As you know, sleep is a topic I’m passionate about because it’s so critical to almost every aspect of being our best selves. If we want to heal our relationship with food, get more movement, have stronger relationships, perform better at work, if we want all of these things, it all begins with sleep. Thriving begins with sleep.

Addressing sleep hygiene is one thing, but it’s a whole other beast altogether if you happen to have sleep apnea or other disordered breathing syndromes that affect your sleep. While we often think that the only solution to this is CPAP–something that does play a really important role for many people–there are other things that you can do in terms of healthy habits and nutrition that can really help optimize your sleep at night in the context of sleep apnea.

To dig deeper on this topic, I’m sharing insights from Dr. Dylan Petkus, a physician, researcher, and health optimization expert who takes an integrated approach to sleep apnea. After his own sleep fell apart 14 years ago, he did some “me-search” to try to understand more about sleep. 

That led him to where he is today, working with sleep apnea but also with people who have autoimmune disorders, Hashimoto’s, or other issues that affect sleep. We dive into all the things that can cause struggles with sleep and what we can work on to improve our sleep patterns.

Factors contributing to sleep apnea

We can’t deny that the prevalence of being overweight is higher in sleep apnea cases, but we also can’t ignore the significant number of other cases where this isn’t a key factor. 

The common mechanism is the gradual narrowing of airways, which can be influenced by factors like inflammation and bad breathing patterns. Even something as seemingly minor as an overbite or the position of the tongue can also play a significant role.

Common symptoms of sleep apnea

1. The mornings can feel rough. You might have a headache, a dry mouth, and get brain fog–almost the same feeling as if you’d been out drinking the night before. When you have sleep apnea, you can’t allow sleep to do what it needs to do, whether it’s allowing certain metabolites to wash out, or inflammation to calm down. This is why you wake up with an inflamed brain and have a headache. 
2. Daytime sleepiness is another key sign. For example, how afraid are you of yourself while driving? Do you tend to get drowsy during the journey? Even if you are in bed for seven or eight hours, you might not notice that you woke up 12 times per hour last night. But your body does and your body’s keeping count. 
3. Mental clarity during the day is something else to look out for because that brain fog just carries through. Some people will inconveniently get the only energy they have between the hours of 7 and 10 PM.

If these symptoms persist for more than two weeks, Dr. Petkus encourages you to see your doctor.

Is CPAP (continuous positive airway pressure) the only option?

When faced with a sleep apnea diagnosis, many individuals turn to CPAP therapy as the primary solution. However, the reality is that CPAP adherence rates are around 40-50%. Even among those who persist, challenges can often arise, including discomfort with masks, equipment malfunctions, and the humorous yet frustrating “face farts” when the mask detaches during sleep. This leaves a significant subset of individuals seeking alternatives.

The natural progression often leads to a crossroads: consider surgery or explore newer options like the Inspire device. Surgical interventions encompass various procedures, each with its recovery challenges and a success rate of only around 40%, measured by a 50% reduction in the AHI (apnea-hypopnea index). Notably, surgeries can involve months of recovery and may lead to complications, making them a less desirable choice. Before considering surgery, Dr. Petkus encourages to consider alternative solutions which focus on breathwork and inflammation.

Alternative Rectangular Breathing: A Simple Technique for CO2 Retention

The primary driver of breathing is the regulation of carbon dioxide in your body. While elevated levels aren’t necessarily dangerous, they play a significant role in instructing your brain to signal the diaphragm for proper breathing.

In sleep apnea or nighttime breathing disorders, there’s a notable loss of the body’s ability to sense carbon dioxide. This lack of regulation is present in both central sleep apnea and, to a lesser extent, obstructive sleep apnea. To address this, retraining your body to respond to carbon dioxide becomes essential.

One effective method to enhance your carbon dioxide sensitivity is through a practice known as rectangular breathing. This technique, a variation of box breathing, involves adopting a breathing pattern that encourages the retention of a slightly elevated level of carbon dioxide. For example, you might inhale for five seconds, then you pause for 10 seconds, then you exhale for five seconds, and pause for 10 seconds. It’s a straightforward yet powerful exercise with potential benefits for managing sleep apnea.

You can incorporate rectangular breathing into your routine, especially before bedtime, as the breathing pattern you establish before sleep tends to carry over into the night. Practicing this technique during daily activities, such as doing dishes or going for a walk, can also contribute to its effectiveness. While the counting aspect might initially seem cumbersome, your body will gradually adapt to this breathing pattern, increasing your carbon dioxide tolerance over time.

The recent mouth taping trend has gained a lot of popularity, but is this a useful technique for CO2? 

Mouth tape will essentially force CO2 retention because you’re breathing through a more narrow nasal passageway. But Dr. Petkus warns that can be inappropriate because now people are going to try to over breathe through their nasal passage and exacerbate the problem. That’s why another very common symptom of sleep apnea is some sort of sinusitis. Ideally you want to be more of a nasal breather, but you want to make sure that you have a certain baseline level of function before trying this.

Tackling inflammation

When it comes to improving sleep and helping sleep apnea, the more you can do to reduce inflammation, the better. The following “big four” categories serve as a roadmap for optimizing sleep and managing sleep apnea:

1. Nutrition

• Consider simple dietary switches to reduce inflammation. For instance, eliminating dairy temporarily or transitioning from coffee to green tea can directly influence airway health and alleviate local inflammation. Identifying and managing food sensitivities is also crucial for a personalized nutrition approach.

2. Circadian Rhythm: Aligning with Your Body’s Natural Clock

• Prioritize maintaining a consistent circadian rhythm. Avoid night shifts whenever possible and increase exposure to morning light to help regulate cortisol levels and signal to the body that it’s daytime. Conversely, limit exposure to artificial light, such as screens, a few hours before bedtime, fostering a conducive environment for rest.

3. Nervous System: Balancing for Better Sleep

• Incorporate practices to calm the nervous system, combating the stress response prevalent in today’s fast-paced world. Find a routine that suits you, whether it’s morning gratitude, meditation, or mindfulness. Managing the nervous system not only sets the tone for your day but profoundly influences your sleep quality at night.
• Recognize the versatility of effective practices—there’s no one-size-fits-all solution. Whether it’s a brief five-minute breathing exercise or a dedicated gratitude journaling session, establish a consistent practice that aligns with your needs.
• Understand the crucial role of the nervous system in determining sleep quality. Studies show that the timing of practices like meditation impacts melatonin levels, emphasizing the interconnectedness between daytime routines and nighttime sleep.

4. Environment: Curating a Sleep-Friendly Surrounding

• Environmental factors play a pivotal role in sleep quality. For those utilizing continuous positive airway pressure (CPAP) devices (happy pappers), maintaining cleanliness is vital to prevent exposure to irritants and minimize inflammation.
• Consider broader environmental aspects, such as air quality, temperature, and external stimuli like light and sound. Addressing these factors contributes to an optimal sleep environment, promoting uninterrupted and restorative sleep.

And the great part is that by paying attention to how we eat, live our day, manage stress, and arrange our sleep space, we’re not just fixing sleep but building a healthier and happier life overall.