, then you’re diverting that column of air from your nose to your mouth. And when that column of air is going back and forth inside your mouth rather than your nose, you’ve got a lot of floppy tissues in the back part of your throat that’s gonna also exacerbate the snoring. We always think of health issues associated with sleep disordered breathing. But also, the other caveat to that is that we’re not really thinking about, you know, our bed partners, our spouses, our significant others, right? Because if you’re a loud snorer or if you’re thrashing in the middle of the night, you may still feel like you slept pretty well, but your significant other probably didn’t. And so then, you’re causing a sleep related problem in your loved ones as well. And so, you know, there’s a lot in this that we really have to parse through.

TODD: Is there a lot of medical research into sleep position?

DR. TAKASHIMA: There isn’t a great deal of research when it comes to sleep position. I do know that at one point, there was a significant amount of research placed in sudden infant death syndrome and how you should be positioning your baby when you place them in the crib. But other than that, there really hasn’t been a great study out there looking at the quantitative data to really support one position over the other. It’s more about general things such as alignment of your spine. Like I talked about, you know, from a sleep disordered breathing standpoint. There’s also some digestive studies out there too showing that if you sleep on your left side, reflux tends to be better. People who are pregnant, they also tend to do better on their left side typically from a comfort standpoint. And so, I mean, I think there’s a lot of different factors out there. But unfortunately, from a research standpoint, it’s quite sparce.

TODD: So, I hear people often going in for sleep studies ‘cause they’re having sleep issues. That’s just, like, an individual thing? It’s not collected as any sort of larger study they’re doing?

DR. TAKASHIMA: Right, so positional sleep therapy is important because there are some patients, when they sleep on their side, their obstructive sleep apnea or their sleep disordered breathing completely goes away. Patients such as that would definitely benefit from changes in their sleep position to help facilitate their breathing. We actually did a study here at Houston Methodist looking at sleep position as well and correlating that with obstructive sleep apnea, seeing if it really makes a significant difference. And what we actually did is looked at patients with obstructive sleep apnea, and while they’re snoring and obstructing in front of us, and this is with sedation, we looked at their airway with a small, little camera going into the nose, into the back of the throat. And so, we turn positions left, we turn positions right, we put them on their back just to see anatomically what that does to their airway. And clearly, on their back, you just have gravity supporting the collapse of the soft palate or the soft part of the roof of the mouth against the back wall of the throat. And that can definitely lead to obstructive sleep apnea and definitely to snoring.

TODD: So, is this a pretty established, settled science, or is there a lot doctors are still learning about this?

DR. TAKASHIMA: You know, overall, there’s some basic concepts that I think are relatively well known in our medical community. However, when it comes to randomized control trials, sham control trials, there really is a possiblity of that.

TODD: So, you mentioned that your sleep can disrupt your partner, but what if you’re sleeping alone? You think you’re sleeping okay, but is there much of a chance that you’re just unaware of what’s going on?

DR. TAKASHIMA: Yeah. And that’s a great question because a lot of our patients that we see from a sleep disorder standpoint, it’s not the patient that’s complaining, it’s typically the significant other that’s forcing the patient to come in. And so, frequently, I’ll have the patient say, “Hey, you know, I don’t have any troubles with my sleep. It’s my wife that has trouble with my sleep.” And we hear that quite often. But you’re correct, you know. If you’re sleeping alone, then you may not realize some of the issues that are occurring. Now, there are a lot of symptoms associated with obstructive sleep apnea such as mental fatigue, just chronic tiredness. It can also cause problems with high blood pressure, it can increase the incidences of stroke. It can decrease libido. It can also cause problems with anxiety and depression. And so, knowing all of that, clearly this is something that we definitely need to address appropriately.

TODD: So, it can be dangerous. It’s not just a quality of life thing or all those -- that litany of things that you mentioned, some of them sounded like it could lead to a shorter life.

DR. TAKASHIMA: Absolutely. You know, when it comes to heart health especially, and that’s what we’re really concerned about. Well, take for instance, if you’re not breathing at night, as you can imagine, your body, sort of, freaks out per se. And it realizes the fact that it’s not oxygenating. And so, then it releases epinephrine, adrenaline, into your body to try to get you to breathe. And by doing that, that raises your blood pressure and then concomitantly, that can also raise it to a significant degree that it can result in strokes and other neurological complications. And so,  clearly, we wanna avoid that. We frequently have cardiologists who have trouble controlling patients’ blood pressure to send patients our way because of their sleep apnea. And once we regulate, treat, control their sleep apnea, their blood pressure also gets better. So, you know, the other way to look at it also I think is, I’m sure you probably have a significant other or family members, friends, who you’ve seen snoring or gasping for air. And just watching them breathe at night, I mean, I get tired just watching some of these folks trying to breathe at night. There’s a lot of energy that’s expended just trying to breathe. And so, because of that, as you can imagine, all that energy utilization at night can also lead to the fatigue the patients experience during the daytime. It’s all about decreasing the upper airway resistance and changing that sleep position, even minimally, can possibly do that.

TODD: So, at a certain age, is it whatever works best for the individual to enable them to fall asleep? I mean, you hear a lot about older people having difficulty falling asleep, does position factor into that much?

DR. TAKASHIMA: You know, that is the ultimate goal, right? Because as long as you’re sleeping well, you know, that is of paramount importance. If you have aches and pains, if you have arthritis, if you have back problems, our main goal is to change your sleep position so that that pain isn’t disrupting your sleep. But on top of that, if you decrease the pain, overall, you’re aligning your body in a better position so that it is less aggravated or less irritated. And so, that’s our ultimate goal. Decrease that irritation, decrease that pain, decrease that inflammation, decrease that upper airway resistance so that overall, patients sleep better. And like I mentioned before, you know, young folks, you know, when they don’t have a lot of these other medical problems that afflict some of the older patient population, it really doesn’t matter how you sleep as long as you’re sleeping well. But, for the older population with some of these medical issues, changing your sleep position in one way or another can definitely help with your overall sleep.

TODD: So, that said, is there generally a best sleep position? I know that it’s, kind of nuanced for different conditions you have, but it seems like I read that sleeping on your side is the best and on your stomach is the worst. Is that true?

DR. TAKASHIMA: Side sleeping in itself is considered the best sleeping position overall, and part of the reason why is because it does decrease a lot of these issues that we talked about such as reflux. It also helps, to some degree, cardiovascular health. And on top of that, decreasing upper airway resistance. And also like I mentioned before, pregnant patients typically do better on their left side too, and that’s just all anatomical where the organs are located, where the fetus is located. You know, the opening of the stomach is more on that right side, and so if you’re sleeping on your left side, it’s harder for reflux to actually occur. And so, it’s all anatomic per se. And that’s, sort of, the reason why side sleeping is considered the best, you know, especially if you have back pain, side sleeping with a pillow between your knees can really help align the spine a little bit better so that there’s less compression of the joints and so forth of your back. But there is the thought that overall, from a spine health standpoint in terms of the curvature of the spine and everything, if you’re not having back pain, and if you want to try to have the optimum position for your spine, it’s actually better to sleep on your back.

TODD: How about sleepers who move around a lot from position to position. Is that somewhat normal or not a good thing?

DR. TAKASHIMA: Overall, it’s not an unusual thing, and we do have some very active sleepers that will toss and turn and so forth, but a lot of times, why they are tossing and turning is what we want to try to figure out. Is it because they are uncomfortable? Is it because they have pains? You know, depending on how you sleep, you can also be blocking circulation to certain parts of the body, you know, such as the arms, such as the hands, and so forth. And so then, you wake up with pain because of that. And so, you know, those things are all factors that we need to consider. There are conditions such as restless leg syndrome or periodic limb movements that can occur in sleep. And so, you know, some people are very vigorous with their leg movements in sleep. And a lot of times, it is related to sleep apnea where patients aren’t breathing very well. But there are also other conditions such as iron deficiency, anemia, that can also cause some of these symptoms. But in the end, if you have a very active person in terms of their legs, it can definitely disrupt their sleep. But on top of that, kicking your spouse probably isn’t the best thing either.

TODD: Like, putting yourself in a certain position isn’t gonna affect that. If you’ve got that syndrome, you’re gonna do it no matter what?

DR. TAKASHIMA: That is correct.

TODD: Okay, so let’s break down these different health conditions that sleep position might affect. You touched on sleep apnea and snoring. Is there anything else you wanna add to that?

DR. TAKASHIMA: You know, from a sleep apnea standpoint, it really doesn’t matter which side you sleep on as long as you’re just fighting gravity, you know, by sleeping on your side so you’re not allowing all your soft palate to collapse to your back wall. And so, sleeping to the left side or sleeping to the right side really doesn’t matter to a significant amount, as long as you’re on your side. With that being said, I do hear all the time patients who state that they get congested out of their nose on one side, and then they’ll flip over to the other side, and then that side will open up, and then the other side will get blocked. And that is all due, pretty much, to gravity, really, to tell you the truth. The side that’s on top when you’re sleeping on your side, there is more gravity pulling that blood out of that turbinate and so, you tend to get decongested on that side. However, the dependent one, the one that’s closer to your pillow will unfortunately, engorge a little bit more with blood. And so, people typically get congested on one side versus the other. And so, they’re breathing better out of their nose, and overall, their sleep apnea is better because they’re not sleeping on their back.

TODD: You do that, sort of, while asleep or are you awake enough to sort of consciously realize that you need to flip?

DR. TAKASHIMA: Yeah. And so, most people don’t realize that, they just realize that subconsciously, they realize that they’re not breathing well out of their nose, and so, they will do that. But, there are very light sleepers out there too that notices that, it wakes them up, you know, they flip. It gets better to some degree for a while, then they’ll flip back. And so, if that becomes a long-term problem, obviously, there are other things that we can do to the swelling that’s occurring inside these patients’ nose so that it doesn’t happen on a regular basis like that.

TODD: Okay. And acid reflux, heartburn, you mentioned those two.

DR. TAKASHIMA: Yeah, so acid reflux, you can definitely reduce the amount of acid reflux, and there’s definitely some literature on this as well by sleeping on that left side. And so, for the most part, looking at all these issues that can occur, and the issues that are resolved with sleep position, overall if you sleep on your left side, it’s typically better for most conditions. Now, obviously, you know, if you have a shoulder injury and you can’t sleep on the left side, and that disrupts your sleep, then of course, you know, you should get into a position that’s most comfortable for you. But overall, reflux, heart health, sleep apnea, as well as pregnancy, all of those is typically better on the left side versus the right side.

TODD: Back issues, you mentioned that’s the one area where sleeping on your back is probably best.

DR. TAKASHIMA: Yeah. So, if you don’t have any back issues, it’s actually better to sleep on your back. And so, overall, the curvature of the spine, typically, is aligned by sleeping on your back. And so, overall, the health is better. But that being said, if you already have back pain, it typically is better to sleep on your side because it puts the spine in a neutral position, less compression of the joints and so forth. And so, it just depends on, you know, if you actually have active back pain or not.

TODD: Okay. And so, you mentioned heart issues. So, that can -- your position can affect high blood pressure or heart failure, those kind of things?

DR. TAKASHIMA: Yeah. And, you know, there really isn’t great literature on that. But just anatomically speaking, the vena cava can be less compressed if you’re actually on the left side versus the right side. There’s also other electrical stimulation research being done in regards to the heart, there’s also other research being done looking at the parasympathetic and the sympathetic pathway that regulates arrhythmias and so forth of the heart, which are improved to some degree on that left side, but then again, like I said, you know, the research is still pretty sparce on that.

TODD: And sleeping on your stomach is bad for wrinkles?

[Laughter]

DR. TAKASHIMA: Well, I think, you know, sleeping on your stomach, there’s a lot of issues associated with sleeping on your stomach because, you know, just look at the position of the person that’s sleeping on their stomach. You know, their head is contorted in a very strange way, definitely not a natural position, then they have to put their arms somewhere as well, a lot of times it’s over their head or under their pillow being compressed. And so, there’s all of those issues, you know, people tend to drool a lot more, obviously. If you’re also sleeping on your stomach. And so, that can also be a potential concern. But you’re right, you know? The more pressure that you have on your facial skin, it can definitely exacerbate wrinkles. And so, from a cosmetic standpoint, it is better to not sleep on your stomach.

TODD: So, is there anything good that comes from sleeping on your stomach? I ask this because I sleep on my stomach. At least to fall asleep, I kinda need to be that way to fall asleep. And then, I think I flip to my side at some point.

DR. TAKASHIMA: You know, there’s also some concerns that the spine isn’t in good alignment when you’re sleeping on your stomach. Knowing all of those things, typically it’s not the best, but I understand, you know. To tell you the truth, I am also more comfortable sleeping on my stomach. But as a surgeon, one of the issues that I was encountering is that as I get older, unfortunately, as we all do, I’m starting to notice more tenderness when I move my neck, especially after sleeping on my stomach. And so, because of that, I’ve been trying to train myself to not sleep on my stomach, to sleep more on my back or more on my side. And that has definitely helped alleviate some of the pain and pressure that I was feeling on my neck.

[Music to signal a brief interjection in the interview]

TODD: After the break, more with Dr. Takashima.

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[Sound effect signals return to the interview]

TODD: How easy is it for people to train themselves to sleep in a different position?

DR. TAKASHIMA: Positional therapy, really, is not a new concept, and people have been doing it for many decades now. And the most common, or the easiest thing that people were doing early on is just sewing a tennis ball onto the back of their pajamas. And so, by doing that, whenever, you know, you rolled on your back, it was uncomfortable for patients. And so, for patients who you really want to force them to sleep on their side, that was a very good therapy for them, and that really helped train them. And so, a lot of other companies have, sort of, joined in the fray here in regards to creating, you know, something a little bit more sophisticated than sewing a tennis ball on the back of your pajamas. And so, there are certain, you know, straps that you can put on around your torso that has something on the back, you know, that prevents you from rolling onto your back, and some of these are air inflated, so it’s very light, and it’s not cumbersome or anything like that. It just really prevents you from sleeping on your back. There’s also other companies out there that have sleep posture training from vibration alone. And so, it realizes that you’re in a certain position that you shouldn’t be, or you don’t wanna be, and it gently vibrates to bring awareness that you’re not in the correct sleeping position. And sometimes, this vibration is so subtle that subconsciously, people realize that it’s occurring without really waking them up. But initially, it can take some time to get used to in regards to that. And I think one thing that people can do if they are not aware of how they are sleeping are some of the wearables that are out there now, you know, such as, probably the most common thing that people wear these days are the Apple watch and so forth. Those things, although it really won’t train you by vibrating or giving you, you know, a shock or anything like that, but what it will do is it will tell you how you slept, how deeply you slept, how much you moved around, you know, if you were sleeping on your side or your back. And then, you can use that data to then try corrective measures to train yourself. And so, just bringing awareness I think is also important. That’s what the wearables are doing these days.

TODD: Do sleep clinics use those kind of tools in helping people change their sleep positions?

DR. TAKASHIMA: They will. You know, they will definitely try to do that, especially if you are a positional sleep apnea patient. Getting you off the back is so important that these clinics will try to train you. But then again, you know, a lot of times, it is just about the concept of sewing a tennis ball to the back of your pajamas, you know, to try to convince you to not sleep on your back. And so, it’s not like it’s intensive therapies regarding trying to keep you off your back or off your stomach, it’s more of some of these things that we’ve already talked about.

TODD: Side sleeping with a pillow between your legs, tell me a little bit more about that.

DR. TAKASHIMA: Yeah. So, if you don’t have a pillow between your knees, the alignment of your hips to your spine is actually torqued in a way that’s not absolutely one, comfortable, or natural. And so, all you’re trying to do is just align your spine into more of a neutral position, and that’s what the pillow between the knees helps achieve.

TODD: This one’s probably beyond your expertise, and maybe it’s an old wives’ tale, but have you ever heard this idea that sleeping on one side versus the other is better for conceiving?

DR. TAKASHIMA: Sure. You’re right, you know? Typically, as an ENT physician, I always say, “Hey, ask me anything clavicles up, and hey, I’ll be able to give you a great answer.” That is a little bit below the clavicles. So, it is not really in my area of expertise. But that being said, I don’t think there’s great research in regards to that. I think it’s more about comfort during pregnancy rather than certain positions that help with conceiving that I’ve seen. And of course, we all know those that are pregnant obviously know that they need to be comfortable when they’re trying to sleep. And we husbands also know that our spouses need to be comfortable during pregnancy. And so, with that, sleeping on the left side is something that I would definitely recommend our pregnant spouses to definitely try.

TODD: How common is it for people with sleep issues to be fixed or at least improved just by changing their sleep position?

DR. TAKASHIMA: Yeah. So, especially snoring is significantly affected by position. You know, when patients are without sleep apnea, but they come in to see me just for snoring. It’s interesting. There’s two things that are very minimally invasive that we really try to achieve. One is sleeping on the side, and then the second thing is to try to get them breathing better out of their nose to bypass all that soft tissue, floppy tissues in the throat because you’re breathing through your nose. And so, you’ll be surprised at how effective just therapies like that can be for patients who have very loud snoring. You know, if there is actually a Guinness book world record in regards to the loudest snorer, and that ranged in the 92-decibel range, which is similar to the range of a subway car roaring by you or an ambulance roaring by you on the street. And so, as you can imagine, that can be a pretty significant issue, especially if you’re the significant other trying to sleep next to that.

TODD: Anything people should know about pillows and mattresses which supports the positions the best?

DR. TAKASHIMA: So, typically if you’re a side sleeper, because of your shoulder, the head position has to be in a neutral position with your spine. And so, the thickness of the pillow needs to be thicker if you are a side sleeper versus a back sleeper. In regards to the firmness --

TODD: Just one pillow or two?

DR. TAKASHIMA: Yeah, it depends, you know. ‘Cause sometimes, there are thicker, you know, pillows versus thinner pillows. If you look at some of these pillow makers, it will tell you “Best for side sleepers,” or “Best for back sleepers. Best for stomach sleepers,” and so forth. And they are taking into account the position of the head depending on which position you actually sleep. And so, with that, you know it’s hard to say one or two pillows because obviously, there could be thicker pillows and thinner pillows and so forth. So, the main goal is to try to keep your cervical spine aligned with the rest of your spine with the height of the pillow that should be appropriate for that function.

TODD: Okay. Any advice on what to do with your hands while you’re sleeping? You mentioned that on  your stomach it’s hard to know where to put them. I do know some people who have trouble sleeping who say they don’t know what to do with their hands.

DR. TAKASHIMA: So, you tell me that you’re a stomach sleeper. So, do your hands get in the way? Or your arms?

TODD: It’s never been an issue for me. I just put them under my chest or something like that and it’s fine.

DR. TAKASHIMA: Sure. So, for myself, I can tell you from experience that when I sleep, I typically do have one arm underneath my pillow, and then the other arm, sort of, stretched out. And I just feel that from a comfort standpoint that’s the most comfortable position. And so, really, it’s more about comfort, it’s more about trying not to pinch any nerves, and it’s also more about decreasing the chances of you compromising your circulation to your arms and your hand. And as long as you can do that, that should be fine. I agree though, some people do complain about their hands and the position of their hands. It’s so different from one patient to the other. It’s hard to give a distinct, you know, one position fits all type of answer for you.

TODD: But just as much, can there be an issue with side sleeping and back sleeping too or just do they tend to fall more naturally there, and people don’t notice that?

DR. TAKASHIMA: Definitely. People don’t notice it if they’re a back sleeper because, you know, it could be on the side, it could be on their chest. You know, those are all relatively natural positions of the arms and hands to actually go. It’s just when you’re sleeping on your side, when you’re sleeping on your stomach, that’s when the positioning of the arms and hands tend to be more of an issue.

TODD: In summary, is there anything you would hope listeners take away from this? Do you wanna summarize, kind of the advantages and disadvantages of the main sleeping positions?

DR. TAKASHIMA: Like I mentioned earlier, if you sleep well in your current position, there really isn’t great data to tell you to change your position. The last thing that I would want to do is to change your position and then your sleep be affected secondary to that. But for those that have issues, keep in mind that side sleeping is typically the best position from a general, overall health perspective, especially for those people who have sleep apnea, acid reflux, or back pain. Back sleeping is best for people who have no significant back pain and want to try to get their spine in perfect alignment, I would recommend sleeping on your back. But the issue with that is that it can, like we mentioned before, worsen sleep apnea or upper airway resistance, snoring issues. And typically, if you can avoid stomach sleeping, it usually is discouraged because of spinal misalignment, issues with positioning of the arms and hands and so forth. So, we all sleep a third of our lives in our beds, and it’s interesting how we don’t really conceptualize that. And what I mean by that is, if we wanna do well on a test, we have tutors. If we want to do well in life, we might have a professional coach, you know, and so forth. But we know so little about sleep, no one trains us how to sleep well. I do think that in order to maximize your performance, sleep is such an important aspect of things that a lot of major league football, baseball teams are really realizing. To maximize their performance, we need to improve these athletes’ sleep. And so, although we know that it is so important, you know, when’s the last time you had someone come by and look at your sleep hygiene, make sure that you’re not drinking caffeine late at night, make sure that, you know, your environment in your room is perfectly placed so that you can maximize your sleep, someone that can council you on your sleep position. I think all of these things are very important when it comes to sleep. And so, hopefully, with this talk that we have today, we can at least improve some people’s quality of life just by changing their sleep position at night.

TODD: Very good, very educational. Thanks again for joining us.

DR. TAKASHIMA: Great. Thank you so much for having me. Appreciate it.

[Sound effect plays to signal end of the interview]

ZACH: Alright Todd, so what’s your biggest takeaway from our conversation with Dr. Takashima today?

TODD: Well, not a takeaway, but the thing I was most struck by was the world’s loudest snorer 92 decibels, the equivalent of a subway car or ambulance.

ZACH: Yeah. I don’t know how the human body can generate that much sound.

TODD: Yeah. What do you think your wife would say yours is?

ZACH: That’s 92?

TODD: Yeah.

ZACH: I mean, realistically, it’s probably like a 60, but she probably says it’s like a 90.

TODD: Yeah. Has she ever had a metaphor for it?

ZACH: No, not like that.

TODD: Yeah.

ZACH: Other than, like, sawing logs is what the vernacular is when people snore very loud. It is a…You know, for those who don’t know what sawing logs sounds like.

TODD: Okay, that’s interesting. I hadn’t really thought of that.

ZACH: Yeah.

TODD: I was, kinda of, struck that there isn’t more research on this.

ZACH: Hmm.

TODD: You know, you go in for those sleep studies. I’ve always wanted to go in for a sleep study, but those things are really expensive. But as I thought with doing those, they were just design experiments around them, I have some hypothesis. And I mean, clearly, he talked about some information that they’ve gleaned from that, but doesn’t seem like there’s a lot of study from that.

ZACH: Like in the sleep apnea thing as we talked about off the top was of interest to me. It, kinda, reiterated a lot of stuff I had already known about myself. So, that was reassuring. You know, it’s good to -- you know, we go into these conversations, and we learn new things, and we also either learn some of what we thought was wrong, or some of what we were already doing and thought was right. So, it’s good to have that rearmament about your opinions.

TODD: But did anything he say make you think you could take it to the next step? He talked about, like, putting a tennis ball on the back.

ZACH: Okay that was the most bizarre thing.

TODD: That seemed pretty crude.

ZACH: Yeah. I mean, that was invented, you know, 100- something years ago.

TODD: But he said there’s better technology now so I think you might try that.

ZACH: No, I’m gonna go old school. Gonna do the tennis ball, Todd. Now, I will say for me, I mean, I talked about this on the sleep apnea episode, I would occasionally -- I’d wake up and have my air blocked, right?

TODD: Right.

ZACH: And that would be a very scary experience. Didn’t happen all the time…

TODD: Right.

ZACH: But it happened a handful of times and that’s a scary experience. And since I’ve been using the CPAP machine, that doesn’t happen to me because it keeps your airways open, right? So, they don’t collapse in. It keeps you from snoring and also keeps you from, you know, not being able to breathe, right? So, that is a positive. So, I mean that was a -- I mean -- you know, we joke about the sound that you make when you’re asleep doesn’t affect you, but that did affect me in a big way, so I’m glad that that doesn’t happen anymore.

TODD: Yeah. That was one of the things that was -- one takeaway of mine was that this isn’t just a quality of life issue. A lot of this can be kinda dangerous. Not just want you mentioned but you know, increases your blood pressure, risk of stroke, just general fatigue…

ZACH: Mhm.

TODD: Possibility of depression. All things that are not great things.

ZACH: So, I don’t know about you, Todd, but I’m gonna start calling snoring “sleep disordered breathing.”

TODD: Sounds better, doesn’t it?

ZACH: It does. It sounds more, you know. I don’t snore, I have sleep disordered breathing.

[Laughter]

TODD: Sleep disordered breathing sounds like it’s something forced upon you. You know, it’s not your fault, whereas snoring, it just sounds --

ZACH: Oh, you’re a snorer, huh? So, like you said, Todd, we spend a third of our lives sleeping. You should, actually. If you do the math, 24 hours a day divided by 3, 8 hours, so.

TODD: Yeah. I bet our listeners appreciate you doing that division for them.

ZACH: People are in their car, they’re driving. They don’t have time to break out the calculator and figure out this math, right? But yeah, roughly a third of your life is sleeping, which it does sound so strange when you put it that way, but all the health things you mentioned, all the things that can add up. Like, you spend a lot of time sleeping and you wanna make sure that you’re getting the most out of your sleep, like, recharging, right? I mean, it’s a whole thing he talked about. Like, if you’re not recharging, repairing, and all that, you’re interrupting that. So, you’re gonna wake up, you’re gonna be, you know, not even, like, more irritable, right? But your body’s not gonna recover the same way. Like, you know, we exert ourselves when we’re sore, you know, when you don’t get enough sleep, that soreness is gonna hang around longer, that sort of thing. Deeper issues too. So, make sure you’re getting the right sleep and you’re in the right position for you because different sleep positions for different people, right Todd?

TODD: Yes. And probably maybe not something you think about. You may not think that your sleep position is affecting your quality of sleep, but it very well may be.

ZACH: Indeed. Alright, that’s gonna do it for this episode of On Health with Houston Methodist. We drop episodes Tuesday mornings, so be sure to share, like, and subscribe wherever you get your podcasts. And until next time, stay tuned and stay healthy.