Why Lying Flat Affects Breathing: Insights on Sleep and Allergies

Difficulty breathing while lying flat?

I have severe nasal allergies and post-nasal drip, making it difficult for me to sleep.
In recent years, I've noticed that whenever I lie flat on my back to sleep, my nasal passages narrow, and I start snoring and have trouble breathing, causing me to wake up immediately.
Therefore, for the past few years, I have been sleeping on my side with my head lowered.
This has already made it hard for me to sleep, and it further complicates my ability to fall asleep, resulting in poor sleep quality.
Could you please explain what might be causing this? P.S.
I have undergone turbinate reduction and septoplasty surgeries.

Min Hsuan, 30~39 year old female. Ask Date: 2023/12/14

Dr. Zheng Jueyi reply Otolaryngology

Hello, your symptoms may be related to sleep apnea.
Common factors could include airway obstruction, such as narrowing in the nasal passages, oropharynx, or at the base of the tongue, or insufficient muscle tone in the oropharynx.
It is recommended to visit a hospital's otolaryngology department, pulmonary medicine department, or a sleep center for evaluation.

Reply Date: 2023/12/14

More Info

Lying flat can significantly affect breathing, especially for individuals with pre-existing conditions like severe nasal allergies. When you lie flat, gravity can cause the tissues in the nasal passages to swell, leading to a narrowing of the airways. This phenomenon is particularly pronounced in individuals who suffer from nasal congestion due to allergies or other conditions.
In your case, the combination of nasal allergies and the anatomical changes from previous surgeries (like turbinate reduction and septoplasty) may exacerbate your symptoms. When you lie down, the position can lead to increased mucus production and post-nasal drip, which can further obstruct airflow. This can result in snoring or even obstructive sleep apnea, where breathing stops temporarily during sleep due to airway blockage.
The act of snoring itself is caused by the vibration of the soft tissues in the throat when airflow is obstructed. In your situation, lying flat likely causes your nasal passages to become congested, leading to mouth breathing, which can also contribute to snoring. This cycle can disrupt your sleep, leading to frequent awakenings and poor sleep quality, as you have experienced.

To improve your situation, consider the following strategies:
1. Elevate Your Head While Sleeping: Using an extra pillow or a wedge pillow can help keep your head elevated, which may reduce nasal congestion and improve airflow. This position can help prevent the tissues in your throat from collapsing and obstructing your airway.

2. Nasal Decongestants: Over-the-counter nasal sprays or oral decongestants may provide temporary relief from nasal congestion. However, be cautious with long-term use of nasal sprays, as they can lead to rebound congestion.

3. Humidifier: Using a humidifier in your bedroom can help keep the air moist, which may alleviate some of the dryness and irritation in your nasal passages, making it easier to breathe at night.

4. Allergy Management: Since you have severe nasal allergies, it’s crucial to manage your allergies effectively. This may include avoiding allergens, using antihistamines, or considering allergy shots (immunotherapy) if appropriate.

5. Consult a Specialist: If your symptoms persist, it may be beneficial to consult an ear, nose, and throat (ENT) specialist or a sleep specialist. They can conduct a thorough evaluation, which may include a sleep study to assess the severity of your sleep-disordered breathing and recommend appropriate treatments.

6. Sleep Hygiene: Establishing a consistent sleep routine can also help improve your overall sleep quality. This includes going to bed and waking up at the same time each day, creating a relaxing bedtime routine, and minimizing screen time before bed.

7. Consider Side Sleeping: Since you have found some relief by sleeping on your side, you might want to continue this practice. Side sleeping can help keep your airways open and reduce the likelihood of snoring.

In summary, the combination of lying flat and having severe nasal allergies can significantly impact your breathing and sleep quality. By implementing some of these strategies and seeking professional guidance, you may find relief from your symptoms and improve your overall sleep experience.

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