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.
Types of Sleep Apnea and Their Health Risks
There are five general types of sleep apnea, and any of them may provoke or exacerbate other health problems:
1. 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.
2. 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.
3. 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.
4. Mixed apnea is a combination of central apnea and obstructive apnea.
5. 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
Impair physical and mental performance, and decrease your problem solving ability
Promote heart disease
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. As reported by The New York Times:7
"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.
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.
I've interviewed Buteyko Breathing specialist Patrick McKeown twice. To learn the details of this breathing technique, please see "Breathing Techniques for Greater Health and Fitness."