Snoring and Sleep Apnea

Patrick McKeown

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WHAT IS SLEEP APNEA AND WHY DO WE SNORE

Apnoea is a Greek word meaning “without breath.” Sleep apnea is a common and severe form of sleep-disordered breathing which involves the sleeper involuntarily stopping their breath during sleep. Later we will outline breathing exercises for sleep apnea and snoring, but first, we will share key points about the two conditions, their causes, their symptoms, and how they are connected.

THE DIFFERENT TYPES OF SLEEP APNEA

There are three types of apnea during sleep: obstructive, central, and mixed. Mixed apnea is a combination of obstructive and central sleep apnea. It can be argued with some conviction that chronic hyperventilation (overbreathing) offers an explanation for all types of sleep apnea.

Patients with sleep apnea breathe extremely heavily while sleeping. A normal routine is thunderous snoring followed by complete cessation of the breath. During an episode of apnea, the sleeper is rarely conscious of holding their breath or the racket created as they resume breathing. Most believe they are sleeping well, which can lead to confusion over why they feel so tired during the day. Meanwhile, their sleeping partner suffers from sleep deprivation as he or she is continually disturbed by the noisy breathing, snoring, and sporadic choking throughout the night.

OBSTRUCTIVE SLEEP APNEA

Obstructive sleep apnea, or OSA, is the most common type of sleep apnea affecting approximately 95% of sufferers. While it more often affects men with a neck size of 17 inches or larger, it can also affect women, children, and adults who are not overweight. It is characterized by repetitive episodes of breath holding. The cause of the breath holding is blocked airways (hence the term ‘obstructive’), which usually occurs because the soft tissue in the back of the throat collapses. This holding of the breath, which prevents airflow to the lungs, may occur between 5 and 50 times per hour. Each breath hold can range from a few seconds to over one minute, causing one’s blood oxygen saturation to dramatically decline.

To understand how and why the breath is held during sleep, imagine drawing in air with your mouth through a collapsible paper straw. If you draw in air gently, the pressure will be minimal and the inner walls of the straw will not collapse. However, if you inhale forcefully through it, the pressure created by the sucking of air will cause the inner walls of the straw to collapse in on itself. The more effort you make to suck in air, the more severely the walls will collapse. In engineering terms this is called the Bernoulli Principle: as fluid (or in this case, air) flows, negative pressure develops at the periphery of the flow. As the flow velocity increases, so does the negative pressure. Now let’s apply this to obstructive sleep apnea. A collapse of the upper airway occurs if the negative upper airway pressure generated as the breath is drawn into the lungs is greater than the dilating force of the upper airway muscles.

People with OSA experience repetitive collapsing of the airways and this results in holding of the breath. As the breath hold continues, the breathing center in the brain sends messages to the diaphragm to resume breathing. As the diaphragm contracts to attempt to draw air into the lungs, increased negative pressure enforces the breath hold. During this time, the chest and diaphragm continue to try to draw air into the lungs. This results in jerking and heaving as the diaphragm pushes downward. Unfortunately, the greater the heaving of the chest and diaphragm, the more the airway walls draw inward and collapse.

After a period of holding the breath during sleep, the oxygen saturation of the blood decreases enough to activate a survival instinct that partially wakes the brain up, and breathing resumes. At this point the sleeper will often take in a breath with a loud gasp, followed by a series of heavy and intense breaths. This causes another collapsing of the airways and the cycle is repeated throughout the night.

There are two factors we need to consider which cause the collapsing of the airways and OSA to occur: the width of the upper airways and breathing volume. An engineer looking at this problem might offer two solutions. The first is to widen the tube. The second is to reduce the airflow and thus breathing volume. Widening a human airway through surgery is a last resort. Losing excess body weight can help by ridding the airways of fat deposits which narrow its size. However, a simpler and more plausible option is to reduce breathing volume which can be achieved with breathing exercises for sleep apnea which we will outline later in this article.

CENTRAL SLEEP APNEA

Central sleep apnea affects approximately 5% of sufferers and in contrast to obstructive sleep apnea, it does not occur because of blocked airways. Central sleep apnea results from the brain not sending the right signals to the muscles that control breathing. A major reason this occurs is because excessive breathing volume during sleep causes a reduction in the partial pressure of carbon dioxide. This shifts the pH of the blood in an alkaline direction. To maintain the pH within normal levels, a natural bodily response is to hold the breath, allowing the pH to revert to normal. In other words, central apnea occurs from breathing in excess of metabolic requirements.

WHAT CAUSES SNORING?

Snoring affects people of all ages and it’s estimated that 45% of men and 25% of women snore habitually. Snoring is a sign of obstructed airways. It occurs due to a large volume of air passing through a narrow space, causing turbulence in the soft palate, nose, or back of the throat, which in turn, causes the tissues to vibrate.

There are two factors at play here: the first is that the individual is breathing too noisily and heavily during sleep, and the second is that their upper airways may be narrow due to nasal congestion or structural issues.

Snorers snore through their mouths, their nose, or both. Snoring through the mouth is the easiest to address. Mouth snoring stops when one learns to breathe through his or her nose during sleep. Stopping snoring through the nose is a bit more complicated but is still very much achievable with the Buteyko Method. By learning to unblock the nose, switching to nasal breathing, and normalizing breathing volume, breathing will become quiet, calm, and still throughout the night and nasal snoring will cease.

THE CONNECTION BETWEEN SLEEP APNEA & SNORING

Not all snorers have sleep apnea, however, snoring is the most common symptom of obstructive sleep apnea and it occurs in 70% to 95% of patients. Snoring is also an indicator of OSA severity – and the louder the snoring is, the more severe OSA usually is. Worth mentioning is the fact that if snoring is left untreated, it can progress into sleep apnea, high blood pressure, and cardiovascular complaints.

SYMPTOMS OF SLEEP APNEA & SNORING

Both sleep apnea and snoring can lead to disturbed sleep, waking up tired, excessive daytime sleepiness, dry throat and mouth, headaches, and needing to urinate during the night. Of course, the loud snoring accompanied by loud snorts and gasps can also lead to marital problems.

Symptoms specific to sleep apnea include insomnia, holding the breath during the night, loud snorts, and gasps and/or jerking movements upon resumption of breathing followed by loud snoring. There are several harmful physical effects of sleep apnea as well. The repeated episodes of falling oxygen levels lead to a variety of physiological changes. During these episodes, the heart, blood vessels, and entire cardiovascular system are stressed and forced to work harder. This, in turn, raises blood pressure and heart rate and can lead to chest pain, and an increased risk for cardiovascular disease, hypertension, stroke, diabetes, metabolic syndrome, and premature death.

Another outcome of sleep apnea is that it increases the secretion of hormones and substances that produce inflammation and are released with stress. One example is the stress hormone adrenaline which surges every time the sleeper is jolted awake. These episodes drain energy reserves and prevent deep, restful sleep. They can also lead to chronic fatigue, problems with memory and concentration, mood fluctuations, depression, anxiety, night sweats, heartburn or reflux, and swelling of the legs. In children, there may additionally be learning and behavioral disorders such as ADHD, poor school performance, and bedwetting.

SLEEP APNEA & SNORING: 10 UNDERLYING CAUSES

As noted above, snoring is caused by obstructed airways and obstructive sleep apnea is primarily caused by a collapsing of the airways. It is rare that a person is born with these issues, and there are usually causative factors at play which we will outline below.

1. OVERBREATHING

Did you know that the number of breaths per minute during normal healthy breathing is about 10 to 12? Each healthy inhale takes in approximately 500 ml of air which provides about 5-6 liters of air per minute. People suffering from sleep apnea and snoring breathe in larger volumes of air, more frequently. An average intake for these people is 15 to 20 breaths per minute and approximately 700 ml of air per inhale. This amounts to 10-15 liters of air being taken in per minute, which is approximately double the healthy volume.

This overbreathing or hyperventilation does not add any more oxygen to the blood, as the blood is normally 97–98% saturated. Instead, it causes a loss of the gas carbon dioxide (CO2). Carbon dioxide is not just a waste gas. For oxygen to be released from the red blood cells, carbon dioxide must be present. Suffice to say that the heavier you breathe, the less oxygen is delivered to tissues and organs.

So what does this have to do with snoring and sleep apnea? The hypocapnia (low CO2 state) induced by overbreathing reduces the upper airway dilator muscles and can lead to collapsing and obstructing of the airways, thereby fueling sleep apnea and snoring. Moreover, CO2 is the alarm bell to breathe and reductions in arterial CO2 can reduce ventilatory drive (the drive to breathe) causing ventilation to cease and apnea events. Worsening all of this, is the fact that when breathing resumes in sleep apnea sufferers, large gasps of air are taken in, further increasing breathing volume, the hyperventilation state, and hypocapnia, creating a viscous, self-perpetuating cycle.

Worth noting is that although hypocapnia often occurs throughout the night in sleep apnea patients, many experience hypercapnia (high CO2 levels) during the daytime. This can lead to several symptoms commonly present in OSA patients including anxiety, shortness of breath, daytime sluggishness, headaches, and fatigue.

2. MOUTH BREATHING

There is an incredible amount of research showing that mouth breathing is a significant causal factor for both sleep apnea and snoring in children and adults. One study which involved 52 patients found that breathing through the mouth changes the upper airway anatomy, causing it to become more elongated and narrower. These changes increase the severity of upper airway collapse and in so doing, the severity of OSA and its symptoms.

Mouth breathing during sleep also leads to overbreathing and a larger breathing volume as too much air is drawn into the lungs. Not only does the negative pressure on the upper airways increase, but overbreathing also causes the airways to cool and dry out, leading to inflammation and further narrowing of the airways. This combination of larger breathing volume and narrower airways is the perfect recipe for snoring and obstructive sleep apnea. Conversely, several studies have shown breathing through the nose offers a distinct advantage during sleep, resulting in fewer incidences of obstructive sleep apnea than breathing through the mouth. One paper found the wearing of a chin strap to prevent mouth breathing demonstrated the same or better results in improving severe obstructive sleep apnea than the use of a CPAP machine.

Children who breathe through their mouths are also at risk of developing permanent craniofacial changes, such as undeveloped jaws, smaller airways, and narrow faces. These changes increase the likelihood of the child snoring and developing lifelong sleep apnea. A study that examined the effects of mouth breathing on children found that 58% of mouth breathing children were snorers and 42% had obstructive sleep apnea. The paper concluded that “primary snoring and OSA are frequent findings in mouth breathing children.”

3. NASAL CONGESTION

It is a well-established fact in medical literature that nasal congestion frequently leads to nocturnal mouth breathing, snoring, and ultimately to OSA. In fact, research shows approximately 52% of people with sleep apnea have nasal congestion. Unfortunately, the mouth breathing that nasal congestion forces on a person, triggers mucus formation, which worsens nasal congestion, creating a progressive cycle of more congestion, more mouth breathing, and more severe snoring and sleep apnea.

4. ALLERGIC RHINITIS

Allergic rhinitis affects between 10-25% of the world population, and it’s an underrecognized and undertreated cause of both sleep apnea and snoring. The reason for this is that one of its primary symptoms is congestion. As noted above, when the nose is congested a person is forced to breathe through their mouths, leading to overbreathing, increased nasal obstruction, and more severe snoring and sleep apnea.

5. GENETICS

Men are 2-3 times more likely to snore and to have sleep apnea than women, and the risk for snoring and sleep apnea increases progressively with age in both genders. Having a family history of sleep apnea or snoring also increases the risk of developing these conditions. So too does having irregularly shaped bones in the face.

6. PHYSIOLOGICAL ISSUES

Narrowed airways is a significant cause of both sleep apnea and snoring and this may be something a person is born with or develops later in life. Some people may have a long soft palate or uvula, large tonsils or adenoids, bulky throat tissue, or an unusually large tongue, and all can narrow the airways and cause snoring and sleep apnea. Nasal polyps (noncancerous growths in the nose) and a deviated septum may also cause snoring and sleep apnea because they block the airways. Worth noting is that narrowed airways can be caused by mouth breathing in childhood, and this in turn can increase the risk for OSA.

7. EXCESS BODY WEIGHT

Being overweight is a major risk factor for both sleep apnea and snoring. In fact, research shows 40% of obese individuals have sleep apnea and 70% of OSA patients are obese. One reason for this, is that excess body weight often leads to fat deposits around the throat which blocks and obstructs the airways. Another reason is that fat deposits increase pressure on upper airways, which can cause collapsing and decreased neuromuscular control.

8. LIFESTYLE FACTORS

People who smoke, drink excessive alcohol, are sleep deprived, or take tranquilizers, sleeping pills, or antihistamines are more at risk for snoring and sleep apnea. A sedentary lifestyle and an unhealthy diet can also increase the risk due to the effects they have on body weight.

9. SLEEPING POSITION

Studies show sleeping on your back can significantly worsen snoring, as well as sleep apnea severity and frequency. The explanation for this can be found in gravity. When you lie on your back, there is no restriction to breathing, and breathing volume grows larger, leading to a greater severity in snoring. Sleeping on your back also encourages the mouth to open, and as the lower jaw hinges downwards it impedes the upper airway, reducing the airway diameter. One study, which conducted an assessment of 2,077 OSA patients over a period of ten years, found that 53.8% had at least twice as many breathing abnormalities while sleeping on their back compared with sleeping on their side. Conversely, sleeping on one’s side or stomach has been found to reduce snoring as well as the frequency and severity of sleep apnea events.

10. MEDICAL CONDITIONS

Medical disorders such as high blood pressure, type 2 diabetes, congestive heart failure, Parkinson’s disease, PCOS, hormonal disorders, prior stroke, or chronic lung diseases like asthma are all risk factors for sleep apnea.

CONVENTIONAL TREATMENTS FOR SLEEP APNEA

Most procedures for improving obstructive sleep apnea involve attempting to open the airways – either by bringing the lower jaw forward with surgery or using a continuous positive airway pressure (CPAP) machine to splint open the airways at night. While these interventions are successful in their own right, the first is invasive and the second is inconvenient and uncomfortable to many and has a low adherence rate. Both also fail to address a major cause of sleep apnea – breathing volume. Any engineer considering the diameter of a tube will also need to consider the flow – after all, one is entirely dependent on the other.

CONVENTIONAL TREATMENTS FOR SNORING

Most treatments for snoring such as nasal decongestants, nasal strips, surgery, and dental appliances aim to expand the airways to make more room for airflow. Similar to sleep apnea treatments, this approach fails to address breathing volume which is a significant contributor to snoring. The Buteyko Method is successful because it corrects breathing volume to normal levels, in addition to expanding the airways and it does so naturally without intrusive devices or costly surgery.

THE NATURAL SOLUTION: BREATHING EXERCISES FOR SLEEP APNEA & SNORING

As we saw in the previous section, overbreathing is a leading causative factor for snoring and sleep apnea. Overbreathing is a problem in its own right, however, it’s made more problematic by the fact that it can lead to nasal congestion, hypocapnia (low CO2), narrowed airways, and anatomical changes which further fuel and increase the severity of snoring and sleep apnea. The Buteyko Method has been successfully implemented for decades to help reverse all of these causative factors, and it does so by retraining how you breathe and normalizing the volume of air you take in. Below are several exercises to help you experience these benefits for yourself.

If you want to reduce snoring and sleep apnea naturally, you need to retrain yourself to breathe softer, slower, and gentler, clear congestion, and get comfortable with a slight air hunger. The following 3 exercises can support you with this.

BREATH EXERCISE #1: BREATHE LIGHT

This exercise focuses on creating a light air hunger. It helps to normalize breathing biochemistry, resulting in improved oxygen uptake and delivery and reduced sensitivity to CO2, while working toward normalizing breathing volume.

Sit up straight in a chair or cross-legged on the floor or lie down on your back. If sitting, imagine a piece of string gently pulling you upwards towards the ceiling from the crown of your head.
Place your hands on your chest and tummy, or in your lap.
Observe your breath as it enters and leaves your nose. Feel the slightly colder air entering your nose and feel the slightly warmer air leaving your nose.
Begin to reduce the speed of each breath as it enters and leaves your nose.
Breathing should be light, quiet, and calm.
Slow down your breathing so that you feel hardly any air entering and leaving your nostrils. Your breathing should be so quiet that the fine hairs in the nostrils do not move.
The goal is to create a feeling that you would like to take in more air. To create air hunger, your breathing now should be “less” than it was when you started.
If you feel stressed or lose control of your breathing, the air hunger is too strong. When this happens, take a rest for 20 or 30 seconds and start again. It is normal at the beginning to take a rest a few times during the exercise.
Continue practicing the exercise for around four minutes.

BREATH EXERCISE #2: BREATHE SLOW

The goal of this exercise is to reduce your breathing and reach a cadence of approximately six breaths per minute. Try not to over-breathe.

Sit up straight on a chair or cross-legged on the floor. Place your hands either side of your abdomen on your lower two ribs.
As you breathe in, feel your ribs moving outwards, and, as you breathe out, feel your ribs moving inwards.
To pace your breathing, inhale for a count of four seconds and exhale for a count of six seconds.
Breathe in, 1, 2, 3, 4, breathe out, 1, 2, 3, 4, 5, 6, (if your Control Pause is less than 15 seconds, breathe in 1,2,3, breathe out, 1, 2, 3).
As you breathe in, feel your ribs moving outwards, and, as you breathe out, feel your ribs moving inwards.
Breathe in for a count of four seconds and breathe out for a count of six seconds.
Continue the exercise for approximately four minutes.

BREATH EXERCISE #3: BREATHE DEEP

This exercise helps you practice diaphragmatic breathing, which in turn enables slow breathing, calms the mind, improves oxygenation within the body, and has many positive effects on posture and breathing mechanics in general.

Sit up straight in a chair or cross-legged on the floor.
Imagine a piece of string gently pulling you upwards towards the ceiling from the crown of your head.
Place your hands at either side of your lower ribs.
Silently breathe in, bringing the air deep into your lungs. As you inhale, feel your ribs expanding outwards. As you exhale, feel your ribs moving inwards.
Take fuller breaths but fewer of them. As you breathe in, feel your lower ribs moving outwards, and, as you breathe out, feel your lower ribs moving inwards.
There is no need to hear your breathing during this exercise.
Continue practicing the exercise for approximately four minutes.
During the inhalation, as the diaphragm moves downwards, expansion is generated to the front, sides, and back of the trunk. Your diaphragm is producing intra-abdominal pressure, which causes the ribs to move outwards.

ADDITIONAL SUPPORTIVE PRACTICES AND EXERCISES

BREATHE THROUGH YOUR NOSE

When you want to control your breathing, the first place to start is with a closed mouth. When it comes to correcting mouth breathing in the night, the most efficient and cost-effective way to stop is mouth taping. MYOTAPE safely brings the lips together to help ensure nasal breathing. It can be worn by adults, teenagers, and children aged 4 years and up and comes in small, medium, and large sizes.

OPTIMIZE SLEEPING POSTURE

Another useful step for correcting overbreathing and overventilation is changing your sleeping position if you lie on your back. Konstantin Buteyko discovered that the best position to sleep for snorers and apnea patients is on the left-hand side because the position of the heart reduces ventilation. Equally as beneficial is sleeping on the tummy because the weight of the body restricts breathing and naturally reduces ventilation.

PRACTICE FACIAL EXERCISES FOR SLEEP APNEA & SNORING

Mouth and face exercises can help to strengthen and tone the muscles which support healthy breathing and to reduce the collapsing that causes snoring and sleep apnea.

Tongue exercises are also beneficial because they help tone the throat and tongue muscles and may reduce the likelihood of the tongue blocking the airways during sleeping. Just like any muscle-building exercise, you will need to stick with it to see results, and we recommend you aim to do these exercises 6 days a week and give it at least 3 months to experience the full benefits. It’s important to note, however, that these exercises won’t be beneficial for everyone, and their effectiveness is dependent on individual factors such as your facial anatomy and the underlying cause of your snoring and sleep apnea.

FACE & JAW EXERCISE

Open your mouth as wide as possible while saying ‘ah’ from the back of your throat for 20 seconds
Close your mouth, pause for 5 seconds, and then repeat 5 times
Once complete, use a finger to hook your cheek and lightly stretch it outwards while simultaneously creating resistance by using your facial and mouth muscles to pull your cheek back inward
Repeat the finger hooking and resistance practice 8 times on each side

3-STEP TONGUE EXERCISE

Stick out your tongue and stretch it as far as it can go
Try touching your tongue to your chin and hold for 10 seconds
Repeat at least 6 times
Next, place your tongue on the roof of your mouth and slowly slide it back and forth just behind your teeth at least 6 times
Finish by placing the tip of your tongue on the lower teeth and pushing the whole tongue flat against the bottom of your mouth
Hold it flat for 8 seconds and repeat 6 times

GET YOUR COMPLETE BUTEYKO SLEEP APNEA GUIDE

Transform your sleep with our comprehensive online course. Learn how to create a better sleep environment, develop healthy sleep habits, and address common sleep issues.

‘The Buteyko Online Sleep Course’ includes:

Streaming video lessons with all breathing exercises for sleep, tailored to your needs
Scientific explanations behind the breathing exercises
The ‘Sleep with Buteyko’ ebook
You can also get the Buteyko belt to help with diaphragmatic breathing. You can learn about the benefits.

The teachings in this course not only help to reduce snoring and OSA, but also activate the body’s relaxation mode, leading to deeper and better-quality sleep, less stress and anxiety, and greater energy, immunity, and vitality.

Improve Your Sleep

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