Is there a way to naturally treat sleep apnea?
A CPAP is a device that helps you breathe when you're sleeping by having a steady flow of air to keep your airway open. If you're in the 15-30% of males (and 10-15% of females) that have sleep apnea, you've definitely heard about a CPAP. When it works, it's amazing and the benefits are quite literally life changing for the better. Improving sleep apnea not only improves sleep quality, it decreases your risk of heart disease, stroke, diabetes, mood disorder and also improves quality of life.
However, when the CPAP leaves you with constant bloody noses, increased congestion, headaches, or stomach discomfort and bloating, those life changing results are far from amazing. If you're sensitive to touch or claustrophobic, wearing the CPAP is darn near impossible, if not traumatic. That's why knowing alternatives are always helpful in case using a CPAP isn't the best option or a viable option for you.
First, let's look at the airway when we sleep. In an ideal world, the tongue gently suctioned to the roof of the mouth, moving the tongue both up and forward creating a stable space within the pharynx for air to freely move.In many cases, the tongue isn't able to stay on the roof and falls into the floor of the mouth and back, cutting off the airway.
Now, let's look at how to improve sleep apnea without a CPAP. And as always, just as a CPAP isn't for everyone, these ideas aren't for everyone (they also aren't medical advice). So talk to your doctor and figure out what will work best for you. Also, even if you don’t want a CPAP alternative, these ideas can help you optimize your body and therefore improve the effectiveness of your CPAP.
Breathe through your nose to improve sleep apnea
The first step to breathing through your nose is making sure you CAN breathe through your nose. The easiest way to do this is to enlist the help of a partner. Once you are asleep, have them note if you are breathing through your mouth or through your nose. You should be breathing through your nose. If your mouth is open, where is your tongue located? It should be gently sectioned on the roof of your mouth. Next, if you are mouth breathing, have them gently touch the underside of your chin and close your mouth by pulling your jaw up and forward. After 3-5 seconds of holding your mouth closed, have them gently close one nostril and note what happens. Release the nostril, wait 5-10 seconds for the body to adjust and close the other nostril. Ideally your body takes over and you naturally start breathing through the nostril that is open. If your partner notes you gasp for air, this is a sign you're not able to nasal breathe well and that needs to be addressed first.
If you have a deviated septum or polyps, it's highly recommended you address those first as they allow you to breathe through your nose more freely. For this, imagine you are drinking water through a straw and someone gently squeeze the straw closed, what happens to the amount of water you are drinking? In this instance, the water is actually air, the straw is your airway and polyps or a deviated septum are the closing of the airway. It's easier to release the straw so you can suck rather than trying to increase the air pressure.
If you can breathe through your nose but feel a little restricted, you can try nasal strips (Breathe right) to keep the nose open more, olbas oil to improve airflow or a product like Mute to also help keep the nose open. If you are frequently congested, using Xclear both morning and night can help clear the nasal passages.
Mouth taping for sleep apnea
You may have read that mouth taping helps with sleep apnea by forcing you to breathe through your nose. Before taping your mouth shut with 3M porous tape, you need to ensure you can breathe through your nose by doing the test mentioned above. So far there hasn't been a ton of research on mouth taping but we have one small study that showed it can improve severity of sleep apnea and snoring in mild cases. Anecdotally, people who mouth tape and snore tend to wake up less frequently and have less snoring.
Myofunctional Therapy for sleep apnea
Myofunctional therapy (myo) is a newer form of therapy that looks at how the tongue, mouth and face moves. You can think of it as PT for the tongue and focusing on strengthening and freely moving the tongue so it is both stable and strong as well as mobile. Fun fact, the tongue is the most important pharyngeal dilator which means by strengthening the tongue we can better open the airway! If you did the exercise above and found your tongue hanging out in the floor of your mouth, Myo is where you need to look at as they can help strengthen the tongue and open your airway.
In recent years the research we have on myofunctional therapy has been increasing and one of those areas of interest is its effect on sleep apnea. We now have a few studies that show that myofunctional therapy alone can improve sleep apnea. In fact, up to 59% of people resolve sleep apnea without the use of a CPAP.
Myofunctional Therapy and Tongue Tie Revisions for Improving sleep apnea
Studies have shown that the genioglossus muscle, which is the biggest tongue muscle, is almost always dysfunctional in sleep apnea. The genioglossus is actually two muscles that have the lingual frenulum running through it. The frenulum can be restricted or tethered down and prevent the genioglossus from moving.
If you find it darn near impossible to get your entire tongue gently suctioned to the roof of your mouth, or you get it there and feel like you are going to choke, you may have a tongue tie. Other signs are air hunger (you gasp for air or sigh while talking), you thrash in your sheets at night, and you choke…even if you're just drinking water.
If this sounds like you, I highly recommend you find a myofunctional therapist to improve your tongue function prior to having a frenuloplasty (commonly called tongue tie revision/procedure).
Improve allergies and sinus congestion to improve sleep apnea
If you have constant allergies or sinus problems, I highly recommend you look into treating those first because the inflammation that comes with both can decrease the space you have available in your throat and can make it harder to breathe through your nose.
Chronic sinus and allergies can also increase the size of tonsils and adenoids which can cut off the space in the back of the throat making it harder to breathe. If you look into a mirror and open your mouth and look in the back, you can typically see your tonsils. Looking at the chart on the side, if they are a grade 3 or 4, you want to check with am ENT to manage your tonsils.
One small study showed that 100mg of Boswellia and 400mg of Curcumin/turmeric twice a day can decrease allergies and sinus congestion as well as inflammation to improve sleep apnea.
Decrease systemic inflammation for sleep apnea
Along with cutting out your specific allergens, decreasing your overall inflammation can improve sleep apnea and sleep quality.
N-acetyl-cysteine is one of the most studied herbs for sleep apnea and 600mg taken daily in the morning over 30 days showed an improvement in sleep apnea severity. Other studies looked at up to 1800mg of NAC a day to improve asthma, allergies and sleep apnea.
For some people, nightshades cause an increase in inflammation. For this, a trial of removing potatoes, tomatoes, eggplants and peppers from your diet for 2 weeks to see if you sleep better.
For others, excess dairy can increase sleep apnea. If you're a lover of dairy, you can try cutting it back to less than 2 servings a day or stopping dairy for a few weeks to see if your sleep apnea improves.
Mandibular advancement for sleep apnea
Mandibular advancements are a way to bring the lower jaw forward so your tongue has more space and is less likely to close off the airway. You can go to a dentist specializing in airway to have one fitted for you liek prosomnus or you can try an over the counter one like Z-Quiet. Current research shows that 48% of people will have an improvement in their sleep apnea with a mandibular advancement. Mandibular advancements tend to work best on people who have retrognathia or their lower jaw sits further back than their upper jaw. If you've been told you have a severe overbite, you may also have retrognathia. One quick test you can do is take your hand and place it on your upper lip and teeth. If your lower lip and teeth don't touch your hand, it's a sign that you may have retrognathia and the mandibular advancement may improve your sleep apnea.
Now, while it hasn't been researched (yet), I prefer to pair a mandibular advancement with myofunctional therapy to simultaneously give the tongue better function and space.
Expansion for Airway and Sleep Apnea
It's common for people with sleep apnea to have a scalloped tongue or little ridges on the side of their tongue. It's also really common to be told your "tongue is too big for your mouth" or "Your mouth is too small for all of your teeth" so if you've had teeth removed for these reasons or if your braces "failed", you may want to look into finding a dentist trained in expansion for airway.
As you were developing, your tongue should have rested on the roof of the mouth with a gentle suction to naturally expand your palate. If your tongue wasn't on the roof of your mouth, it wasn't able to expand. You may see this now if you look at the roof of your mouth and you see it looks like a pitched tent rather than a rainbow. A high palate, large tongue and mouth breathing are all signs of sleep apnea and dysfunctional tongue us
While I frequently recommend expansion, I recommend myofunctional therapy in addition to expansion so you can work on the root cause while correcting what didn't develop when you were younger.
Tongue Repositioning Devices (TRDs) for Sleep Apnea
TRDs move the tongue forward with suction devices. TRDs tend to be help at the same rate as mandibular advancement devices. With that being said, they are my least favorite alternative as the placement of the tongue isn't ideal and may lead to tension elsewhere in the body due to the forced location of the tongue.
Hormone Replacement Therapy for Sleep Apnea
If you are perimenopausal or menopausal and just started experiencing sleep apnea, you may want to reach out to your OB, Midwife or PCP. The drastic drop in estrogen has been linked to increased sleep apnea and equally as important, the addition of estrogen has been shown to decrease the need for a CPAP.
Body work for Sleep Apnea
Okay, this one is completely cheating. There's no amount of body work or chiropractic adjusting that will magically make you breathe better and resolve sleep apnea. What body work will do is help resolve many of the compensations that were created to keep you breathing.
You may notice chronic neck pain, shoulder pain, chest tightness, inability to get a full breath, pelvic floor pain or constipation secondary to your sleep apnea. That's where body work comes into play…to give you the mobility and stability your body is craving to feel safe.
It's also common for people with sleep apnea to have increased neck extension, protrusion of the neck and increased kyohosis/rounding of the upper back. The body does this to allow you to breathe by creating a bigger airway and allowing more air through the space. Basically, people with sleep apnea are more likely to have the dreaded "chicken neck" and poor posture as a way to keep them alive. This change in center of gravity can also alter balance and the pelvis has to adapt. While body work won't directly improve your sleep apnea, it can improve the compensations created to give you more airway space.
Basic Sleep Hygiene to Improve Sleep Apnea
This is the information you can get pretty much anywhere for sleep hygiene…make sure you sleep on your side, have a cool room, avoid alcohol before bed and try to have a normal BMI while also sticking to your circadian rhythm.
Now, let's address those further.
Sleeping on your side is pretty straight forward. When you lie on your back, gravity typically takes over and let's the tongue fall back towards the throat. By changing your position, you can prevent this from happening (maybe…check myofunctional therapy section above for a better outcome).
Sleeping in a cool room can decrease sleep apnea by allowing your body to cool down, something it automatically does as you enter a deeper sleep. In general, studies recommend sleeping in temperatures between 62-67. But if you're closer to the equator, that temperature can go up to 80.
Alcohol consumption has been shown to increase sleep apnea. Now, the studies typically look at moderate to excessive alcohol near bedtime. So if you enjoy a glass of wine at midday or with dinner, the current research does not deter you from that.
10-15% weight loss can improve sleep apnea by up to 50% in moderately obese people. While it isn't a full resolution, it can definitely decrease the severity while you work on other aspects of breathing at night.
Circadian Rhythm and Sleep Apnea
I'm including Vitamin D levels in this section but they could also go in the inflammatory section. People with sleep apnea frequently have lower levels of Vitamin D. Now, in my opinion, this is a "which came first - the chicken or the egg" situation because people with sleep apnea are often tired and don't get a lot of sunlight. Sunlight is what helps the body create Vitamin D as well as melatonin to help you sleep. Some studies have shown that use of a CPAP does not change Vitamin D levels. On the other hand, two small studies have shown but making sure Vitamin D levels are around 50 can significantly improve sleep apnea and sleep quality. The catch is that this can take up to 8 weeks for benefits to be seen.
If you've made it this far, I hope you have found a few options to discuss with your provider so you can determine what your next best step is to improve your sleep.
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