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Sleep Disorders

Inability to sleep on my back



If I fall asleep in a chair or on my back in bed, within a few minutes I wake up coughing heavily because I have inhaled saliva. At times I can sleep in one of those positions long enough to begin snoring, and when I do, I snore as I exhale (not inhale). The snoring irritates my throat quite a lot. I am male; married; 68 years old; in excellent health; not overweight; don`t smoke or drink excessively. I manage to sleep well enough on my front (as long as I don`t roll over) and never feel sleep deprived.

Is there anything that could be done to correct my problem?


It seems that you have already done some reading about snoring, sleep apnea and the association between the two. While sleep apnea is definitely a possibility, based on the information you provided, there are other conditions to consider as well.  I'll address sleep apnea first.

As you know, snoring is a common problem. Snoring is a sleep related breathing disorder. Snoring can occur during inhalation and during exhalation and results from the vibration of soft tissue in the back of the throat and therefore may irritate the throat, and cause the sensation of dry mouth on waking. Loud snoring often accompanies obstructive sleep apnea syndrome, which is also a sleep related breathing disorder. Obstructive sleep apnea occurs when the back of the throat relaxes with sleep leading to airway collapse and apnea (stopping breathing). When the airway collapses, the brain and body protect themselves by making the individual briefly awaken (arouse) in order to resume normal breathing. During these arousals, a person may inhale saliva which results in cough.

Conditions that may be related to snoring and also to sleep apnea include being overweight, having history of stroke, smoking, alcohol intake, various sedating medications, having large tonsils or tongue, and having an abnormal jaw or nasal anatomy. Many people find that sleeping on their side or on their front decreases snoring. Many patients with sleep apnea have worse disease when sleeping on their back.

Not every snorer has sleep apnea. While 40% of the adult population snore, only 8% men have significant sleep apnea that requires treatment. However, in order to treat snoring, a physician who practices in this field needs to evaluate your condition in order to rule out the presence of sleep apnea first. This is important because not every person with sleep apnea has the classical symptom of daytime sleepiness.

Treatment options for all sleep related breathing disorders (including sleep apnea and snoring) fall into four general categories:

Aside from sleep apnea, waking up coughing or with a sensation of choking when sleeping on your back could be related to other problems, mostly commonly post-nasal drainage and gastroesophageal reflux disease.  Post-nasal drainage frequently occurs in the setting of ongoing nasal congestion, which can be related to a number of factors, and is worsened by lying down on your back.  Typically, nasal sprays or other medications can effectively control this symptom.  Gastroesophageal reflux disease (also know as GERD or heartburn) is due to gastric contents coming up into the esophagus and irritating the esophagus and/or the upper airway.  This condition is often aggravated by lying supine, especially if one eats near bedtime.  Treatment of GERD includes lifestyle changes, diet changes and medications. 

I recommend you discuss your problems with your doctor. Evaluation by a Sleep Specialist may be necessary to determine how best to evaluate and treat your problem.

If you would like additional information regarding sleep and sleep disorders, you can obtain it on the American Academy of Sleep Medicine website. This website also contains a list of Sleep Centers across the country so you can locate one near you if need it. Good luck, and sleep well.

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Response by:

Ziad  Shaman, MD Ziad Shaman, MD
Assistant Professor of Medicine
School of Medicine
Case Western Reserve University