By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.
Sleep apnea is a real concern; there’s no doubt about it. Personally speaking, I have it so I know the challenges it presents. And as a cardiologist, I know how interconnected sleep apnea and ischemic heart disease are. Not only does sleep apnea raise the risk of developing heart problems in the first place, it increases complications—even death—in people with existing heart disease.
So, yes – sleep apnea is a potentially serious sleep disorder. People who have it experience multiple—sometimes hundreds—of episodes throughout the night when they stop breathing anywhere from a few seconds to a full minute. The result is less oxygen getting delivered to the brain and the rest of the body. Most sufferers wake up feeling unrefreshed, wondering why they’re so tired when they supposedly got eight or more hours of sleep.
But tiredness is not the worst of it. If left undiagnosed and untreated, sleep apnea can lead to a variety of cardiovascular conditions: high blood pressure, ischemic heart disease, stroke, heart failure, irregular heartbeat (arrhythmia), and heart attack. Scary stuff, I know…and all the more reason to live as healthfully as possible through other lifestyle habits, like an anti-inflammatory diet, exercise, stress management, and detox. A heart-healthy lifestyle is the primary way to reduce your risk of serious sleep-apnea related problems.
Types, Causes and Symptoms of Sleep Apnea
There are a couple different types of sleep apnea. Central sleep apnea occurs when your brain doesn’t send the right signals to the muscles that control your breathing, so you repeatedly stop and start breathing during sleep.
Obstructive sleep apnea is much more common. It is caused by a blockage in the airway—often the soft tissue in the back of the throat collapsing. I, myself, broke my nose as a college athlete and have never breathed the same since. If you have a large tongue or tonsils, a small jawbone, or issues that cause nasal obstruction such as a deviated septum or chronic allergies, you also have significantly higher risk of sleep apnea. Other risk factors include family history, obesity (which usually causes excess fat in the neck/throat area), and having a larger neck (17 inches or more for men, 16 inches or more for women).
If your spouse/partner constantly complains of your snoring, you very well could have sleep apnea—especially if you also have any of the risk factors mentioned above. Loud, nightly snoring is the biggest sign, but others include waking up tired, headache and/or sore/dry throat upon awakening, and coughing or gasping for air in the middle of the night.
Sleep Apnea and the Heart
As someone who has been called out for “sawing wood” at night for decades, and as a cardiologist, I have a keen interest in sleep apnea and reducing the health risks it poses. Unfortunately, sleep apnea is, itself, a cardiovascular risk factor.
“Although obstructive sleep apnea and cardiovascular disease have common risk factors, epidemiologic studies show that sleep apnea increases risks for cardiovascular disease independently of individuals’ demographic characteristics (i.e., age, sex, and race) or risk markers (i.e., smoking, alcohol, obesity, diabetes, dyslipidemia, atrial fibrillation, and hypertension). Individuals with severe sleep apnea are at increased risk for coronary artery disease, congestive heart failure, and stroke.”
Through another study (Circulation, 2017), researchers cited:
“Obstructive sleep apnea is associated with increases in the incidence and progression of coronary heart disease, heart failure, stroke, and atrial fibrillation. Central sleep apnea associated with Cheyne-Stokes respiration [abnormal breathing pattern] predicts incident heart failure and atrial fibrillation; among patients with heart failure, it strongly predicts mortality.”
In a study of overweight patients with sleep apnea and coronary artery disease, researchers have found a link between frequency of sleep apnea episodes and volume of arterial plaque—the more sleep disturbances, the more plaque. And in people who already have cardiovascular disease, research shows that obstructive sleep apnea is a strong predictor of fatal events.
All of this happens thanks to the severe drop on oxygen that occurs during sleep apnea episodes. When oxygen levels fall, the body responds by releasing the neurotransmitter epinephrine (also known as adrenaline). Constant episodes of stopped breathing causes epinephrine to stay high, which can lead to high blood pressure.
Also, when oxygen saturation falls during sleep, both arrhythmias and heart attacks can occur. In fact, up to a quarter of heart attacks happen during sleep.
I know this all sounds dire, but it is certainly not a hopeless situation. You are not a victim. If you have sleep apnea, it doesn’t mean that you’re going to have a cardiac event. You just need to be more careful with how you live your life.
As I mentioned earlier, a heart-healthy lifestyle is one of your best defenses against the serious risks sleep apnea can pose. The 6 best ways to achieve it, are:
- An anti-inflammatory diet like my PAMM Diet, full of nutrient-rich, fresh, colorful veggies and fruits, healthy fats like those found in olive oil and avocado, and some quality protein like wild migratory fish, free range poultry, or grass fed beef. No processed junk or insulin-spiking drinks, just whole, natural, nourishment.
- Regular moderate exercise – 20 to 40 minutes per day. Even moderate-intensity exercises like walking or swimming can decrease excess fat and padding in the neck area.
- Nutritional supplements that give your body the micronutrient nutrition it needs for optimal function, plus extra antioxidants to help your body defend against free radical stress. Here are my top 6.
- Managing your stress by finding ways to regularly relax (besides when you sleep).
- Grounding, or “Earthing” – connecting with the Earth’s natural energy by going barefoot on earth, or using a conductive device indoors, can also help you relax and offset the physiological effects of stress.
- Detoxing – helping rid your body of environmental toxins through a fiber-rich diet, sweating, exercise, and deep breathing.
For more detailed information on how to protect and care for your heart, check out my downloadable Ebook: Your Healthiest Heart Now.
The catch-22 with sleep apnea is that getting enough sleep is one of the cornerstones of staying healthy. So you can also reduce your cardiovascular risk by treating sleep apnea directly.
Treating Sleep Apnea
The most common way to treat sleep apnea is with a CPAP (continuous positive airway pressure) device. These machines deliver a stream of compressed air to a nose or full-face mask, which forces the airway to stay open. Some patients notice an improvement in sleep quality in as little as one night.
Unfortunately, that wasn’t my case. I’ve tried CPAP and I can’t tolerate it. Many people can’t—especially those who are mouth breathers or have an obstruction in the nasal canal. Others simply have a hard time getting used to having their mouth and nose covered by a mask all night. However, if you can get used to wearing a CPAP at night, it can really work wonders.
For those who can’t use CPAPs, all hope’s not lost.
I use a nasal cannula, which has helped my own sleep apnea. A cannula is a flexible tube that includes two prongs that go inside your nostrils. (You have likely seen these used with patients in a hospital setting, but they can also be used at home.) Cannulas deliver low, slow levels of oxygen, and they have been shown to be a great alternative to CPAP machines.
In a study of 11 people with obstructive sleep apnea who were administered warm, moist air via nasal cannula, this treatment option was shown to reduce condition severity and the number of respiratory events and awakenings at night. The cannula works by increasing pressure at the pharynx, which is the part of the throat right behind the nasal cavity. Doing so alleviates upper airway obstruction and improves ventilation.
Cannulas are also far more comfortable to wear and less intrusive than CPAPs, so compliance is much higher.
Another exciting development in treatment comes courtesy of newer generation dentists who specialize in sleep disorder treatment. (Yes, there are dentists who do this! My own dentist is one such trailblazer.)
Using X-rays and dental impressions, these specialists are trained to create custom-fitted mouth guards that work by keeping the jaw in a forward position, which prevents the airway from collapsing.
The results of a JAMA study found that the use of oral appliances “reduces obstructive sleep apnea, snoring, and possibly restless legs…among patients with daytime sleepiness and snoring or mild to moderate sleep apnea.”
If you choose to investigate this option, be sure to use a dentist certified and accredited in sleep medicine. Visit the American Academy of Dental Sleep Medicine or the American Board of Dental Sleep Medicine to find a specialist near you.
Additional Tips for Alleviating Sleep Apnea
There are also a few other things you can do to reduce your sleep apnea episodes and achieve better, more restful sleep:
- Avoid eating at night, after 6 or 7 pm.
- Use a humidifier to moisten the air in your bedroom.
- If you smoke, you obviously need to stop.
- Sleep positions play a role in sleep apnea. Avoid sleeping on your back; sleep on your side instead. If you don’t use a CPAP, find a pillow that positions your neck so that your airway is more likely to stay open. If you do use a CPAP, get yourself an ergonomically designed CPAP pillow to keep your head, neck, spine, and airway in alignment. They pillows also have cutouts where the mask can fit when you are sleeping on your side.
Finally, if your airway is really obstructed, you may need surgery. I know that surgery is no fun and always involves risk, but some obstructions can be fixed, eliminating sleep apnea altogether. It’s worth at least a discussion with your doctor or sleep specialist.
- Drager LF, et al. Sleep apnea and cardiovascular disease: Lessons from recent trials and need for team science. Circulation. 2017 Nov 7;136(19):1840–50.
- Girardin JL, et al. Obstruction sleep apnea and cardiovascular disease: Role of the metabolic syndrome and its components. J Clin Sleep Med. 2008 Jun 15;4(3):261–72.
- McGinley BM, et al. A nasal cannula can be used to treat obstructive sleep apnea. Am J Respir Crit Care Med. 2007 Jul 15; 176(2): 194–200.
- Sinatra ST. The Heart Disease Risk Factors You Don’t Know About. Drsinatra.com, accessed Feb. 16, 2016.
© Stephen Sinatra, MD. All rights reserved.