By Joanna Kippax RGN/RSCN/NMP/SP
If you snore or have sleep apnoea symptoms then this page by sleep practitioner Joanna Kippax, aims to provide some actionable lifestyle advice.
Maintaining a healthy weight is important to reduce the symptoms of obstructive sleep apnoea.
Excess fat, muscle and soft tissue, especially around the neck area, can squash your airway and the reduced muscle tone may not be sufficient to prevent it from narrowing.
This blockage can result in an apnoea, when the airflow is
blocked for 10 seconds or more.
A large neck size of 43 cm (size 17 inch collar) for men and 41cm (16inch ) for women and a BMI (Body Mass Index) of over 25, can increase the risk of obstructive sleep apnoea, so every effort should be taken to reduce this as far as possible.
An ideal BMI would be between 18.5-24.9
Body Mass Index
below 18.5 underweight
between 18.5 and 24.9 healthy weight range
between 25 and 29.9 overweight
between 30 and 39.9 obese
above 40 severely obese
Simply losing excess weight can drastically reduce or even stop snoring and OSA
Weight loss advice
Expert dietary advice should be given by a trained nutrition professional, but general advice to decrease calorie intake and increase energy output may help to promote weight loss.
More specific sleep-related weight loss advice includes avoiding eating late in the evening or during the night.
The hormone, Leptin, that gives you a feeling of fullness/satiety and suppresses your appetite, is lower when sleep deprived.
In addition, the hormone, ghrelin, that controls your appetite, is raised, making you feel more hungry during the night.
Therefore, you have a greater desire to eat and need more food to make you “feel full”. This contributes to weight gain.
Sleep deprivation, fatigue and weight management
Sleep deprivation and fatigue cause the patient to alter their food choices. High carbohydrate and high sugar foods are more appealing to boost blood sugar levels, which further compounds the problem.
Shift workers may find this particularly difficult, as the food available at night from vending machines etc is usually the worst type of food to support weight loss.
If at all possible, advise removing this type of food from temptation and, if it’s absolutely necessary to eat, have low carbohydrate food to reduce weight gain.
The body is slower at metabolising blood sugar at night, increasing the risk of diabetes. Diabetes, therefore frequently co-exists with OSA. Advise a blood glucose check to detect for diabetes.
Encourage a “fasting” or food abstinence episode of a minimum of 10-12 hours. e.g. Evening meal at 7.30pm, no further food until 07.30 am.
It is not just the calorie intake but the timing of eating, that affects weight management. This is known as time restricted eating.
Consistency of mealtime is also key here. Having meals at the same time every day helps the circadian clock ( body clock) to keep metabolism steady. A disrupted body clock causes a disruption in metabolism.
Weight gain and OSA in children:
Children who are overweight or obese and snore should be investigated for OSA. Symptoms of sleep deprivation in children are very similar to that of ADHD.
Hyperactivity, impulsivity, poor concentration, with additional snoring or enlarged tonsils are all symptoms of OSA , worthy of further investigation.
Weight loss helps to reduce OSA in children in the same way it does in adults.
Weight gain and OSA in the menopause
OSA due to weight gain is also common in menopausal ladies as the levels of the hormones oestrogen and progesterone, decrease in women’s bodies, leading to an increased accumulation of fat.
Oestrogen and progesterone also help to maintain muscle tone in the throat, so as the levels decrease,the chances of obstructed breathing rise which can cause disrupted breathing. Weight loss can improve and sometimes reverse this.
Other factors that potentially cause the airway to narrow:
Enlarged tonsils and adenoids can also cause swelling in the neck area, so a history of repeated tonsillitis, quinsy, or enlarged adenoids, in addition to snoring and possible apnoea should be explored further by the GP, with a possible referral to an ENT specialist if appropriate.
This is especially common in children but can also be present in adults.
Cigarette smoke, including vaping fumes, irritates the lining of the nose, causing it to swell and produce an excess of mucus. This nasal congestion results in an increase in mouth breathing, reduces the air flow making an apnoea episode more likely.
Treating blocked or congested nasal passages with nasal spray may help to reduce this congestion. Stop smoking advice gives longer-term relief of this problem!
The use of nicotine patches in the evening may offer short-term relief but nicotine will still cause a disruption to the sleep pattern, fragment sleep and exacerbate daytime fatigue .
Alcohol and medication:
Alcohol and sedative medication causes a reduction in the tone of the muscles that keep the airway open.
Drinking alcohol before bedtime, therefore, can result in the collapse of these muscles and increases the likelihood of obstructive sleep apnoea.
Alcohol also decreases your drive to breathe. A greater reduction in oxygen is required to stimulate a breath, making breathing even more laboured if intoxicated. If severe, this could be fatal.
Alcohol also causes a disruption in the sleep pattern. Whilst getting to sleep, it sedates you and then during the night, causes fragmented sleep, leading to worsening daytime fatigue.
It takes one unit per hour for the liver to process and eliminate alcohol.
This formula can be useful to work out when to stop drinking prior to bedtime. Late evening drinking is particularly problematic. Alcohol consumed at lunchtime is therefore preferable, but not always practical!
Exercises to strengthen the muscles of the airway:
- Press your tongue flat against the floor of your mouth and brush top and sides with a toothbrush. Repeat brushing movement five times, three times a day
- Press the length of your tongue to the roof of your mouth and hold for three minutes a day.
- Place a finger into one side of your mouth. Hold the finger against your cheek while pulling the cheek muscle in at the same time
- Repeat 10 times, rest, and then alternate sides. Repeat this sequence three times
- Purse your lips as if to kiss. Hold your lips tightly together and move them up and to the right, then up and to the left 10 times
- Repeat this sequence three times
- Place your lips on a balloon. Take a deep breath through your nose then blow out through your mouth to inflate the balloon as much as possible. Repeat five times without removing balloon from your mouth
- Gargle with water for five minutes, twice a day
- Lightly hold your tongue between your teeth. Swallow five times. Repeat this five times a day
- Activities such as singing and playing a wind instrument may also help to strengthen the muscles around the airway
Position in bed
OSA is more likely to occur when lying flat on your back (supine). Placing a pillow behind the back, to support sleeping on one’s side can relieve the increased pressure on the neck muscles and airway. Lying on the left side is the optimum position for cardiac and respiratory function.
Read our anti-snore pillows review
General sleep hygiene advice:
This will help improve both the quality and quantity of sleep:
- Wake up at the same time every day to set the body clock
- Expose yourself to morning light for a minimum of 20-30 minutes. Consider the use of a daylight lamp, if natural daylight is not practical
- Dim light in the evening, avoiding screen activity to allow the release of melatonin, the sleep hormone.
- Keep active /exercise during the day to ensure the body is physically tired. Exercise improves the quality and quantity of sleep, especially NonREM, deep restorative sleep
- Wind down before bed time: put the mind to bed before the body
- Avoid caffeine at least after 4pm. Half life of caffeine is 6-8 hours. Full clearance of caffeine is 12-24 hours
- Avoid daytime naps. If unavoidable, nap for 20 minutes no later than 3pm. Napping is similar to eating a doughnut before a meal: it suppresses the sleep appetite and weakens the sleep drive. This results in the being able to get to sleep (sleep initiation) but then have difficulty staying asleep (sleep maintenance)
Read our range of snoring and sleep apnoea information guides
Recommended associated tests/symptoms that should cause further
questions to be asked:
- Blood pressure- hypertension is common in those with OSA symptoms
- Blood sugar test- Diabetes is commonly associated with OSA
- Low mood- OSA can be mistaken for depression as to the effects of daytime fatigue
- Poor concentration and difficulty with word finding etc.
- Headaches – a morning headache is a common symptom of OSA
- Dry mouth – again a common symptom of OSA
- Urine test- Frequent visits to the bathroom to pass urine are a symptom of OSA
- Insomnia- Frequently mistaken for OSA- some people report repeated awakenings. These may be caused by low oxygen saturation that the individual is unaware of
Created with many thanks to the author: Joanna Kippax RGN/RSCN/NMP/SP of WyeSleep ↗
Page created by Adrian Zacher | Last updated 20th May 2020