We lose muscle tone while we sleep, increasing the risk of our tongue falling backward and the collapse of our throat muscles.
When this happens, the result is obstructive sleep apnea (OSA) — partial or complete blockage of the upper airway, interfering with air passage to and from your lungs during sleep. This interference reduces the amount of oxygen reaching the body and brain and releases adrenaline, hindering the body’s ability to sleep.
Normal sleep physiology occurs in stages, which I’ve written about extensively. OSA disrupts these stages because of hindered breathing, causing many serious problems.
In the short term, OSA can cause poor memory, headaches, and fatigue, which may cause the patient to fall asleep while driving. Long-term complications include:
- Increased risk of obstructive airway disease
- Heart attacks and congestive heart failure
- Non-alcoholic fatty liver disease
- Non-insulin-dependent diabetes
- High blood pressure
- Insulin resistance
- Atrial fibrillation
- Dementia
Obstructive Sleep Apnea’s Impact on Hormones
Obstructive sleep apnea increases the release of stress hormones such as adrenaline and epinephrine.
Beneficial hormones OSA reduces:
- Human growth hormone (HGH): Repairs and builds muscles.
- Testosterone: Maintains sexual function and healthy body composition in terms of muscle mass and fat distribution.
- Estrogen: Maintains healthy body composition and bone health.
Potentially harmful hormones OSA increases:
- Cortisol: Impairs immune function and increases the risk of obesity.
- Leptin: Decreases satiety.
- Ghrelin: Increases appetite.
Athletic Issues
Not only does OSA impair day-to-day functioning and increase the risk of long-term illnesses, but it also interferes with athletic performance in terms of strength, endurance, and cognition.
In 2013, the Journal of Clinical Sleep Medicine examined 12 male, middle-aged golfers with severe OSA. The golfers underwent treatment with continuous positive airway pressure (CPAP — more on this later). Then, after 20 rounds of golf, every golfer’s handicap index (HI) was evaluated.
While the non-OSA control group showed no improvement, the OSA group treated with CPAP improved by 11.3%, and the more skilled players (HI<12) improved by 31.5%.
I’m not a golfer, but I’ve worked with many and have recognized their devotion to the sport. This study proved they’ll do anything to improve their game.
Hurdles to Treatment
CPAP treatments are effective and beneficial. However, patients often hesitate to discuss their OSA symptoms with a physician because they’re afraid they’ll be prescribed a CPAP machine.
CPAP (continuous positive airway pressure) is the gold standard of obstructive sleep apnea treatment. Unfortunately, for most people, it evokes Darth Vader, with a face obscured behind a large mask.
Thankfully, CPAP machines have come a long way since their inception in the 1980s. They’re no longer vacuum cleaner-esque appliances. Even the full-face models are whisper-quiet. If you can’t stand the thought of re-enacting the “Luke, I am your father” scene with your spouse every night, there are plenty of variations to choose from.
For severe OSA or mild-to-moderate OSA with risk factors for complications such as heart attack, AFib, or stroke, the first choice and standard of care is a CPAP machine. But if you suffer from mild-to-moderate OSA and a CPAP machine is off the table for you, you may benefit from an array of alternative treatments.
The Evolution of OSA Treatment
The old-school diagnosis of obstructive sleep apnea required an overnight polysomnogram (at a sleep study facility) with 22 wires attached to you. If you received a diagnosis of OSA, a CPAP machine prescription followed. It wasn’t practical to repeat the sleep study to assess how well the CPAP machine worked for you.
At-home sleep studies and sleep-tracking tools (such as SleepImage) have since improved OSA treatment. These advancements allow for effortless multi-night testing in the comfort of your home, allowing a trial-and-error approach to OSA treatment. This is revolutionary, not only diagnostically but therapeutically.
Stacking Therapy Modalities
Stacking modalities means combining multiple therapies. Each individual therapy may offer only a minimal benefit, but combined together, they can provide significant improvement. Each person can experiment with combining a variety of treatments to create a successful outcome, rather than reaching for the biggest gun (i.e., CPAP) first.
At Banner Peak Health, we use SleepImage and collaborate with Empower Sleep. We also consider adding other modalities to the stack, including tools that:
- Improve nasal patency: Nasal steroids, nasal strips, and nasal dilators improve airflow through the nostrils.
- Minimize mouth breathing: Tools like external straps and tape close the mouth and encourage nasal breathing. These tools also hold the tongue in a more forward position and prevent it from falling backward as we sleep, where it might obstruct the airway.
- Improve sleep position: Pillows and wedges prevent people from sleeping on their backs. A supine (lying flat on the back) position puts a person at risk of obstruction, and gravity compounds this risk. Side sleeping helps stabilize the throat muscles so they don’t collapse and interfere with air passage in and out of our lungs.
- Improve tone and tongue position: Excite OSA and REMplenish Straw are like push-ups for your tongue. Mandibular advancement devices like myTAP and Zyppah bring the lower jaw forward. Since the lower jaw anchors the tongue, this repositioning reduces the obstruction risk by keeping your tongue clear of the airway.
- Modify airway pressure (without CPAP): Try Bongo Rx for increased expiratory positive airway pressure.
Today’s Takeaways
Sleep is the foundation of good health. That’s why Banner Peak Health stays at the cutting edge of sleep science. We’re always brainstorming new ways to maximize and optimize your sleep.
Reach out today and tell us about your sleep concerns. We’re happy to help you.
