Sleep apnea typically refers to impaired breathing from
an obstructed airway during sleep, which can promote a
number of health problems, including diabetes, gout, and
heart disease
Sleep apnea promotes heart disease in women to a greater
degree than in men. Even among women who didn’t develop
heart failure, sleep apnea was associated with heart
damage that led to worse health outcomes
Two treatment alternatives that offer a great deal of
hope are oral myofascial therapy and learning how to
breathe properly while you’re awake
By Dr. Mercola
Sleep apnea typically refers to impaired breathing from an
obstructed airway during sleep, which can have serious health
consequences. It's a common problem, affecting more than half of all
men and over one-quarter of women.1
It's also becoming more prevalent among children, largely due to
lack of breast feeding and eating processed foods. Snoring is a
related problem, caused by a restriction in your airway stemming
from either your throat or nasal passageway.
The vibrations produced as the air struggles to get past your
soft palate, uvula, tongue, tonsils, and/or muscles in the back of
your throat causes the snore.
Fortunately, there are ways to address these kinds of breathing
problems that don't necessarily involve resorting to a CPAP machine.
Two treatment alternatives that offer a great deal of hope are oral
myofunctional therapy and learning how to breathe properly while
you're awake.
It's also important to address any breathing problems your child
might have, as it can have serious repercussions for their health.
If you're pregnant, I urge you to consider
breast feeding, and to pay careful attention to their diet
during their early years as this may prevent such problems from
occurring in the first place.
Sleep Apnea Increases Your Risk for Health Problems
There are five general types of sleep apnea, and any of them may
provoke or exacerbate other health problems:
Upper airway resistance syndrome or UARS is a sleep disorder
characterized by airway resistance during sleep. The primary
symptoms include daytime sleepiness and excessive fatigue.
During sleep the muscles of the airway become relaxed. The
relaxation of these muscles in turn reduces the diameter of the
airway.
Typically, the airway of a person with UARS is already
restricted or reduced in size, and this natural relaxation
reduces the airway further. Therefore, breathing becomes
labored.
It can be likened to breathing through a straw. UARS is often
confused with fibromyalgia or chronic fatigue syndrome.
Central apnea typically relates to your diaphragm and chest
wall and an inability to properly pull air in. Central sleep
apnea occurs because your brain doesn't send proper signals to
the muscles that control your breathing.
Central sleep apnea may occur as a result of other
conditions, such as heart failure and stroke. Sleeping at a high
altitude also may cause central sleep apnea.
Obstructive apnea relates to an obstruction of your airway
that begins in your nose and ends in your lungs. The frequent
collapse of the airway during sleep makes it difficult to
breathe for periods lasting as long as 10 seconds.
Those with a severe form of the disorder have at least 30
disruptions per hour. Obstructive sleep apnea, or OSA, arises
from what is basically a mechanical problem.
During sleep the patient's tongue falls back against his or
her soft palate, and the soft palate and uvula fall back against
the back of the throat, effectively closing the airway.
Breathing usually resumes with a large GASP, SNORT, or BODY
JERK.
These movements interfere with sound sleep. They can also
reduce the flow of oxygen to vital organs and cause irregular
heart rhythms.
Mixed apnea is a combination of central apnea and
obstructive apnea.
Snoring is the first sign of sleep apnea. Snoring is the
hoarse or harsh sound that occurs when your breathing is
partially obstructed in some way while you are sleeping.
Not only is snoring a nuisance to others, but 75 percent of
people who snore regularly have OSA (when breathing is disrupted
during sleep for short periods), which may increase the risk of
developing heart disease.
Not only do these breathing disruptions interfere with sleep,
leaving you unusually tired the next day, it also promotes poor
health and chronic disease by:
Reducing the amount of oxygen in your blood, which can
impair the function of internal organs and/or exacerbate other
health conditions you may have
Slowing down or preventing critical detoxification of your
brain tissue, as your brain's waste removal system, known as the
glymphatic system, only operates during deep sleep
Disrupting your circadian rhythms, resulting in reduced
melatonin production and the disruption of other body chemicals
A number of recent studies have highlighted the health risks
associated with sleep apnea. For example, sleep apnea can:
Dramatically weaken your immune system
Accelerate tumor growth
Cause a pre-diabetic state, and promote diabetes
Speed up memory loss and promote Alzheimer's disease2,3,4
Impair physical and mental performance, and decrease
your problem solving ability
Promote depression. It's also frequently misdiagnosed as
depression,5
and the greater the severity of your sleep apnea, the
greater your likelihood of feeling depressed
Recent research has also found that sleep apnea appears to be far
more hazardous for women than men, and that children are
increasingly at risk for sleep apnea and associated health problems.
Sleep Apnea May Be More Dangerous for Women Than Men
Previous studies have linked sleep apnea to heart disease in men,
but the risk for women remained largely unknown. To assess whether
this risk applies equally to both women and men, researchers
measured the sleep quality of 737 men and 879 women.
None had been diagnosed with cardiovascular disease at the outset
of the study,6
which ran for 14 years. All were also tested for troponin T. This
protein is a marker for heart damage, and elevated levels suggest
you're at increased risk for
heart disease.
As it turns out, sleep apnea appears to be far more hazardous to
women than men. Even among women who didn't develop heart failure,
sleep apnea was associated with damage in the heart that led to
worse health outcomes.
"Obstructive sleep apnea was independently associated
with increased troponin T, heart failure, and death in women,
but not in men. And in women, but not men, sleep apnea was
associated with an enlarged heart, another risk factor for
cardiovascular disease."
Sleep Apnea Linked to Higher Risk of Gout
One of the most recently added side effects of sleep apnea is an
increased risk of gout, a type of painful arthritis where the
inflammation frequently targets the base of your big toe.
A recent British study8,9
found that people with sleep apnea were about 50 percent more likely
to have gout than those who sleep well, and this held true
regardless of sex, age, or weight.
According to the lead author: "Our findings call for future
studies to evaluate the effect of treating sleep apnea on serum uric
acid levels and the risk of gout."
Snoring and Sleep Apnea Raises Your Risk of Diabetes
One of the reasons why sleep deprivation is so damaging to your
health is related to how it impairs your body's response to insulin.
Impaired insulin sensitivity, also known as
insulin resistance, is a precursor to type 2 diabetes as well as
a risk factor in many other chronic diseases.
In fact, controlling insulin levels is one of the most powerful
ways to reduce your risk of chronic disease, including high blood
pressure, heart disease, and cancer. A number of studies have shown
that lack of sleep can very quickly put you into a pre-diabetic
state, and chronic sleep disturbance significantly raises your risk
of type 2 diabetes.
One of the most recent long-term studies10
looking at this link found that seniors who snore or suffer with
sleep apnea are 27 and 50 percent more likely, respectively, to
develop type 2 diabetes compared to those who sleep well.
Eve Van Cauter, a sleep and metabolism researcher at the
University of Chicago who was not involved in the study told Reuters11
that "getting good sleep is as important as nutrition and
exercise to remain healthy during the aging process," and that
"people must insist that their doctors include sleep hygiene and
sleep health in their evaluation and recommendations."
Sleep Apnea in Children Linked to Lower Grades in School
As mentioned in the list above, sleep apnea also affects your
mental functioning, and this can have dire ramifications for
school-age children. According to recent research analysis of 16
published studies, kids with sleep apnea tend to struggle in school
and perform worse in language arts, math, and science compared to
those who do not have sleep or breathing problems. As noted by lead
author Barbara Galland, a research associate professor at the
University of Otago in Dunedin, New Zealand:
"Sleep apnea... may interfere with getting a good night's
sleep, which may, in turn, contribute to children having a hard
time paying attention and being less ready to learn and perform
academically during the day. If a large sample of children
without sleep-disordered breathing achieved an average 70
percent score for a test examination, a comparable sample of
children of the same age with sleep-disordered breathing would
be estimated to achieve an average score 11 percent below (59
percent)."
Did You Know? The Size and Shape of Your Mouth May Cause Breathing
Problems Like Sleep Apnea
While
obesity is a common factor that increases your risk for sleep
apnea, an increasingly common root cause is related to having an
improperly shaped mouth and incorrect positioning of the tongue.
This is particularly true for the younger generations who were
raised on infant formula and processed foods. Dr. Weston Price's
pioneering work showed how diet can affect your entire mouth, yet
most people are still clueless about this effect, and how the size
and shape of your oral cavity affects the placement of your tongue
and your ability to breathe.
According to Dr. Arthur Strauss, a dental physician and diplomat
of the American Board of Dental Sleep Medicine, our mouths have
progressively gotten smaller through the generations due to lack of
breastfeeding and poor nutrition. Breastfeeding actually helps
expand the size of your child's palate and helps move the jaw
further forward – two factors that help prevent sleep apnea by
creating more room for breathing.
Your tongue placement also plays an important role, as revealed
in a recent pediatric study.12
As explained in this study, having an abnormally short lingual
frenulum can result in impaired orofacial growth in early childhood,
reducing the width of the upper airway.
The upper airway is very pliable, so this increases the risk of it
collapsing during sleep. They found that children with untreated
short frenulum developed abnormal tongue function early in life,
which also impacted their orofacial growth and led to disordered
breathing during sleep.
The researchers suggest that pediatricians and otolaryngologists
should systematically examine the lingual frenulum in children
exhibiting difficulties such as trouble sucking, speech impediments,
snoring, or other breathing problems. They also note that while a
frenectomy (removal of the frenum) is helpful, it's often
insufficient to resolve all abnormal breathing patterns, and
recommend incorporating oral myofunctional therapy after surgery to
restore normal nasal breathing.
How Oral Myofunctional Therapy Can Help Relieve Sleep Apnea
A form of facial muscle therapy called
oral myofunctional therapy can help reshape your oral cavity and
promote proper placement of your tongue, thereby alleviating sleep
apnea. In a meta-review13
of nine studies that included a total of 120 patients with
obstructive sleep apnea, myofunctional therapy reduced the severity
of sleep apnea by about 50 percent in adults, and 62 percent in
children.
It also teaches you to breathe through your nose, with your
tongue resting against the roof of your mouth. This is an important
aspect of proper breathing that the Buteyko Breathing Method also
addresses (see the next section). If you're a chronic mouth
breather, you're also at increased risk of snoring and/or sleep
apnea.
One low-cost trick to help retrain yourself to keep your mouth
closed is to place a small strip of surgical tape over your mouth to
keep your lips together while you sleep. (Don't go crazy; this is
not the time to use duct tape, as it may damage the sensitive skin
around your mouth and lips. All you're trying to achieve is some
resistance to prevent your mouth from automatically falling open.)
Grinding and clenching your teeth is one common sign indicating
you may have a sleep disorder and/or need to retrain your orofacial
muscles. More specifically, teeth grinding is indicative of an upper
airway obstruction, causing your body to compensate by attempting to
move your jaw to open the airway. Getting all your oral-facial and
neck muscles to work correctly can make a big difference in this
case. To find a qualified therapist, see the
Academy of Orofacial Myofunctional Therapy's (AOMT) website.14
Ideally, Find a Specialist to Help You Address the Root Cause
A simple test you can perform to check whether or not you're
breathing properly is to stand with your back against a wall, with
your heels, buttocks, shoulder blades, and head touching the wall.
Say "Hello," swallow, and then breathe. If you can speak, swallow,
and breathe easily and comfortably in this position, then your mouth
and throat are clear. If you cannot perform those three functions,
your breathing is probably obstructed, which may be exacerbated when
lying down to sleep.
If you suspect you may be suffering from sleep apnea, your first
step would be to identify a qualified sleep specialist. It's worth
doing your homework here, as many have nothing in their tool bag
besides the conventional treatment using a CPAP machine, which is
little more than a band-aid.
CPAP (an acronym for "continuous positive airway pressure") is a
machine that mechanically opens up your airway using air pressure so
that you can breathe. But while it may provide symptom relief, it
does not in any way address the root cause of the problem. Many also
find them difficult to use, clean, and maintain, not to mention it
takes some getting used to sleeping with a mask strapped to your
face. Bedroom partners may also be disturbed by the sound. That
said, for severe sleep apnea, a CPAP may be a wise choice, at least
to start.
Ideally, you want to find a specialist that can help you address
your sleep apnea at the foundational level. For example, if you're
obese, losing weight might significantly improve the problem.
If your sleep apnea is related to your tongue or jaw position,
specialty trained dentists can design a custom oral appliance to
address the issue. These include mandibular repositioning devices,
designed to shift your jaw forward. Others help hold your tongue
forward without moving your jaw.
The oral appliance approach has been recognized as part of the
standard of care for sleep apnea since about 1995, and oral
appliances are typically recommended as the first line treatment for
mild to moderate sleep apnea. One source where you can find a
treatment specialist familiar with oral appliances is the Academy of
Dental Sleep Medicine.15
Learning to Breathe Properly While Awake May Also Help
The
Buteyko Breathing Method — named after the Russian physician who
developed the technique — is another powerful approach for reversing
health problems associated with improper breathing, including sleep
apnea. By learning to consistently breathe through your nose rather
than your mouth, your breathing volume will be brought back to
normal. This will allow for optimal oxygenation of your tissues and
organs, including your brain.
When it comes to your breathing patterns, diet may again play a
role. Processed foods, which tend to acidify your blood in an
attempt to maintain normal pH, will make you breathe heavier and can
lead to chronic overbreathing.
The reason for this is because carbon dioxide, which is in your
blood, helps regulate pH. Besides water, raw fruits and vegetables
have the least impact on your breathing, followed by cooked
vegetables. Processed, high-protein, and high-grain meals have the
greatest adverse effect on the way you breathe.
Typical characteristics of overbreathing include mouth breathing,
upper chest breathing, sighing, noticeable breathing during rest,
and taking large breaths prior to talking. If you recognize these
signs, I would suggest taking a look at the Buteyko breathing
method, because if you're not breathing correctly while awake,
you're at increased risk of breathing problems while sleeping as
well.