Positional Therapy: Sleep Apnea & the Tennis Ball Technique

A new study from Australia examined long-term compliance with the tennis ball technique in people with obstructive sleep apnea. The results were published in the Journal of Clinical Sleep Medicine.

What is the tennis ball technique? It is a simple method of positional therapy that helps you avoid sleeping on your back. It was first introduced in the early 1980s.

A tennis ball is fastened to the back with a belt or strap. This makes sleeping on your back uncomfortable.

Soft tissue in the throat is less likely to collapse and block the airway when you sleep on your side. As a result positional therapy may help reduce the breathing pauses that occur when you have OSA.

The study involved 67 people with OSA, mostly men. They were overweight and had an average age of 60 years.

They had an overall apnea-hypopnea index of 29.6 breathing pauses per hour of sleep; an AHI of 15 to 30 is considered “moderate” sleep apnea. Their average AHI soared to 53 when sleeping on their back; it dropped to 14.1 when side sleeping.

They were instructed to use the tennis ball technique. Then they were followed up after an average of 2.5 years.

Results show that only four people reported that they were still using the technique. Nine people claimed that they had learned to avoid sleeping on their back.

The primary complaint was that the technique was too uncomfortable. Another common complaint was that the tennis ball moved around. Some people said the technique was ineffective. Others reported that it caused backache.

A similar study in 2006 followed up 50 people after six months. Nineteen people were still using the technique; 12 said that they had learned to avoid back sleeping.

Other variations of the technique have been used. These include a backpack with a foam ball inside, a vest that contains a piece of hard foam, a thoracic anti-supine band, a triangular pillow, and a posture alarm.

The AASM reports that positional therapy can be an effective treatment option. But some people with OSA will continue to have breathing pauses while side sleeping. Talk to your sleep specialist to see if positional therapy is a good option for you.

Get help for sleep apnea at an AASM-accredited sleep center near you.

Image by Tiffany

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Use Bedtime Routines and Relaxation Techniques to Sleep Better

A new study in the Journal of Clinical Sleep Medicine examines the strategies people use to reduce daytime sleepiness.

Taking a bath was the most common sleep management practice for both men and women; 59 percent of men and 64.4 percent of women used it. Keeping a regular sleep schedule was the second most popular tactic.

People also wound down for the night by listening to music, snacking and exercising.

The results show that taking a bath and going to bed at the same time every night were the best ways to decrease daytime sleepiness. Snacking at night made people feel sleepier the next day.

One of the study’s authors said that culture influences the way people manage their sleep.

The study, conducted in Japan, includes data from 24,686 adults who completed a national health survey.

Don’t worry if you have a few sleepless nights. It is common to suffer from occasional bouts of insomnia. Stress, irregular sleep patterns and pain can cause you to lose sleep for short periods of time. This is known as adjustment insomnia. Once the problem is resolved sleep usually returns to normal.

What are some healthy ways to get better sleep?

The AASM recommends:

• Go to bed at a regular time each night.


• Wake up at the same time each night, even on weekends.


• Avoid naps if you can during the day.


• Don’t drink caffeine in the afternoon.

Find more tips about good sleep hygiene at Sleep Education.com.

Contact an AASM-accredited sleep disorders center if you have an ongoing sleep problem.

Image by Laura Taylor

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LESSON 8: Money Isn't Nothing.

Like many sorta-liberal, sorta-hippie, independent NYC gals in their early 30s, I never wanted to believe a wealthy man was the key to a happy life. On the contrary, in fact. I have dated enough moneybags to know, they’re more trouble than they’re worth. In short, I’ve always found that money often equals freaky, weird, fucked-up.

BUT I also knew I couldn't live with poor.

My career has never ever been the driving force of my life. However, in the last few years, I’ve established one. A decent one, actually. These days, I could easily take care of myself, a small child and even a cute puppy, if one found its way under the Christmas tree. But even in my pre-working girl days of fun, travel and freelance, I managed to live decently, never incurring debt nor sleeping on too many couches (some i admit). Overall, I lived within my means, one pizza slice at a time. Sure, I couldn't afford a lot of banana pudding from Magnolia but I had my basic needs covered. And then, a few years ago, I knew I wanted more. So I got myself a real job. Do I cheer when I wake up every morning to go to work? No. Do I ask for sleepless nights dreaming up the big idea for a reinsurance company? No. Can I live with it, because I’m a grown-up who can take care of myself and contribute to something, anything other than my self-involved self? Yes, sadly.

My point: if you want a grown-up relationship, don't get involved with a pauper. Generally speaking, people who can take care of themselves, financially and emotionally, are more likely to have the bandwidth and ability to support another person—and I'm not talking about financially. Wanna be in a well-balanced relationship? Don't get involved with someone raiding your couch for lunch money.

You may wonder how I define "poor". I actually think of it as more a state of mind than circumstancial. Meaning a 27-year-old creative writing grad student with ambition and potential is very different than a 45-year-old career Dominos pizza delivery boy. And of course, we all have our individual definitions. After the age of 26, I could no longer date another struggling actor. But then again, that probably had nothing to do with the money thing.

Ultimately, you're gonna do what you want to get to where you're going. And hopefully, you'll learn lots of good stuff a long the way. But at the very least, heed my advice: Stay away from actors*—however poor or wealthy. Don't say, I didn't warn you.

*you know the kind

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Lesson 7: First Soul-Search. Then Soulmate Search.

We’ve all gone through personal crises—for some, it’s the realization that your 22-year career has been a huge mistake; for others, it’s the discovery you’ve been drinking decaf for the last two months. Whatever it is, it rocks your world in such a way that you question EVERYTHING—your life, your purpose, your choices, your family, friends, partners, job, home, or for some, lack thereof.

And this, ladies and gentlemen, is the exact WRONG time to drag anyone into your personal drama.

It’s a fact of life, we all have bigger baggage at many points of our lives. But if you’re looking to get into a relationship, strive to bring the lightest load possible.

Yes, people grow in relationships. And yes, there are ample opportunities to develop. But only when you’re able to see them. Right now, you can’t find a tree in the forest.

I’m not saying someone new won’t be able to give you a new perspective and help you emotionally through a rough patch. It’s possible, but it’s short-lived and highly-dysfunctional. You must ask yourself, “Who is this person? And why is she wiping the snot from my nose and making this big investment in someone she met last week?” You might say you offer something else to him that he needs. Most likely though, you’re just two troubled souls providing each other solace until you break up and realize you’ve got some stuff to sort out on your own. That’s the thing with relationships, they’re great hiding spots.

I had a succession of relationships with really troubled characters and I am fairly certain that I caused more damage than good—to them and certainly to myself. I was looking for stable, normal relationships with men with whom I became emotionally attached and were completely unable to reciprocate, as they were so entirely up their own butts in their own issues. This, I can assure you, was no fun for me and made me question what the hell I was doing. For them, I allowed them to avoid their issues until the relationships ended and until they found their next pathetic victims, god bless them. Sadly, some people will always live in a permanent crisis. I have no answers for this.

So when do you know it’s safe to get into a relationship? Well, only you know when you’re able to stand on your own, without crutches or an electric scooter. And when you are ready, you’re more likely to find some other not-crippled individual. Sure, you may need some piggy-back rides along the way, but at the end, you’ll always have your own two, beautiful (or crusty and callused) feet to keep you standing.

Remember, successful relationships involve two strong people. When two people enter a relationship in positions of strength, there is a healthy balance of give and take—which over time will fluctuate with shifting needs and circumstances. Without this delicate balance, your relationship is sure to be one more area for crisis. But maybe you’re into that sort of thing.

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Lesson 6: Sleep With Him. Just Don’t Sleep Over. Not Until You’re Ready.

Of all my relationship memories, the ones that stand out the most have little to do with sex, vacations, events, pizza or “real” life for that matter. The images that are firmly imprinted in my mind I have no photographs of. They’ve never been described in an entertaining story told to friends or journal entries for myself. Yet, the connections associated with bedtime and sleeping next to someone—spooning, snoring, sheet-stealing, puppy breath and all—have stayed with me longer than the length of the relationships.

I’ve always believed that your sleeping (subconscious) relationship mirrors your conscious relationship. Sleep is where all your “stuff” about yourself, and in effect your relationship, surfaces, i.e., intimacy issues, blah blah… But I also believe that sleep is where your subconscious can triumph over the conscious mind, and allow your “real” self and needs to expose themselves. It’s like when someone with sleep issues finally sleeps soundly next to a new partner.

Of course, this clearly explains the fear of “sleeping over” in a new relationship. Fear which can sometimes translate to courage as seen in my friend, Frank’s case. After the dirty deed, he would very politely ask his new partner to sleep on the couch. The mensch could never actually ask her to leave.

Many years ago I was dating Pierre, a Frenchman. After dating a little while, he finally acquiesced to the "sleep over". In our first few months sleeping next to each other, he refused to have any part of his body come into contact with mine. I remember living in fear that I would accidently graze his ankle with my foot in the middle if the night and he would scream in horror, waking the neighbors who would call the cops. I knew our relationship had progressed once his body was wrapped around mine as we fell asleep. He was finally vulnerable to me. Yet he remained the prick with intimacy issues in real life. But at least in bed, he belonged to me. Not sure if that was great, but a consolation prize I valued. I guess we spend so much of our lives sleeping that if we are cherished for that part of it, that’s a lot. Isn’t it?

Actually I find the whole sleeping together thing quite heartbreaking. For a very long time, I thought that spending the night together after sex, the most intimate of acts, was a normal, mandatory thing. It wasn’t until recently that I realized that “the spending the night together” part was actually a million times more intimate. So I eventually stopped spending the night and asked people to leave. I finally knew what it was like to be a dude.

It hasn’t occurred to me until recently that the hardest part of my breakups have been leaving the sleep relationships. In bed with a partner, I never felt lonely. The rituals were natural and always comforting. I enjoyed someone stealing my pillows, sleeping on someone else’s wrist, breathing my sweet puppy breath on someone, keeping someone up with insipid chatter…

So now I have a sleep partner I adore. When he’s sweaty, I push him over. When I pull his arm, he spoons me. When I ask him to sing me to sleep, he tells me he knows no songs and I sing the Star Spangled Banner. There’s a whole system worked out, which for me is a microcosm of our relationship.

Sleep is intimate stuff. My advice: Don’t jump into it until you’re good and ready.

I’m quoting a doctor in a recent NY Times article: “Even though we may take sleeping with our partner for granted, it’s through these kinds of shared social systems that we build and nurture our relationships, and perhaps uncover the underlying meaning of our lives.”

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Lesson 5: Don’t Fall For the Accent

Accents are sexy. But so are 5-inch stilettos. They’re both dangerous and bad ideas. And trust me I know. As a reformed Francophile and general Europhile (and clutz) prone to falling deeply in love with anyone who I couldn’t understand, I know too well the needless drama involved with dating men of mystery.

Here’s the first thing that I always resented: They know they’re hot. So they automatically have an edge over you. And the thing is, you’re pathetically helpless. So as you’re drooling over him during your dinner of salad Nicoise, Frenchie knows you want him. The Spaniard calls you after three weeks of unreturned calls and you drop everything to meet her. The Italian cheats on you, makes up a story about pity sex with his ex and you forgive him. The whole thing is just unbearable. When did an accent become a reusable get-out-of-jail-free-card?

You may be asking yourself how different is a Swedish hottie from the Texan-accented sweetie? Loads. The Swede has a whole other life in another language that you will probably never know—even with years of dedication to Rosetta Stone. Never. Which might be fine and sexy for a while. But in the long run, the meatballs get tiresome. And well, Tex, at least, you can pretend to kind of understand when you’re drunk!

I’m not saying that there’s no chance in having a good relationship with foreign-accented guy/girl. Of course, it’s possible. You just have to step back from the relationship and see if it’s just the mystery, or accent, that’s keeping your weak self from dumping her.

At the tender age of 24, I was very much in my francophilic years. I had just come out of a tormenting relationship with a psychopathic Parisian actor and after a long recovery, I went back to Europe, looking for a replacement. I was traveling through French-speaking Switzerland when I met a sweet Swiss-French/Spanish boy, Miguel. Miguel did not speak a lick of English. To no one’s surprise here, it was love at first sight. With my high-school Spanish, we tried pathetically to communicate as we traveled through Spain together. He would whisper something about potato omelettes in my ear and I would swoon. Eventually, I went back home to New York but a couple miserable months later, I decided to move to Geneva to be with him and work on my even-more-sorry French. Despite everything I’ve said about people with sexy accents, I don’t totally believe sexy accent = bad people. Miguel was actually a lovely person. But the funny thing is that as my French language skills improved over six months, I found him less and less attractive. We broke up. After learning a painful, prolonged lesson about accents, I went home to date more boys with accents.

So who am I to tell you what to do? I was suckered for years and years. Until I was over it. And now I date a Southerner I can mostly understand: ) Anyhow, date as many accents as you want. Get it out of your system. Just don’t get too distracted to recognize that dog doo in francais or espanol or italiano is still dog doo.

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LESSON 4: Be Grateful for the Fade-Out

A few winters ago I was fixed up by a friend of mine. The guy was a magazine publisher, Jack, and we hit it off on our first date. Lightning didn’t strike or anything but we liked each other and we made a second date a week later. Again, good date. He took me to Artisanal and we had great fondue with lots of fine cheese. What’s not to like? Our third date the next week was plain awkward. To provide a little bit of context, we had not gone further than kissing on the corner hailing separate cabs at the end of our dates. And that’s precisely what happened at the end of the evening of our really strange third date. Anyway, I was hoping to never hear from him again. I certainly wasn’t gonna contact him. There was no need to confirm the obvious. I WANTED the fade-out.

So what happens? He emails me and explicitly states that he doesn’t think we would work out. Um, really? No kidding. Ughhh. I was so mad. How did he get off “breaking up” with me? Weren’t we supposed to let this go gracefully? Did he really need to confirm the obvious? Jeez, I could’ve wrote him the same email but DIDN’T. Because it WASN’T necessary. We hadn’t emailed in a few days, we didn’t sleep together, he was a brother of a friend of a friend… it was NOT necessary to REJECT me. And as gentlemanly as I’m sure he thought he was being, he actually looked like a big fat jerk. So in that instance, ladies and gentlemen, not fading-out was a jerk move.

Yes, I fully support the fade-out—in any non-serious dating situation. I am not a sadist nor masochist. I think when it’s pretty clear the feelings aren’t there and there are no obligations, the fade-out is the BEST way out. Why suffer the needless drama and feelings associated with rejection/rejecting? WHY? Really now. Who needs it?

Ok, but what happens when you really like someone who is fading you out? First consideration: does this person have any obligations to you? Let’s define obligations. For me, it’s if you’ve been dating “seriously” (whatever you mean by that) for over a couple of months. (But of course, this is another post topic to be tackled later.)

If there is no obligation then well, you call him once/twice to follow up. And if there’s no response after your attempts, that person is a jerk plain and simple. But he is a kind jerk. Really, did you need an explanation? What would it do for you but make you question your self-worth and obsess over every little step/misstep of your short-lived relationship? This person is NOT for you, that’s it. Trust me on this. As my very wise friend Peter says, “Your true love won’t reject you.” This I believe. If you need a reason, chalk it up to the ex or her job or “bad timing”—which I think is always a big factor. Whatever, it’s probably not personal. And if it is, who cares? It’s his problem. Not yours. You’re now extricated from a relationship with no future. How great is that?

So what happens if you’re being faded-out by someone who really owes you more? Well, you hunt her down and pelt her with frozen marshmallows. Just kidding. This person is not a kind jerk but a jerk-jerk of the worst kind. This fade-out I don’t approve of. It’s a lousy, cowardly thing to do. And you do not want to be involved with a coward. Of course, you aren’t necessarily a coward if you do cowardly things. But after you call/email/text him a few too many times and there are no/few adequate responses. You’ve got yourself a coward that you can kiss goodbye. And the break-up was probably long overdue anyway.

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