Everyone has experienced interrupted sleep. From having a new child, to car alarms or a barking dog, it’s a given that our sleep will be interrupted as a part of life. However, some people are awakened every few hours, even every few minutes during sleep due to breathing pauses. Obstructive sleep apnea can cause this, but you can also have frequent breathing pauses without having apneas. This is called upper airway resistance syndrome, which I describe in my book, Sleep, Interrupted. The main premise is that all modern Western humans have various degrees of dental crowding and upper airway narrowing, leading to interrupted sleep.
Here’s a Time Magazine article which supports the main point of my book and everything I write on my blog. They cite a Johns Hopkins University study which found that interrupted sleep and short sleep lead to drops in positive mood ratings compared with controls. However, on subsequent nights, interrupted sleepers had continued declines in positive mood, whereas the short sleepers stayed the same.
Furthermore, the researchers found that interrupted sleepers had significantly lower levels of slow-wave sleep, or deep sleep. About the study, the lead researcher commented, “We saw a drop in slow wave sleep so large and sudden, and it was associated with a striking drop in positive mood that was significantly different than in the other group.” We know that deep sleep is needed for your body to heal and regenerate.
There are lots of studies showing that prolonged interrupted sleep also lead to a major chronic stress response, which alters your mood, energy levels, and your hormones. A great book to read about stress is “Why Zebras Don’t Get Ulcers,” by Dr. Robert Sapolsky.
Another known consequence of interrupted sleep due to frequent breathing pauses is nighttime urination. Obstructed breathing stretches the heart muscles, which makes atrial natriuretic peptide, a hormone that makes your kidneys make more urine. People who get up to go in the middle of the night do it on a regular time interval, anywhere from 1.5 to 2 hours, which is one sleep cycle. Whenever you cycle through to deeper levels of sleep, your muscles relax to the point of obstructed breathing severe enough to wake you up completely. Oftentimes, there won’t be too much urine.
Many people with interrupted sleep get by with drinking lots of coffee or exercising intensely. Some even resort to taking prescription stimulants or anti-depression/anti-anxiety medications. The possibility of a sleep-breathing problems is not often considered, even by most physicians.
You may be asking how can you know if you have this, and what can you do about it? One simple clue is to look at your sleep position. If you prefer to sleep on your side or your tummy, that means that it may be harder for you to breathe on your back, due to your tongue falling back more often due to having a mouth that’s too small, and due to gravity. Many people will also have chronic nasal congestion. You may also suffer from fatigue, headaches, anxiety, TMJ, digestive problems, cold hands. Snoring is helpful but you don’t have to snore to have sleep apnea or upper airway resistance syndrome. Being overweight or obese is also not a requirement. Most people with upper airway resistance syndrome are usually young and thin, and don’t snore.
The first step in addressing this problem is to improve your sleep hygiene: make sure you’re sleeping long enough, don’t eat or drink alcohol within 3-4 hours of bedtime, and don’t use anything with an electronic screen before bedtime. Improve your nasal breathing the best that you can. Start with nasal saline irrigation, breathe right strips, allergy medications. If this isn’t helpful, see your doctor for more definitive options.
The above tips will help some of you, but many will need additional help from a doctor that understands what’s going on. The first step is to determine if you have obstructive sleep apnea. Even if you don’t officially have sleep apnea on a sleep study, don’t rule out upper airway resistance syndrome. It’s important to find an otolaryngologist (ENT) who can look at your airway to see what’s going on.
If you have interrupted sleep, it’s important to look beyond the typical things that keep waking you up. Sleep-related breathing disorders can be a good explanation, whether or not it’s due to obstructive sleep apnea.