[richard d]

hi, just curious how do you avoid sleeping on your back, I find sleeping on either side just aggravates my neck, shoulders and ultimately increased arm and hand numbness.

[Jomar]

Until towelhorse replies -
I was remembering that many use a lot of extra pillows to hold and support the body in various sleeping positions.

And a good supportive neck shape pillow really helps too.
I had good luck with the generic memory foam ones - some come in small, med & large for what size fits best for you.

[olecyn]

Yes, pillows
I must have 12 pillows on my bed from med - feather

2 doc's have told me to lay flat on a TEMPURPEDIC pillow so the neck nerves do not tighten
And NEVER lay on the sides of the compression

My issues is when in pain my muscles tighten
My hands wake up in fists so I have learned to listen to hypnotherapy tapes, slather herbal rub, relax before sleeping and focus on hands calm and open (sometimes I put them inside my pjs on my tummy as not to tighten).

NO TV WHICH BENDS THE NECK

[fern]

i'm the same as olecyn. docs and PTs and TOS neurologist have told me to sleep on my back ONLY. when i sleep on my side both arms get very numb. i had such a hard time implementing this--it wasn't until i got a wedge of sorts to put under my legs that i was able to stay on my back through the night. i also put a small roll vertically between the shoulder blades and this helps keep my chest open and my spine in correct posture. i have worked it all out with the PT. And a tempurpedic traditional pillow (with the big curve) under my neck. It's important to get the right size tempurpedic pillow.

am curious to learn if towelhorse has a diff solution for his particular issues.

[olecyn]

Pillows under the knees in order for you low back to convert and rest the muscles.

[momzpeachy]

I can't wait til I can have a full night's sleep...pain free! A year now and I hate it! I have tried so many different pillows and nothing works. Laying on my back works but I can't sleep that way. I'm a side sleeper and usually my right side which happens to be my TOS side. I roll over on it and they go crazy with numbness in my hand and pain in the neck! I lay on my left side and use one of those cervical pillows for my right arm. I found it works real well for an arm holder. I put my arm in it and prop it up on another pillow. I'm good until I go moving in my sleep. It's soooo frustrating!

[fern]

when sleeping on your back you can try this as an alternative to using a pillow under each arm. i tie a soft scarf around my forearms so that arms don't roll out. and it's hard for me to keep my arms on the pillows all night long. i think i might sleep better in a gravity-free environment!

[dabbo]

whats a full nights sleep? between my beautiful daughter, this, and my pre-disposition to not getting "deep" sleep, I think I've forgotten what it feels like!!

[towelhorse]

Sorry if this becomes a long story but it is the contribution of all of the factors that in my opinion constitute Thoracic Outlet Syndrome.

Prior to my injury

1. I did not have a breathing problem
2. I did not have a sleeping problem
3. I did not have arm problems (heavy arm, cyanosis, cold hand, loss of sensation, pain)
4. I could sit for any reasonable amount of time
5. I did not have muscles in my upper back in spasm continuously
6. I had performed my very strenuous job for 10 years
And then I had a pain in my thoracic spine which caused my neck to stiffen (wry neck) and I could not lift things in my affected arm in front of my body as I could previously.

I had scapular instability.
However I continued to work through the busy season for the next ten weeks up to 11 hours per day. I thought that the 3 week break at Christmas would allow my shoulder to recover. I was still very fit, whilst on holidays during the Christmas break I was going bush walking (10 miles) through steep terrain daily. But my arm was not working properly. I sought expert advice. Within 3 months I was struggling to walk ˝ a mile on flat terrain. Something strange had happened. Physiotherapists said that I had thoracic outlet syndrome and told me that I was chest breathing.
Now
1. I had a breathing problem
2. I had a sleeping problem
3. I had arm problems (heavy arm, cyanosis, cold hand, loss of sensation, pain)
4. I could not sit for any reasonable amount of time
5. I had muscles in my upper back in spasm continuously
6. I could not perform my very strenuous job that I had had 10 years.

After considerable advice and many unfortunate things happening

I found that I could relieve the muscle spasms in my upper back (which had been continuous and I rated them as 8/10) by lying on a chi ball (between my shoulder blades). This stopped the compromising of a nerve which ran under my scapula the long thoracic nerve (LTN). This was not a thoracic mobilisation exercise, this was not a pectoralis minor stretching exercise. I had greater scapula stability after lying on the ball, my arm did not feel as heavy.
By decompressing the nerve, other muscles relaxed in the area. Other muscles did not have to compensate for the weak serratus anterior muscle (the muscle to which the nerve which is compromised is attached).

I believe that scapular instability causes thoracic outlet syndrome not the other way around. The scapular instability causes my arm to feel heavy. Scapular instability causes my pec minor to compromise my brachial plexus. Scapular instability cause postural problems. Scapular instability means I can’t lay on that side, scapular instability means that I am more likely to compromise the very nerve which causes scapular instability (long thoracic nerve).

One hot summer night I was having trouble sleeping (due to TOS) so I lay on the chi ball on the floor near the foot of our bed. I fell asleep on the floor. When I woke up I did not have the disgusting headache which extended from the right of my thoracic spine up the right back side of my neck and across the top of my head which I normally woke up with since my condition had deteriorated. I slept on the floor each night for over a year. I worked out that it was lying on my affected scapula which was causing the problem. I fitted a bolster in a shirt that I wore at night time that would a)stop me sleeping on my back or b) if I was on my back would allow my affected scapula to relax away from my ribcage thereby decompressing the LTN, but this was only 50% successful. I spent hours and hours decompressing the nerve by lying on the chi ball on my bed as I used a laptop on a special table to complete my OHS&W studies. Using my arm compressed the nerve, sitting compressed the nerve, lying on the scapula compressed the nerve, relaxing on the chi ball decompressed the nerve, taping my shoulder back decompressed the nerve, wearing an elastic brace to pull my shoulder down and back decompressed the nerve.
Whereas my life had improved it was a balancing act between compromising and all the consequences, and de-compromising and not being able to use my arm. An Occupational physician diagnosed partial long thoracic nerve palsy after conducting nerve conduction tests. 2 years earlier a neuro surgeon had asked me to push against a wall and dismissed long thoracic nerve palsy as a possibility!!

2006 brought chest X-rays for hypertension showed that I had hyper-inflated chest fields, pulmonary function tests which made my scapula stability significantly worse, breathing medication (pulmicort) which made my rib cage relax (it was as though I was sleeping on a different mattress) and an improvement in my condition.
In 2007 I told my story to a physiotherapist who recommended another physiotherapist who suggested other breathing medication, my doctor prescribed symbicort, since taking symbicort my scapular stability has improved such that I believe I will recover completely. Since taking the new medicine I have not had the same headache as I awake in the morning. I sleep without the bolster between my shoulders. My scapula stability is the best it has been for over seven years.

For many years I have been attempting to decompress the long thoracic nerve from the outside by using a chi ball, a shoulder brace and taping, I now can decompress it from the inside by breathing properly. Previously the physiotherapists had told me that I was chest breathing, they showed exercises to improve my breathing. These were unsuccessful.
I have since learnt that chest breathing is also known as paradoxical breathing, it affects persons with other conditions such as fibromyalgia, COPD. I found that intra-abdominal pressure can precipitate paradoxical breathing.

I believe that paradoxical breathing is the reason that TOS sufferer’s bodies do not heal. I believe it is the reason that it is so difficult to sleep, the reason that nerves are compromised, the reason that sitting is uncomfortable (intra-abdominal pressure), the reason that we do not receive the benefits of proper sleep, the reason we are exhausted, one of the reasons that the our ribcages are sore, etc.

If you are having trouble sleeping I recommend that you
• Fix a bolster between your shoulder blades (on a tight garment or taped to your back) which will not be completely absorbed into a soft mattress.
• Not use medication that will allow you to sleep through nerve compromise which will make you situation worse
• Use a segmented pillow that allows your neck to be straight when you are lying on your side
• Not lie on your affected arm
• When lying on the other side keep the affected arm on the top and don’t allow it to fall to your front
• If your scapular stability is really bad place a thin pillow between the affected arm and your ribcage when you are lying on the opposite side
• If you can convince a doctor that the chest breathing is significant and you are not responding to other strategies to correct the problem try for some medication.

I understand that my perspective is controversial however can anybody tell me how TOS can start on one side then after some time appear on the other side if it is not due to something which is common to both sides (paradoxical breathing combined with spending increased time lying down)

I hope this may help someone regards towelhorse.

[fern]

i think your idea works to sleep on your side if you have only 1 affected side Towelhorse. So what if both sides are affected? That's why I sleep on my back. And rolled-up bubble wrap, scotch-taped does the trick for me. placed lengthwise, in between the shoulder blades.