Things That Help in Managing Sleep Apnea

Sleep apnea is a common sleep disorder that is marked by intermittent cessation, or decreased depth, of breathing during sleep. The person is likely to snore loudly while asleep and, occasionally, wake up startled and gasping for breath to let in the air into his or her lungs.

Obviously, we all may have pauses in breathing from time to time; however, for such pauses, or decreased depth of breathing, to be considered abnormal, they should last at least 12 seconds, and it is not uncommon for them to last a minute or even more. Generally, individuals suffering from such episodes of abnormal breathing are completely unaware of it.

According to the National Sleep Foundation, this disorder affects more than 18 million Americans.^[2]

Signs and Symptoms of Sleep Apnea

The telltale signs of sleep apnea are loud snoring, excessive daytime sleepiness, and waking up from sleep gasping.

Other symptoms of sleep apnea include:^[4]

1. Waking up with a dry mouth
2. Excessive urination at night
3. Irritability
4. Morning headache
5. Concentration problems
6. Inability to stay asleep after falling asleep

Standard Treatment for Sleep Apnea

• Continuous positive airway pressure (CPAP) device – The American Sleep Apnea Association highly recommends the use of CPAP for the treatment of obstructive sleep apnea syndrome.^[5] CPAP therapy remains the standard gold treatment for obstructive sleep apnea.^[6] It involves the use of a mask that is worn over the nose and/or mouth to maintain the flow of air into the air passages. This helps keep them open while sleeping. It is essential to follow this treatment method continuously and as directed by your doctor to ward off the symptoms.
• Dental appliances – Dental appliances reposition the lower jaw and tongue and resemble a mouth guard. These should be strictly fitted by a dentist.
• Upper airway surgery – Surgery is done to remove excess tissue and/or correct the anatomical abnormalities that are causing an obstruction in the airways.
• Newer treatments for obstructive sleep apnea include implantable and noninvasive electrical stimulation of the upper airway muscles.^[12][14]

Possible Alternative Therapy

Acupuncture Therapy

Although acupuncture is not a “home” remedy, it is worth mentioning as a potential alternative treatment. This is not an approved treatment modality; however, when standard treatment is not available, affordable, or be well tolerated, acupuncture may prove helpful.

It is not well known how acupuncture works on sleep apnea, but some studies have shown beneficial effects from acupuncture on the severity of sleep apnea. It is suspected that acupuncture affects the nerves supplying the areas of the mouth and throat involved in sleep apnea.

Interestingly, one of the newer “approved” treatment involves the stimulation of the nerves supplying the back of the tongue.^[13] This may or may not explain why electro-acupuncture may work better than manual acupuncture, but it gives some support to the concept that the manipulation of peripheral nerves may have a welcome effect on sleep apnea.

How to Manage Sleep Apnea at Home

Sleeping better has a lot to do with your lifestyle. You can help mitigate the risks of sleep apnea by incorporating some changes in your daily activities:

1. Lose Some Weight

Obesity is among the factors that are associated with sleep apnea. The accumulation of fat in the body tissues, especially the upper airway, can constrict the air passages and cause interrupted breathing during sleep.

In fact, the prevalence of obstructive sleep apnea in obese or severely obese patients is nearly twice that of normal-weight adults.^[7]

Maintain healthy body weight. If you are obese, besides following a healthy diet and eliminating fattening foods, exercise daily to reach your ideal body weight

2. Do Orofacial and Throat Exercises

One-week routine exercises for the tongue and throat were associated with a 48% decrease in obstructive breathing disturbances during REM sleep.^[8]

Orofacial and throat exercises can take time to be effective; hence, it is advised to be consistent in your efforts in order to reap the benefits.

Tongue Exercise

The abnormalities in tongue anatomy that can contribute to sleep apnea include an enlarged tongue and weak muscles at the base of the tongue. This can cause obstruction while sleeping.

Tongue exercises aim to strengthen the tongue muscles and prevent them from shifting backward, which can cause blockage in your airways. The point where the posterior end of your tongue and throat meet should remain open to keep you breathing normal while you sleep.

• Run your tongue throughout the inside space of your mouth, up and down the palate, behind the teeth, and in between the lips.
• Press your tongue on the upper palate or the roof of your mouth for 3 minutes every day.

Throat and Mouth Exercise

Doing throat exercises regularly can help ease sleep apnea symptoms. These exercises help strengthen the muscles to prevent blocked or narrowed airways in your nose, mouth, or throat. They also help reduce snoring and promote sound sleep at night.

Weak throat muscles can disrupt the breathing process throughout the day as well as during the night time.

• Purse your lips in a pout and move them up and left 10 times, and up and right 10 times. Repeat this exercise three times a day.
• Gargle twice every day for 5 minutes.

Use a balloon for this mouth exercise.

1. Place your lips on the balloon to inflate it.
2. Take a deep breath through your nose, and then blow out the air into the balloon as much as possible.
3. Repeat the process without removing your lips from the balloon.

Consult your doctor if you wish to learn more about these exercises.

3. Adjust Your Sleeping Position

Several people with obstructive sleep apnea are more likely to have a sleep apnea episode or snore while lying on a supine position.^[9]

Sleeping on your side, or laterally, can help you reduce your risks of having apneas.

Alternatively, you can prop your head up by 4-6 inches to reduce the risk of upper airway obstruction. You can also use a special cervical pillow or a foam wedge.

4. Quit Smoking

Smoking is likely to induce sleep apnea. People who are in the habit of smoking regularly tend to develop sleep apnea three times more than nonsmoking individuals.

Smoking can pose adverse effects on your respiratory system by increasing inflammation and retaining fluids that would otherwise be drained off. These can accompany disturbances in sleep by altering the neuromuscular functions, blocking the airflow of the upper respiratory tract, and causing or aggravating obstructive sleep apnea.^[10]

A study suggested that smoking is likely to increase the existence of obstructive sleep apnea in any individual. Smoking cessation is a prerequisite to the treatment of obstructive sleep apnea, and the treatment of obstructive sleep apnea is a primary condition for successfully quitting smoking.^[11]

Is Your Snoring Normal or Not?

Although loud snoring is commonly cited as a trademark sign of sleep apnea, not everyone who snores suffers from the condition.

The loud noise, or snore, is produced by the vibration of the tissue in the upper airways when you breathe in air while sleeping. Unlike the “usual” snoring, sleep apnea is accompanied by disruptions in breathing as a result of the various reasons stated above.

Sleep apnea can cause major discomfort by degrading the quality of your sleep and can affect your day to day activities as well.

Bedtime Tips to Reduce the Risk of Sleep Apnea and Poor Sleep Quality

Following some tips may help reduce the severity of the condition:

1. Keep your nasal passages clear. Inhale steam, or use a saline spray or a nasal irrigation system before going to bed to prevent nasal congestion.
2. Avoid caffeine and heavy meals 2 hours before bedtime.
3. Restrict the use of sedatives and alcohol, which can disrupt the flow of oxygen to the brain.
4. Install a humidifier in your room to keep your nasal passages moist.

Factors that Increase the Risk for Sleep Apnea

Sleep apnea can affect individuals of any age group. This interruption of the natural course of breathing happens when the upper respiratory passages are blocked, interrupting the flow of air – either reducing or completely stopping it. This is termed as obstructive sleep apnea.

The risk for obstructive sleep apnea may be increased by an enlargement of tonsils or adenoids in children, whereas in adults, it may be associated with obesity, male sex, and aging.^[1] Obviously, some of these risk factors are not modifiable.

When apneas happen because of the failure of the breathing muscles to initiate breathing, the condition is termed central sleep apnea.^[3] The causes of such impaired function can range from problems of muscle function to those of brain function.

Sometimes, both forms can occur together.

Risk factors for obstructive sleep apnea include:

1. Obesity and a thick neck
2. Anatomical abnormality in the throat, upper airways, and nose
3. Older age
4. Nasal congestion
5. Cigarette smoking
6. Having close relatives with obstructive sleep apnea
7. Excessive intake of alcohol close to bedtime
8. Use of sedatives or tranquilizers close to bedtime

When to See a Doctor

It is essential to address your sleep apnea problem if it persists for long and is affecting your health and wellness. Seek medical attention when you observe the following:

• Loud snoring that tends to disturb your sleep and that of your partner
• Waking up gasping for breath or choking
• Drowsiness during the day that causes you to fall asleep while working or doing any other activity

Your doctor will evaluate your condition based on your sleep history and symptoms, which can be provided by someone with whom you share your bed.

You might be referred to a sleep specialist who can help you with your condition.

End Note

Sleep apnea can be caused by varied reasons and can affect your performance and quality of life. Thus, it is of paramount importance to treat this condition.

You can quit smoking, change your sleep position, and do regular orofacial and throat exercises to help yourself with a good night’s sleep.

If your sleep apnea persists for long and is causing significant discomfort, consider getting medical help.

Expert Answers (Q&A)

Answered by Dr. Jeffrey L. Brown, DDS (Dentist)

Can sleep apnea lead to other health ailments?

When a person has sleep apnea, they are fighting to breathe and at times actually, stop breathing altogether. This lack of good oxygenation forces the heart to pump harder to get more oxygen into the stressed system of the body. This can lead to high blood pressure.

Apnea also contributes to many other ailments and even a shortened lifespan. When you have sleep apnea, your hormones do not get charged up properly at night, and this can lead to weight gain, and diabetes as well.

Can sleep apnea be treated without any medication?

Yes, in our office we actually fix apnea as best as we can using the very special ALF appliance which opens the airway, widens the dental arches, and brings down the palatal vault to improve nasal breathing.

The MAD (Mandibular Advancement Device) is an older concept that simply opens the airway but does not actually repair the problem, whereas the ALF actually fixes the underlying issues. The other way to deal with apnea is to wear a CPAP – this forces air down your throat basically. It does not fix anything either, but it does help with your breathing.

Most of our new patients who already have CPAP’s have told me they do not like the device at all, but know that they need it to survive. Then, once we do the ALFs, many of them can either get the CPAP off, or reduce the air pressure so the force is not as great and this is more comfortable for them.

Can sleep apnea worsen with age?

Indeed, it does, in most cases. As we age, our muscle tonicity tends to decrease, and this can cause more ‘sagging’ in the throat tissues. Also, the tongue is quite well known for holding fat deposits, so if we are a bit overweight, we can have an enlarged tongue which further blocks the airway. It is very difficult to lose fat in the tongue.

Additionally, with apnea the body is in a mode where hormones are depleted, and we are basically ‘running on empty’ so imagine how your adrenal glands will be after all those years. Your body is producing cortisol as best it can, and eventually you run out due to the stress your body is facing.

Is it possible to get rid of sleep apnea by losing weight?

Losing weight can definitely help to reduce sleep apnea if the patient is overweight. I still have many patients who are either perfect weight or even underweight, and they have apnea. This is usually due to a structural issue like a high palatal vault or very narrow dental arches.

Also, many of these patients had teeth extracted for braces, and this effectively collapsed their airway. Remember that losing fat in the tongue is very difficult once it begins, and a smaller tongue is always helpful in reducing apnea.

Is a CPAP the only option for sleep apnea treatment?

CPAP is considered the standard of care when treating sleep apnea and if your doctor instructs you to wear one, then you should follow the instruction. In almost all cases, the patient eventually has trouble wearing the CPAP due to discomfort of some kind- usually, it blows air up their nose and dries out the eyes.

In the past, the next level of care would be the MAD, as previously described. Today, almost 95% of the time, my patients choose the ALF to actually fix the problem. Almost every day of the week, I have an apnea patient who is wearing ALFs and reports better sleep and better overall health.

Can children have sleep apnea?

Most definitely. Children can have apnea for varied reasons. Many children have allergies which block the throat and reduce the airway volume. Many children today are also overweight, and that fat tissue blocks the airway as well.

If a child snores, this is actually quite dangerous. The carotid artery vibrates when a child snores, thus causing damage to it due to the vibrations. This is not healthy for a child. 

Is snoring in children normal?

As mentioned above, snoring in children is quite dangerous because it causes the carotid artery to vibrate, and this leads to damage. When the artery is damaged, plaque will fill the damaged site, and if this plaque dislodges, it could cause a blockage elsewhere in the body also. This is not healthy for a child.

Is there anything one can do to help relax and fall asleep?

We often recommend a product called ‘Natural Calm’. The magnesium helps to calm muscles, and we have found a reduction in grinding/clenching assists in falling asleep. We also recommend a good hot bath with Epson salt and lavender or chamomile to relax the entire body.

In our office, we actually teach our patients some other techniques to encourage relaxation. Training in meditation and chi kung are also quite helpful.

About Dr. Jeffrey L. Brown, DDS: Dr. Brown grew up in Maine and went on to Graduate Magna Cum Laude from Bowdoin College. He entered into the Georgetown School of Dentistry and completed his studies from there in 1986.

He has knowledge expanding over the fields of TMJ, sleep, craniofacial pain, and orthodontics, which has given him an unlike edge over other practitioners who perform basic dentistry. In addition, Dr. Brown has also learned the advanced techniques and medical procedures involved in expanding an airway and reducing craniofacial pain so that both children and adults can breathe and function better. He is currently the owner of Sleep & TMJ Therapy in Falls Church, Virginia, and is a certified Fellow of the American Academy of Craniofacial Pain.

Resources:

1. Slowik JM. Obstructive Sleep Apnea. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK459252/. Published March 11, 2019.
2. Sleep Apnea and Sleep. National Sleep Foundation. https://www.sleepfoundation.org/sleep-disorders-problems/sleep-related-breathing-disorders/obstructive-sleep-apnea.
3. Sleep Apnea. National Heart Lung and Blood Institute. https://www.nhlbi.nih.gov/health-topics/sleep-apnea.
4. Stansbury RC, Strollo PJ. Clinical manifestations of sleep apnea. Journal of thoracic disease. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4598518/. Published September 2015.
5. Sleep Apnea Treatment Options. Sleepapnea.org. https://www.sleepapnea.org/treat/sleep-apnea-treatment-options/. Published February 25, 2019.
6. Pavwoski P, Shelgikar AV. Treatment options for obstructive sleep apnea. Neurology. Clinical practice. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5964869/. Published February 2017.
7. Romero-Corral A, Caples SM, Lopez-Jimenez F, Somers VK. Interactions between obesity and obstructive sleep apnea: implications for treatment. Chest. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3021364. Published March 2010.
8. Rousseau E, Silva C, Gakwaya S, Sériès F. Effects of one-week tongue task training on sleep apnea severity: A pilot study. Canadian respiratory journal. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4470553/. Published 2015.
9. Joosten SA, O’Driscoll DM, Berger PJ, Hamilton GS. Supine position related obstructive sleep apnea in adults: pathogenesis and treatment. Sleep medicine reviews. https://www.ncbi.nlm.nih.gov/pubmed/23669094. Published February 2014.
10. Vidya Krishnan, Sherrie Dixon-Williams, J. Daryl Thornton. Where There Is Smoke…There Is Sleep Apnea. Chest. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4251622/. Published 2014.
11. Lin YN, Li QY, Zhang XJ. Interaction between smoking and obstructive sleep apnea: not just participants. Current neurology and neuroscience reports. https://www.ncbi.nlm.nih.gov/pubmed/22932197. Published September 2012.
12. Bisogni V, Pengo MF, De Vito A, et al. Electrical stimulation for the treatment of obstructive sleep apnoea: a review of the evidence. Expert review of respiratory medicine. https://www.ncbi.nlm.nih.gov/pubmed/28730908. Published September 2017.
13. Lv Z-T, Jiang W-X, Huang J-M, Zhang J-M, Chen A-M. The Clinical Effect of Acupuncture in the Treatment of Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Evidence-based complementary and alternative medicine: eCAM. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4834396/. Published 2016
14. Commissioner Of the. Always Tired? You May Have Sleep Apnea. Always Tired? You May Have Sleep Apnea. https://www.fda.gov/consumers/consumer-updates/always-tired-you-may-have-sleep-apnea.