By Dr. Mercola
Sleep apnea is a common problem, affecting as many as 53 percent of men and 26 percent of women.1 Apnea is a Greek word that means "want of breath." Sleep apnea is the inability to breathe properly, or the limitation of breath or breathing, during sleep, which can have serious health consequences.
Central apnea refers to an inability to properly pull air in, whereas obstructive apnea refers to a frequent collapse of the airway during sleep, hindering breathing for periods that can last for several seconds. Mixed apnea is a combination of both.
Snoring is a related problem, caused by a restriction in your airway stemming from either your throat or nasal passageway. It's the vibrations as the air struggles to get through your soft palate, uvula, tongue, tonsils, and/or muscles in the back of your throat that causes the snore.
Not only do these breathing disruptions interfere with sleep, leaving you unusually tired the next day, it also reduces the amount of oxygen in your blood, which can impair the function of internal organs and/or exacerbate other health conditions you may have.
This includes cognitive decline and dementia, as evidenced in a new study.
Sleep Apnea May Hasten Memory Loss and Alzheimer's
Published in the journal Neurology, the study2,3,4 found that patients with sleep apnea and/or snoring were diagnosed with mild cognitive impairment more than a decade earlier than those without sleep apnea.
On average, those with untreated obstructed sleep apnea started experiencing cognitive impairment at the age of 77, compared to 90 among those without breathing problems.
Those who used a CPAP machine to address their sleep apnea started declining mentally at the same age as those who did not have sleep apnea.
Onset of Alzheimer's disease was also more rapid among those with untreated sleep apnea. On average, they were diagnosed about five years earlier than those slept well. According to coauthor Dr. Andrew Varga:
"This study is adding to the emerging story that sleep apnea may be contributing in some way to the acceleration of cognitive decline as you age, and that is potentially another good reason to get evaluated and treated."
Reduced oxygen levels isn't the only reason sleep apnea may hasten cognitive decline. Lack of sleep also promotes Alzheimer's by preventing critical detoxification. In a nutshell, your brain's waste removal system, known as the glymphatic system, only operates during deep sleep.
The glymphatic system allows your brain to clear out toxins, including harmful proteins called amyloid-beta, the buildup of which has been linked to Alzheimer's. Without proper sleep, harmful waste begins to accumulate in your brain.
Not Sleeping Well? Check Your Breathing…
Unfortunately, sleep apnea often goes undiagnosed and untreated. As reported by NBC News:5
"'The message has to be loud and clear to family practitioners, primary care physicians, and ob-gyns that sleep apnea should be screened for,' agreed Dr. Alon Avidan, a professor of neurology... and director of the UCLA Sleep Disorders Center.
'Unfortunately, sleep apnea doesn't hurt like chest pain. It doesn't bring up a specific complaint. The patient may be a little sleepy or confused. People often fail to make the correlation that the daytime sleepiness may be related to disrupted sleep at night,' Avidan added."
So what are some of the tip-offs that you may be suffering with sleep apnea? One way is to check for posture compensations. It would be easiest to ask a partner to look at how you're laying while sleeping.
At night, your body constantly shifts and compensates to keep you breathing. One sign that you're having trouble breathing is when your body compensates with increased forward head posture during sleep.
The worse your apnea gets, the more pronounced this forward posture becomes, because pulling your head forward helps compensate for the lack of room behind the back of your tongue.
Another common compensation that can indicate sleep apnea is frequent tossing and turning at night, because when you're laying on your back, gravity will pull your jaw and tongue further into your throat, which can obstruct breathing.
Snoring can also be an indication of sleep apnea, as can waking up with heart palpitations and a sense of distress, feeling like you're choking or suffocating.
A simple test 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 can't perform those three functions, your breathing is probably obstructed, which may be exacerbated when lying down to sleep.
Other Helpful Tools
There are also technologies available that can help you determine whether or not you have a breathing problem that may require seeing a specialist. For example, you can:
- Measure your snoring with iPhone apps
- Record the sounds of you sleeping using Audacity, a free software program available online
- Measure your blood oxygen levels with an oximeter. Oftentimes, if you have sleep apnea, you're going to have a drop in blood oxygen. When it drops to a certain level, it indicates you have a problem
If you suspect you may be suffering from sleep apnea, your next 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. Obesity can be a significant contributing factor, but it's not the only one. An increasingly common root cause today is related to the shape and size of your mouth, and the positioning of your tongue. Diet is also important. Dr. Weston Price's pioneering work showed how diet can affect your entire mouth, not just your teeth.
According to Dr. Arthur Strauss, a dental physician and a 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.
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.6
How Oral Myofunctional Therapy Can Relieve Sleep Apnea
Relief may also be found in the form of oral myofunctional therapy, a form of facial muscle therapy that helps "reshape" your oral cavity and promotes proper placement of your tongue. It also addresses functional posture, and all of your facial muscles, including the muscles in your head and neck. Importantly, it teaches you to breathe through your nose, resting your tongue against the roof of your mouth.
Grinding and clenching your teeth is one common sign indicating you may have a sleep disorder and/or need to retrain your orofacial muscles. Teeth grinding specifically is an indication of an upper airway obstruction. Your body tries to compensate by attempting to move your jaw to help open the airway.
Getting all your oral-facial and neck muscles to work correctly can make a big difference in this case. In one recent meta-review7 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.
Another recent pediatric study8 reveals why addressing the tongue is so important for resolving sleep apnea. 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 post surgery to restore normal nasal breathing.
Learning to Breathe Properly (While Awake) May Also Be Helpful
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 how you breathe, 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 one of the roles of carbon dioxide, which is in your blood, is to 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.