Why Your Sleep-Ability Depends on Your Breathe-Ability

On his yearly physical, Jack’s doctor asked if he had any problems sleeping. The first thing that came to mind was his annoying frequent trips to the bathroom to urinate. During the day, he’s been more tired and feeling anxious lately. As a 60 years old man, he just assumed that this was a normal part of aging. His doctor suggested he see a uologist to see if he had an enlarged prostate gland. Jack was relieved to find out that his prostate was normal and his PSA was not elevated. 
There are millions of men and women with sleep problems, usually blamed on insomnia, stress, or  frequent nighttime urination. Depending on what type of doctor you see for your particular symptom, you’re likely to be given a particular diagnosis. Medications may help somewhat but you’re still not getting a good night’s sleep.
Is it stress, or is is it a breathing problem?
When I bring up the possibility of a breathing problem, most of my patients are usually surprized, if not a bit skeptical. The usual comments are typically, “but I have an enlarged prostate,”  I’m under intense stress right now,” or “I’m just getting older.” When I show patients their tiny airways using a fiber optic camera, many people have major revelations about their entire health history.
Some women are convinced that their insomnia is due to stress, or from menopause. Some men swear that they sleep great, but their spouses say that they snore like a chainsaw and choke a lot during sleep. Regardless of the reasons that you use to blame for your sleep problems, the last thing you or your doctor may consider is a breathing problem. This may be a potentially fatal mistake.
Going back to Jack, the reason for his night-time urination as follows: Frequently obstructed breathing stimulates your heart muscles, which makes your heart think that you have too much fluid. To compensate, it produces a hormone called atrial natriuretic peptide to make your kidneys urinate slight more than usual. Most commonly you’ll wake up around 3AM, when you’re most likely to go into longer periods of REM sleep, when you’re dreaming, and also when your muscles are most relaxed. You’ll wake up because you stopped breathing, and feel like you have to empty your bladder. However, in most instances, it’s not a lot of urine. The cycle can happen more than once, but usually in 90 to 120 minute intervals, which is one sleep cycles.
An explanation for short and long sleepers
This may be the reason why some of you can only sleep 5 to hours. As you enter REM sleep, you are more likely  to wake up due to this choking episode. Your heart rate goes up and you’ve just experienced a major physiologic stress response. 
At the other extreme, long sleepers may need to sleep for a longer period of time due to low quality sleep in general. You won’t wake up repeatedly choking or gasping, but undergo frequent partial obstructions and arousals which prevents you from staying in sleep sleep. 
This may explain why epidemiologic studies have shown that short sleepers (< 5 hours) or long sleepers (>9 hours) have significantly higher rates of death, suicide, depression, obesity, and diabetes.
Quality is as important as quantity
If you’re not able to get quality sleep, and you are experiencing a stressful situation in your job or relationship, you won’t be able to shut down your mind before you go to sleep. This is consistent wth research showing that insomniacs have brains that are hyper-activated. It’s also difficult  to calm your brain and your mind if you’re stressed about not getting 8 hours of sleep for your important test in the morning. Additionally, the more narrow your upper airway, they more susceptible you’ll be to sleep problems in general.
This is why it’s important to regularly manage life stresses with counseling, therapy, yoga, meditation, exercise, or relaxation exercises. But if you are predisposed to a breathing problem while sleeping, you may not get as gook results with the above conservative options. Some of the potential signs or symptoms of a sleep-breathing problem includes: night-time urination, not being able to sleep on your back, nasal congestion, anxiety or depression, snoring, chronic fatigue no matter how long you sleep, and having a small mouth with dental crowding.
How to get a good night’s sleep
To begin to get a better night’s sleep, don’t expose yourself to any stimulating activities a few hours before bedtime, including any form of digital media, electronic screens (which have extra blue light), caffeine, alcohol, or any snacks. Make sure you’re able to breathe well through your nose. Start with nasal saline and Breathe Rite strips, then to medical therapy, and even surgery if needed. Avoid sleeping on your back. If these steps don’t help, then it’s time to see a sleep professional. If you are struggling with chronic insomnia despite trying every supplement or sleep hack that’s available, it may be time to consider another reason for your sleep problems. 

For those of you with chronic insomnia, what’s the one thing you’ve tried or changed that has made the most improvement in your sleep quantity or quality?

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3 thoughts on “Why Your Sleep-Ability Depends on Your Breathe-Ability

  1. If you have not already read my monthly articles on Sleep Apnea, I suggest you seek them out through my website as I discussed this in November 2015 article: Oral Appliances for Sleep Apnea Improve Insomnia. It was a culmination of observation of information available in separated information within the reductionist system of Medicine. See my article: Sleep Apnea Dentistry What We Don’t Know of May 2012, OSA Relation to ADHD of June 2012 and Trapped in Sleep from December 2012. I first addressed Obstructive Sleep Apnea and the Stress response in May 2010, And Impaired Oral Function and Stress Beyond OSA in January 2013.
    It appears to me that your article dodges around the issue that OSA is a diagnosis of a symptom of the impacts of an anatomic condition that you as an ENT and I as a dentist are RESPONS-ABLE for 24 hours each day. And WE are ethically bound to connect the dots separated by the reductionist nature of the practices of medicine and dentistry and perhaps create an observation that calls for connecting them, despite the separation created by specializations and professional trade associations that represent this.
    Please, respond to this!

  2. Dr. Strauss,

    Thanks for commenting. I completely agree with you that OSA is at one end of the spectrum of symptoms that is caused by craniofacial anatomic narrowing. I’ve also associated OSA with insomnia, ADHD, PTSD, dementia, and various other conditions in past years, including cancer. I first described the physiologic stress response that OSA and UARS can cause in my 2008 book, Sleep Interrupted. As you’ll see in coming months, I will try to pull back from using the term obstructive sleep apnea, and instead try to describe the myriad of consequences that sleep-related breathing disorders can cause.