Sleep Disorders & Snoring

Are you tired of feeling tired? Do you find yourself battling brain fog and fatigue day in and day out? You’re not alone.

Sleep is one of the most vital aspects of our lives, yet it’s often the most neglected.

Snoring, mouth breathing, and restless nights have become so common that we forget they’re not normal.

JUST BECAUSE IT’S COMMON DOESN’T MEAN IT’S NORMAL.

It’s time to change how we think about sleep and take back control of our nights.

During the hours you are asleep, your body can recover from the day. Sleep is just as important as the air we breathe. Just like breathing, good quality sleep can improve brain and immune function, concentration, and productivity and can create a positive attitude.

So many of us live with fatigue and brain fog and think it’s just part of everyday life. But it doesn’t have to be. If you don’t know what normal sleep is, how are you supposed to know there is a problem to fix?

We create habits in our daily lives that mess with our sleep cycles and don’t even realize it. We get caught in a continuous cycle of life on the hamster wheel. To break the cycle of how you prepare for sleep, you have to look inward.

Ask yourself: Am I really getting enough sleep? What would it take to start a sleep hygiene routine before bed?

What is a sleep hygiene routine?

Sleep hygiene is choosing good habits that promote good sleep.

First, become aware of your daily routine and bedroom environment. How often are you on your cell phone, computer, or watching TV? Daily routines that can improve sleep include limiting screen time. Our eyes aren’t meant to look at screens all day. Electronic devices emit blue light that can suppress melatonin production (which is what you need for proper sleep) and disturb our circadian rhythms, creating problems in our sleep cycle. Shut down your screens and dim your lights one to two hours before bedtime. Remove cell phones and computers from the bedroom. Your bedroom should be for sleep and intimacy only.

Second, establish a sleep schedule and get consistent with it. Be realistic when choosing the time you go to bed and the time you wake up. If you’re only getting 4 hours of sleep, don’t aim for 8 hours immediately. Stick to your usual schedule and gradually increase your sleep by small increments. Even adjusting by 30 minutes can be a good start. Keep a schedule, even on weekends.

Third, establish a bedtime routine. This means you should end your day the same way each day. You should fall asleep within 15 minutes of putting your head on your pillow. If you like to read or meditate with yoga Nidra before bed, go for it, but don’t turn on the TV. Choose a hobby that is relaxing before bed, such as an Epsom salt bath or foot soak. If you’re a napper, limit naps to 20 minutes. This will help you fall asleep faster in the evening.

Fourth, avoid big meals, caffeine, and alcohol before bed, especially when it’s really late. Try to avoid eating past 7 PM to allow your body to digest fully. A full stomach can keep you up at night. Avoid caffeine after 2 PM and reduce fluid intake before bed. Everyone reacts differently to caffeine and alcohol, so pay attention to how late you’re consuming that second or third cup of coffee and avoid nightcaps. Take some CBD before bed if you still can’t get to sleep, but don’t rely on it, this is just to get you started. Herbal teas such as lemon balm, chamomile, and lavender are great ways to get sleepy.

Fifth, perform nasal hygiene before bed to open up nasal passages. Get outside more and get direct access to sunlight first thing in the morning. Grounding, putting your feet in direct contact with the earth’s natural electric charge by taking your shoes off in the grass, dirt, sand, or a body of water—no socks or shoes.

Last but not least, exercise regularly, but not right before bed. I know there are many rules when it comes to sleep hygiene, but I promise I saved the best for last. Working out, even as little as 20-30 minutes, can improve your sleep quality. Don’t believe me? Try going for a jog or a run for my overachievers, 2-3 hours before bedtime. I dare you! The results may not be immediate, so be patient for 2 weeks or so and see how rested you feel.

It is important to explain how a person sleeps. This way, you can understand why sleep isn’t something you want to push off.

Let me explain the stages of sleep.

STAGES OF SLEEP:

Non-REM: About 75% of the night REM: About 25% of the night

N1: This is when we doze off; it happens about 5% of our sleep, lasting 1-7 minutes.

N2: This is the most common stage of sleep, happening about 50% of our sleep. Our muscles are relaxed and our heart rate slows down. Memories and learning take place in this stage. It usually lasts between 10-25 minutes but can increase throughout the night.

N3 (Deep sleep/Delta sleep): This is the deepest, most restorative, and most important stage of sleep. The first episode lasts between 20-40 minutes and then shortens as night progresses. Night terrors and sleepwalking occur in this stage. Memories and thoughts are compiled. Protein plaque build-up is removed from our body in this stage. Dementia and memory loss can happen here from too much plaque buildup. Hormones such as growth hormone are secreted in stage 3 sleep. If people aren’t getting enough sleep in the first period of stage 3, they might have insufficient growth. Ken Hooks, a respiratory therapist, states that lack of stage 3 sleep and lack of secretion of growth hormone can lead to baldness in adulthood. This sleep stage gets shorter and shorter as we age.

Stage 4-REM: This stage of sleep helps provide energy to the body. It usually lasts 10-60 minutes and happens within the first hour of falling asleep, increasing as the night progresses. It is usually when our eye movement happens because our brain is extremely active. The only muscle that is working in this stage is the diaphragm so we can breathe; however, we are pretty much paralyzed in this sleep.

People with narcolepsy immediately enter stage 3 sleep. There is a deficiency in a chemical called hypocretin in the brain, which regulates sleep. You can reverse this by changing your sleep hygiene habits and evaluating your vitamin D levels. Low vitamin D levels in the body are connected to narcolepsy. Eliminating processed carbohydrates from your diet can also help.

People with sleep apnea have fragmented sleep. This means repeated, short interruptions in your sleep all night long. They might alternate between N1 and N2 and never really enter N3, which is where the repair happens.

Now that you understand the stages of sleep, let me explain how maintaining proper oral posture during the day can help improve your sleep quality at night.

You want your tongue to sit high up on the roof of your mouth to maintain optimal airway function.

When the tongue sits low in the mouth, it blocks the airway, leading to problems with mouth breathing, sleep disturbances, and maxillary (upper jaw) growth. You need enough room on your upper jaw for your tongue to sit properly. Increased effort to breathe through the nose can increase tension throughout the rest of your body. When the tongue is high and the lips are closed, you are forced to breathe through your nose. If you remember to keep your tongue high on the roof of your mouth during the day, your body will likely remember to do it at night, promoting optimal sleep. It takes time, but it is possible to retrain your brain to nose breathe. Be patient, and within a few months, you will catch yourself with your tongue high on your palate instead of low in your mouth.

Remember, you should aim to fall asleep within 30 minutes or less.

If you don’t get the proper amount of sleep, health problems can arise and even cognitive function decreases.

Certain health conditions that can result from lack of sleep include:

• Dementia
• Heart disease
• Type 2 diabetes
• Obesity
• Breast cancer
• Colon cancer
• Ovarian and prostate cancer

Now that we’re done talking about sleep hygiene, let me explain that quality beats quantity in sleep talk every time. You might be thinking, “I get 8 hours of sleep every night and I still feel tired when I wake up.” But just because you got 8 hours of sleep doesn’t mean you slept that full amount. Sleep quantity is defined as the number of hours of sleep required to restore your energy.

How many hours of sleep should you be getting?

• Adults ages 18-64 years: 7-9 hours
• Adults ages 65+ years: 7-8 hours
• Adolescents ages 13-18 years: 8-10 hours
• Children ages 6-12 years: 9-12 hours
• Preschool children ages 3-5 years: 10-12 hours
• Toddlers ages 1-2 years: 11-14 hours
• Infants ages 4-11 months: 12-15 hours
• Newborns ages 0-3 months: 14-17 hours

There are many different types of sleep-related breathing disorders:

• Mouth breathing
• Snoring
• Upper airway resistance syndrome
• Obstructive sleep apnea

MOUTH BREATHING VS NASAL BREATHING

MOUTH BREATHING: When someone snores, their mouth is open and the tongue falls back, blocking the airway, which in turn causes sleep apnea events. There are four different kinds of sleep apnea, which we will get into later. Mouth breathing can cause narrow arches of jaws and may even cause a deviated septum. The sympathetic (fight or flight) nervous system is active with mouth breathing. Mouth breathing can lead to forward head posture and allows too much air, including viruses and particles you don’t want, to enter the body.

NASAL BREATHING: When the mouth is closed, inhaling and exhaling air is slower because the nostrils are smaller than the oral cavity. The less air the better—six breaths per minute is what you are aiming for when breathing through the nose. Oxygen is directed to the brain and muscles, which is where it should be going when nasal breathing. Nasal breathing cleans the air before entering the body and can filter 98-99% of allergens, bacteria, viruses, and dust mites. The best part about nasal breathing is the increase in nasal nitric oxide as well as activating the parasympathetic nervous system (rest and digest). You will achieve better overall posture with nasal breathing.

Now let’s talk hormones and how they can affect sleep!

There are two hormones that control our food intake, weight gain, and metabolism: Ghrelin and Leptin.

Ghrelin “The Hunger Hormone” This hormone tells the brain that the body is hungry. It regulates our appetite, and with good sleep, ghrelin decreases and we don’t crave sugary, carby foods, which helps us burn calories. When we don’t get enough sleep, there is an increase in this hormone ghrelin. This is why some people crave a midnight snack, which can lead to weight gain.

Leptin “Satiety Hormone” This hormone decreases our appetite and makes us feel full. With good quality sleep, this hormone increases, which is why we feel satisfied because our body is using the calories. With poor sleep, this hormone decreases. This means your body stores the calories as fat instead of burning them.

Vasopressin or Antidiuretic Hormone “The Stress Hormone” This is released in stage 3 sleep. It helps avoid needing to use the restroom during the night. When sleep is poor or you don’t enter stage 3 sleep, vasopressin is not released, and the need to urinate in the middle of the night occurs. This is why bed-wetting happens in children.

Sleep apnea is just as common as type 2 diabetes!

According to The National Sleep Foundation, it affects more than 18 million Americans. In order to understand what that really means, let’s take a deep dive into sleep apnea.

Types of sleep apnea:

1) Obstructive sleep apnea (OSA):

• Most common.
• When the airway gets partially or completely BLOCKED during sleep for at least 10 seconds.
• OSA occurs when the muscles in the back of the throat fail to keep the airway open, despite efforts to breathe.
• Usually, obesity is associated with this.

2) Central sleep apnea (CSA):

• When breathing repeatedly stops and starts during sleep with no actual obstruction. This occurs because the BRAIN (usually the lower brain stem) doesn’t send proper signals to the muscles that control your breathing.
• Usually, obesity is not associated.
• Might have excessive daytime sleepiness.

3) Mixed (both OSA & CSA):

• Also called complex sleep apnea. Where a person has mixed characteristics of blockage and lacking brain signals. Breathing will not be alleviated with a CPAP in this type of apnea.

4) Upper Airway Resistance Syndrome (UARS):

• Narrowing of the airway that causes disruptions during sleep.
• This usually happens in young fit females with normal or low blood pressure, and they don’t even know they are struggling to get rest. Usually happens from a small jaw size and a history of orthodontic treatment.
• Similar to OSA where the soft tissue of the throat relaxes, reducing the size of the airway and disrupting sleep.
• There are no apneas in this syndrome. The person doesn’t know they are waking at night, and it won’t show up on a sleep study.

There are many different types of sleep studies.

Each of these tests measures sleep differently, so you won’t get the same results when using different tests. A sleep study measures the cortical arousals in the brain. The watchPAT measures from the peripheral arterial tone. A Pes test (peripheral esophageal manometry or pressure) measures swallows and determines if you wake up that way.

Medication, stress, and health conditions can all disrupt the test results.

1-4% of children suffer from sleep apnea around 2-8 years old. 25% of children diagnosed with ADHD may have obstructive sleep apnea. Their learning difficulties and behavior problems can be the consequence of chronic fragmented sleep.

The American Academy of Pediatrics estimates that sleep problems affect 25%-50% of children and 40% of adolescents.

30% of adults (1 in 3 people) also suffer from sleep apnea.

Apnea = a complete blockage of air for 10 seconds or more (10 seconds is considered a panic event)

Hypopnea = 10 seconds or more of shallow breathing (most common)

AHI (apnea-hypopnea index) per hour of sleep. This is an index used in a sleep study to indicate the severity of sleep apnea and it is represented by the number of apnea and hypopnea events per hour of sleep.

AHI in adults:

• 1-4 is normal
• 5-14 is mild
• 15-29 is moderate
• 30+ is severe

AHI in kids:

• 0 is normal
• 1-5 is mild
• 5-10 is moderate
• 10+ is severe

During a sleep study, they combine the hypopnea and apnea, which is how they determine if you have sleep apnea.

Signs and risks of sleep apnea:

• Mouth breathing
• Snoring
• Large tonsils and adenoids
• Childhood obesity
• Tossing and turning in bed
• Night sweats
• Bed wetting (Enuresis)
• Napping in older children
• Slowed growth
• Failure to thrive
• Restless leg syndrome
• ADHD/ADD/sleep deprivation
• Brain function
• TMJD
• Depression
• GERD
• High cholesterol
• Diabetes
• High blood pressure
• Asthma

How to fix sleep issues:

• Get a consult from an Ear, Nose, and Throat Doctor (laryngologist-ENT) to evaluate your airway.
• Get a sleep study and have it evaluated by a sleep physician.
• Complete the 3-minute breath test. If you can breathe through your nose for 3 minutes, you can start mouth taping to retrain your brain on how to breathe. Make sure that tongue is up on the myo spot! (If you do not know what the myo spot is, read my WHAT IS MYO BLOG).
• Add regular physical activity to your daily routine. Move your body. Try different weight loss techniques if obese.
• Meditation & Yoga before bed.
• Buteyko breathing for sleep.
• Emotional freedom technique (tapping on meridian points in the acupuncture system).
• Quit smoking and limit alcohol.
• Clean diet, limit gluten, dairy, sugar, and inflammatory foods.
• Eliminate allergy-causing irritants in your home. This could be as simple as a certain plant you are allergic to, all the way to your pets. Get an allergy test if needed.
• Positional tricks when sleeping. Try sleeping on your side instead of your back. Get a new pillow.
• Improvements in sleep hygiene.
• Daily nasal hygiene.

CPAPs can help you sleep apnea at night by managing your symptoms, but what are you doing during the day? Your body remembers how it should act when you are sleeping by what you teach it to do during waking hours.

There are three main types of CPAPs. Mouth breathing is still possible with all of them, but most common with a full-face mask that covers both the nose and mouth. This kind of mask prevents dry mouth. Using a CPAP can be beneficial in transitioning to nasal breathing.

Sleep guards custom vs. OTC (over the counter)

Just like CPAPs, sleep guards are only a band-aid for the symptom of not being able to breathe during sleep. Depending on your stage in life and what you have already been through with jaw development, expansion, and orthodontics, a sleep guard may be the right choice for you. If choosing between a custom guard vs. OTC, I always suggest getting a custom sleep apnea appliance that fits your mouth specifically. OTC Guards can affect your TMJ and may make issues worse. If you have moderate or severe obstructive sleep apnea, a guard is not recommended as you might need extra help from a CPAP while you are working on fixing the root cause. Sometimes jaw surgery or nasal surgeries are recommended by some specialists depending on your case. Second opinions from ENT and sleep providers are always advised if you aren’t receiving the answers you want. Again, figuring out the root cause of your sleep issues is ALWAYS the first step!

All in all, we know that mouth breathing at night can lead to daytime fatigue. If you have any signs or symptoms mentioned above, just know that myofunctional therapy can be one piece of the puzzle when it comes to reversing sleep issues.

These problems don’t just happen overnight 😉

According to the Sleep Foundation:

It takes four days to recover from one hour of lost sleep and up to nine days to completely eliminate sleep debt!

The first step is awareness of your sleep issues and implementing a healthy sleep hygiene routine. If you get your sleep right, you’ll get sick less often, reduce your stress load, think more clearly, lower your risk for serious health conditions like diabetes and heart disease, and be able to live your best life.

Breathe, Sleep, Eat, Speak, LIVE  🙂