Dr. Boggess (Medical Director)
Dr. Tony Boggess is a Physical Medicine and Rehabilitation (PM&R) physician, speaker, and writer who specializes in Nutritional and... read more
Sleep Apnea and Disordered Breathing
Sleep Apnea is common, but often overlooked. More than 12 million Americans have been diagnosed with sleep apnea, and it is estimated that far more than that have undiagnosed apnea, disordered sleep or subtle Upper Airway Resistance Syndrome (UARS) that compromise ones overnight breathing enough to prevent restorative sleep. This is especially the case in many of our patients who are constitutional weak, overstressed, nutritionally compromised, and biologically imbalanced.
Anatomy of Sleep Apnea: Throat muscles, which are usually tense when a person is awake and even during early stages of sleep, can relax fully during deeper stages of sleep, allowing the airway to become plugged by the tongue, surrounding muscles, palate or all three. As with a kinked hose, the flow stops, sometimes for 30,60, even 90 seconds or more. As the brain senses distress people might bolt upright and gasp for air, snort and go back to sleep. The brain may also initiate a person to grind their teeth in an attempt to reposition their lower jaw and tongue to clear the airway. Or to thrash about in bed or undergo some other subconscious efforts to relieve the obstruction. All of these consequences lead to subconsciously arousing into earlier stages of sleep. The end result is that if this is happening it is difficult to achieve the deeper and more restorative stages of sleep that help the body to recover, recoup, and repair.
Consequences of Sleep Apnea: The arousing out of deep sleep can happen 30, 50, even 100 times a night, without the person realizing it. And it can erode health completely over time due to the chronic release of stress hormones and one or more specific disease process that are known to be associated. Basically, when one wrestles with a bear all night named hypoxia (lack of oxygen) you are going to pay the consequences the next day. Hold your breath for a moment longer than is comfortable to see how the body has no other choice than to arouse you out of deep sleep so your relaxed tongue and oropharyngeal muscles will tense up and allow 02 to flow freely. You may not be getting restorative sleep with the brains strategy to arouse, but the way the body sees it, at least you are still alive to fight another day.
Conditions associated with Sleep Apnea: Untreated, the many forms of disordered sleep and apneas have been linked to high and low blood pressure, heart disease, stroke, memory loss, obesity, cachexia, parasomnias, insulin resistance, and even type 2 diabetes. This is not to mention the multitude of subclinical problems related to chronic overnight arousal, stress biology, and the chronic neuroimmune activation leading to continuous bodily stress which impacts hormones, neurochemical balance, thyroid, and the bodies ability to produce energy from fats and sugars using oxygen the way it was designed to. Chronic sleep distress also leads to eventual sickness behaviors, similar to chronic infections (i.e. lack of appetite in the morning, lack of thirst, social isolation, lack of interest in plesuarable things, and the like). By the mechanism previously describes, it has been clearly correlated with many psychological maladaptive states such as depression, anxiety, panic attacks, and even mental illness. Finally, it is also know to be association with pain disorders such as fibromyalgia, myofascial pain, centralized pain sensitivity, and the list goes on.
Snoring loudly? If, you do snore, consider yourself more fortunate because you are actually at an advantage. Why? Because it is a sign that your effort is fighting the restricted airway and you are actually getting some oxygen. My experience is the worst cases of sleep apnea and disordered sleep are those who feel exhausted despite a “good night’s rest” because they arouse out of restorative sleep up to 70 to 100 times per night but have no clue it is happening except that they feel like they’ve been fighting with a bear all night. Muscle pain, unstable blood sugar, anxiety upon waking, headaches, and nausea. Many think they are toxic from the meal the evening prior or that they have parasites, or heavy metal poisoning or any number of other possible reasons for why they feel the way they do. The reality is they are probably not “sleeping through the night” though they have no idea they are arousing.
*Treatment? An in-home or in-lab sleep diagnostic test needs to be order and interpreted by a medical clinic to determine the best course of action!
Things that make Sleep Apnea worse!
In addition to a poor constitutional baseline that goes hand in hand with conditions such as adrenal fatigue, thyroid disorders, depression, methylation problems, toxicity, etc, there are also many lifestyle and health factors that further worsen a patients disposition for disordered sleep and nighttime airway obstruction. For example:
Non-ideal weight and body composition: While it has long been know that being overweight is a risk factor for airway obstruction due to bulking neck tissue pressing in around the neck, throat, and airway, the worst cases I work with are the underweight, constitutionally weak, and nutritionally deficient patients.
Frustratingly, sleep apnea further contributes to weight fluctuations making it a central culprit in two vicious cycle of worsening apnea that eventually become chronic.
1) For the overweight predisposed, apnea increases the stress hormone cortisol which also leads to unstable blood sugar and excessive cravings for unhealthy, simple carb foods. Additionally, chronic sleep deprivation dramatically messes with hormones and neurotransmitters (like serotonin) that suppress appetite and lead to the body’s signal to put on weight like a bear in preparation for hibernation due to the “stress” of winter looming. To the body stress is stress. Stress from not sleeping restoratively chronically signals the body to pack it on.
2) For the (less common, but still serious) manifestation in underweight patients, chronic sleep deprivation leads to appetite and weight loss because the ratio of cortisol to other hormones like DHEA become even more catabolic (breaking down) and significantly impact the joy, taste and chemical rewards associated with eating. These individuals wake up nauseated and feeling toxic. They will usually force themselves to eat. However, by virtue of the fact the body thinks it’s been running from a tiger all night (i.e. fight or flight), the digestive system (i.e. rest and digest) is essentially turned off. These individuals usually wake up anxious, hypoglycemic, and dreading the day ahead for no apparent reason.
Alcohol consumption: While alcohol is a popular evening past time and an easy “go-to” for self medicating depression, anxiety, pain, and the like, it is not a wise choice if you suspect a disordered sleep condition or apnea. Alcohol while known to help induce sleeping, is also dramatically shortens the REM (Rapid Eye Movement) stage of sleep which is arguably the most important. Also, alcohol is a potent muscle relaxant which can further slacken compromised throat tissues making the airway even more vulnerable to obstruction as described above.
Medications. Prescription medications can worsen the situation. Bottom line any medication that is a muscle relaxants of any kind, prescription, over the counter, herbal, or otherwise is going to increase the likely hood of apnea. The hard truth is: that the vast majority of natural and prescription sleeping remedies have a muscle relaxant aspect to them. Therefore one must be careful to know exactly what is the cause of disordered sleep prior to taking sleeping aids. But the even greater danger for apnea patients taking sleeping aids in my opinion is that ALL consumable sleeping aids will make it harder for one to arouse, which as I mentioned is the bodies primary strategy to get the neck and airway muscle to tense up to allow air to flow. In such case, noises must be louder. Pain sharper, stronger. Grinding more agressive, adamant. Likewise, an episode of sleep apnea must last longer because “more respiratory compromise” is needed to wake the brain up to restore normal breathing. To arouse under such extreme circumstances means all sorts of risks such as increased generalized pain sensitivity, muscle pain, central sensory ramp up, and TMJ arthritis as examples. Your body will ultimately win for the most part and oxygenate itself unless you are overly sedated (which is life threatening). But at what cost to your health?
Sleep position. It is usually better to sleep in any way other than on your back which makes apnea episodes more likely due to the impact of gravity. In fact, many people report sleeping better in general on their stomach or either side. However, it ultimately depends on how and where weight falls on the airway and this usually varies from person to person, circumstance to circumstance.
Heightened stress & exhaustion. It is obvious that the body craves the deepest kind of sleep when overextended. In other words, the brain will launch a person quickly into the deepest and most restorative sleep if possible when you are exhausted, especially when the exhaustion is chronic. But as I mentioned above apnea tends to be worse during the deepest, most relaxed stages of sleep. So basically now you are skipping the normal stages of decent that work for you and struggling sooner and worse because the body is desperately trying to catch up. The best solution is for patients with apnea or disordered sleep to carve out enough time to journey’s through the sleep cycle fully, especially when your day has been stressful. So if you are one that needs 10 hours of sleep to feel even remotely rested, then I’m referring to you here…
Remember, a sleep diagnostic test is always required to determine the best course of action.
Sleep Deprivation! This is a cruel fact, because it is well known that sleep deprivation is the obvious consequence of sleep apnea, which may create a chronic cycle based on the same mechanisms outlined with stress and exhaustion.
Anatomy. For some people, anatomic abnormalities may be the straw that breaks the camel’s back, but also may be the key to breaking this nasty cycle. We’ve already discussed how baseline constitution, muscle function, stress, exhaustion, and medications can take a person over the edge, especially during the deepest stages of sleep. But if you ALSO have enlarged tonsils, swollen throat, a deviated septum, inflamed nasal passages, allergies, big tongue, floppy palate, or a smaller-than-normal airway, this can really be the difference maker. Fixing these things is sometimes easy. Surgery options, dental appliances (designed for apnea – NOT grinding), tongue holders, or other niche products abound and may be exactly what the doctor ordered for a good nights sleep…
Smoking. This aberrant habit clearly irritates and insults the throat, the uvula, the soft palate, the tongue, which end up swelling over time. It is no surprise that smoking is associated with sleep apnea given all we have discussed up to this point. Our clinic has great success helping even the most addicted patients to stop smoking because the act of smoking is a “self-medicating” strategy for chemicals lacking in the brain. At Natural Balance Wellness we diagnose and treat what is lacking.
Bruxism Appliances (for Teeth Grinding). I know this one is a shocker, but it is not wise to use a dental splint that is not specifically designed to keep the jaw forward and the airway cleared. On one hand dental appliances designed by a competent dentist for apnea — NOT grinding alone can be very helpful. However a poorly designed oral guard that does not take into account that grinding is often the result of the bodies attempt to clear the airway during the deepest stages of sleep can actually be very harmful. Worsening apnea, harder grinding, and severe deterioration of the TMJ joint overtime is the eventual outcome of a poorly designed night guard (see full article for more details.)
*An in-home or in-lab sleep diagnostic test needs to be order and interpreted by a medical clinic to determine the best course of action!